Politics identification, development, and implementation process in

Politics is mainly defined by Lasswell, asclassically as who gets what, when and how, Lasswell define that who affectsthe origins, formulation, and implantation of public policy in the healthsector, Politics in many dictates, for example who all the people entitled toservices, and who will provide services with what are the priority areas, whoall of them will be subsidized, and how the allocation of budget would be doneand the budget ought to be allocated and spent. The implementation of reformsis basically associated with new administration and the political crises, whilereforms can also affect the stability of political administrations, In spite of its acknowledged importance, there is alsobroad agreement that politics and political issues are rarely analysed andfrequently ignored at all stages of the policy identification, development, andimplementation process in the health sector, particularly in the interactionsbetween international donor agencies, recipient developing country governments, and their domestic political context. There is ample documentation thatpolitics frequently trumps evidence as a driver of policy priorities andreforms and there are calls for both prospective and retrospective analyses ofthe politics of public health policy to improve the probability of policyimplementation and impact and to understand more fully the politicalenvironments in which reforms operate. The political will ortechnocratic model assumes that decisions by political leaders or a reformchampion are necessary and sufficient for policy change and that these leadersare rational actors maximizing the public interest (Alesina, 1992). Reform canoccur from outside the political system, it is a policy-making model that isfrequently referenced in the public health literature as the mechanism viawhich to effect change in the sector. The political factions or partisan orpluralist model assumes that politicians seek to serve the desires of differentgroups, including interest groups, bureaucratic agencies, and politicalparties. It encompasses the interest group approach to policy-making, with itsemphasis on the political competition of groups and ideas (Kingdon, 1984), aswell as the bureaucratic politics approach, with its emphasis on how governmentorganizations and employees seek to protect and promote their own narrowsectarian interests.

Reform occurs when incentives and benefits to preferredconstituencies are sufficiently large. The political importance ofhealth care is apparent today in the spate of clinics sponsored by movementsand parties. Some political groups use health services merely as a form ofpatronage, but in most instances the motive is to mobilize popular support byusing health as an issue of popular empowerment. InIndia, the persistent gap between promised proper policies such as the NationalRural Health Mission (an initiative to deliver primary care to the poorintended to increase the national health budget by 1% of GDP) and budgetallocation and execution is attributed in part to the practices of the Indiancivil service, where frequent rotation among ministries is common, driven bypolitical party affiliation, and expertise in a particular area, such ashealth, is infrequent, leading to poor follow-up and little ownership. Ifgovernments make policies that are strongly disliked by the public orparticular groups, they know that these may well be resisted with the resultthat their policies may not be implemented. In most countries, there are agrowing number of groups outside government, referred to as interest orpressure groups, which want to influence government thinking on policy or theprovision of services in a direction favourable to their point of view, socialgroup, or material position. They use a range of tactics to get their voicesheard, including building relationships with those in power, mobilizing themedia, setting up formal discussions, or providing the political oppositionwith criticisms of government policy. Although the existence of interest groupsindicates that political power is not the monopoly of any one group, it isclear that some interest groups are far more influential than others.

In thehealth field, the medical profession is still the most significant interestgroup outside government in most countries