PEOPLE and places
The People who Participate in Policy and the
Places (Institutions) They Represent
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
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
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).