PEOPLE and places

People: Individual Stakeholders
Individual stakeholders (the people involved in policymaking) and the institutions (the places) they represent are central to policymaking. Individual stakeholders involved come from within and outside government. A stakeholder is an individual or group that makes a difference or that can affect or be affected by the achievement of the organization’s objectives (POLICY Project, 1999; Brinkerhoff and Crosby, 2002).

Public sector individual stakeholders can include politicians (heads of state and legislators), government bureaucrats and technocrats from various sectors (e.g., health, education, finance, local government) and public sector staff who implement programs. Stakeholders from the nongovernmental sector can include representatives from civil society organizations, support groups (e.g., from groups of people living with HIV/AIDS, women’s health advocacy groups, or networks of these groups), or from faith-based organizations. They can be researchers and others such as media personalities. Individual beneficiaries of policy can also be involved in calling for policy change.

Places: Stakeholder Institutions
The institutions involved in policymaking are closely linked with the individual policy stakeholders. It is important to know the roles and responsibilities of the various institutions (e.g., How is a policy submitted for approval? Which institutions can draft policies? What institutions can promulgate policies or pass laws?).

Various parts of the government clearly play key roles in formal policymaking, including the executive branch (the head of state and the ministerial or departmental agencies of government), the legislative branch (the Parliament, congress or equivalent), and the judiciary branch. Local governments have their own policymaking structures, if they have decentralized authority to do so. In addition, the parts of government in which policies are carried out also play important roles in policymaking—for example, the need for a policy may emanate from the Ministry of Health or from another ministry. The strength of institutions involved in policymaking can have a direct impact on the success of the policies and programs.

Institutions outside the government play a role in policymaking by acting as advocates for policy change (civil society groups, grassroots organizations, NGOs, and advocacy groups), by providing data for decision making (academic and research organizations), and by providing funding (donor organizations) for policy research, policy dialogue and formulation, and implementation. Finally, international organizations also play a role in supporting—and influencing—policymaking.

An analysis of the structure of government as it relates to policymaking conducted in Ukraine in preparation for developing a national reproductive health strategy addressed decision making in the Parliament, in the administration of the President, in the Cabinet of Ministers, and in the Ministry of Health. The assessment also included research organizations and women’s organizations with influence on reproductive health policy (Kohut and Lakiza-Sachuk, 1999). Limiting the stakeholder analysis only to government and official policymakers ignores the role that other groups have in policy development and formulation. A similar assessment in Jamaica outlined the steps to passing a law and policy in that country—steps that few stakeholders actually understand (Hardee and Subaran, 2001).

The Expanded Role of Nongovernmental Stakeholders in Policy
In the past, policymaking was concentrated in the hands of policymakers and a few influential people/organizations outside government. Over the past decade, policymaking has increasingly included the participation of a wider range of stakeholders outside of government. Nongovernmental stakeholders participate as through advocacy, representation in government bodies, consultation and policy dialogue with policymakers, and participation on coordination mechanisms (UNFPA, 1999). Family planning, reproductive health, safe motherhood, and HIV/AIDS policymaking includes a broad range of government (including from the central and decentralized levels) and civil society stakeholders who play different roles in the process. Omitting groups of people living with HIV/AIDS (PLHAs) from policy formulation concerning ARVs runs the risk of developing an unrealistic, unfeasible policy.

Strong evidence of the role of NGOs and civil society came during the preparations for the 1994 International Conference on Population and Development (ICPD) when women’s health advocates and other civil society organizations were instrumental in reshaping the family planning agenda to include reproductive health and rights more broadly. Their participation ensured that the Program of Action (POA) was fundamentally different than POAs at previous international conferences on population and development in which policy deliberations were more the purview of official government delegations (UNFPA, 1999; Ashford and Noble, 1996).

Including civil society groups and ensuring multisectoral participation in reproductive health policymaking in Latin America have resulted in agendas that are more oriented to the needs of stakeholders (POLICY Project, 2000). Youth participation has been heralded as a key to developing and implementing policies for youth (UNFPA, 2003). Examples from Nigeria and Jamaica show that youth participation can improve policies and programs (POLICY, 2004a and 2004b). In both countries, multisectoral groups were involved in developing youth policies and strategic plans.

In the AIDS policy arena, the GIPA Principle has highlighted the need for greater involvement of people living with HIV/AIDS in policymaking and program implementation (UNAIDS, 1999; UN, 2002). UNAIDS has developed a continuum of participation, which culminates with the involvement of PLHAs in decision making and policymaking (UNAIDS, 1999). PLHA advocates and activists have also played an enormous role over the past few years in making AIDS treatment available in developing countries at an affordable price (AFSC, 2003; TAC, 2003).

Zimbabwe encouraged participation during the development of its HIV/AIDS policy. Progress toward a national HIV/AIDS policy did not formally begin until the creation of a Steering Committee in 1994. The Steering Committee, charged with planning the process and providing leadership, was composed of representatives from a variety of sectors, including universities, the Attorney General’s Office, PLHAs, NGOs, and the National AIDS Control Program. The committee solicited a great deal of input from the public and made significant attempts to widely circulate draft documents, even printing drafts in newspapers to ensure widespread readership. In forums held in seven provincial workshops, more than 4,500 people participated in a discussion of the policy (Stover and Johnston, 1999). 

In some cases, NGOs actually draft policies for governments and ministries. For example, in Haiti, the Child Health Institute (IHE) drafted the National Strategic HIV/AIDS Plan in December 2001 and submitted it to Haiti’s Ministry of Health for approval (POLICY Project results database, 2003). Allowing NGOs to participate in the drafting of national policies contributes to developing technically sound policies and stakeholder agreement on the problem definitions and solutions.

International organizations and bilateral donors that fund family planning, reproductive health, and HIV/AIDS programs are also important stakeholders in policy development and implementation. Donor funds often drive policy agendas. The U.S. government’s 2003 announcement of a presidential initiative to provide US$15 billion in funds for 14–15 countries hit hard by the HIV/AIDS epidemic will likely have an enormous effect on how HIV/AIDS policies are shaped in coming years in those—and other— countries (President’s Emergency Plan, 2004).

The Importance of High-level Support and Policy Champions

High-level support within government is crucial for policy change to occur. As noted in an eight-country study, “Countries with an earlier and greater commitment to population policies and family planning programs were characterized by the formation of coalitions of senior policymakers who were able to identify coherent rationales, share political risk, and, therefore, become important contributors to the sustainability of population policies. This process was influenced by a number of different factors: strong leadership by key individuals, a low level of organized opposition, and continuous institutional and financial support” (Lush et al., 2000: 21).

Policy champions who are committed to promoting a policy issue are important advocates for policy development and reform. Policy champions can come from any stakeholder group; what is important is that they have access to key decision makers. Generally, the higher level the policy champion, the more likely the impact on policy related to an issue. For example, Uganda’s President Museveni is widely credited for playing a key leadership role in reducing HIV prevalence in that country during the 1990s, in part by continually mentioning the epidemic in public speeches and signaling to the country that his government was (and still is) serious about reversing the spread of HIV/AIDS (Hogel et al., 2002).