The importance of public policy

The importance of public policy INTRODUCTION Public policy refers to the action or inaction of the government on an issue(s) (Thomas 2001 cited in Buse et al 2005). It sets hierarchy by carrying out the choices of those with the command of authority in the public. This makes public policy change very complex as various individuals, organisations and even the state have conflicting interest and capacities. There is therefore the need for coherence of interest/capacities in an attempt to effect a change (Colebatch 2002). AIM: The aim of this paper is to explain the strategies that would be used to effect a change in public policy on road safety in Nigeria. Health Issue and Public Health Importance: Road Traffic Collision (RTC) is a major public health issue globally. It is defined as personal injury resulting from collision of a vehicle with another vehicle(s) or a pedestrian, occurring on the public highway or footways (Worcestershire County Council 2010). The Situation Globally: RTC accounts for over 1.2 million deaths with about 20 to 50 million non fatal injuries (a major cause of disability) occurring annually. It is the 9th leading cause of death globally and is estimated to rise to be the 5th leading cause of death by year 2030 (with about 2.4 million fatalities per year) out ranking public health issues like tuberculosis, HIV/AIDS (presently the 5th leading cause of death) and diarrhoea diseases (WHO 2008). This means that by the year 2030, RTC will be perceived as deadly as HIV/AIDS is today, if urgent action is not taken. The global losses due to road traffic injuries are estimated to cost about 518 billion USD, costing the government between 1 3 % of its gross national product (WHO 2009a). Nigeria: Nigeria is Africas most populous country, with an estimated population size of about 151,319,500 (World Bank 2010). It is one of the 10 countries with the highest Road traffic death rates in the world (WHO 2009a). RTA is the commonest cause of death from unintentional injuries/ public violence in the country (Nigeria Watch 2007). Usoro (2010) stated that there are about 30,000 accidents with about 35,000 casualties occurring yearly. About 90 persons are killed or injured daily and about 4 persons dies or get injured every hour from RTA. He argues that the figures are underestimated because of poor reporting and poor recording of road accidents in the country. Low socio economic groups have been found to be at higher risk of road traffic injuries (Thomas et al 2004) and they are less likely to have the capacity to bear the direct or indirect cost related to RTA. They are faced with more poverty burden as they lose their bread winner; lose earnings while caring for the injured or disabled, the cost for funeral and prolonged health care (DFID 2003). RTC has its greatest impact among the young and is the third leading cause of death between ages 5 45years (WHO 2009) with a reduction in the Countrys productive force, further worsening the economic situation, thus affecting the country achieving its MDGS 1 AND 4. The major causes of RTC in Nigeria are; high speed, alcohol, bad roads, poor vehicle conditions etc (Usoro 2010). Although there is limited literature to show the different percentages of the causes of RTC in Nigeria, high speed is most implicated in low income countries (WHO 2009). Studies have shown that a 5% increase in average speed can result in approximately 20% increase in fatal crashes (Transport Research centre 2006) and with a 1mph reduction in average speed there is a reduction in accident injuries by 5% (Finch et al 1994). The introduction of speed cameras in the Isle of Wight, UK resulted in an 83% reduction of speed on the island (Environment and Transport select Committee 2004). Reducing speed has also been shown to have positive effects on health outcomes e.g. reducing respiratory problems associated with health outcomes (Transport Research Centre 2006). There is therefore urgent need for action to prevent this future pandemic. PROPOSED CHANGE (POLICY CONTENT): Introduction of speed cameras and enforcement of speed limits on Nigerian roads. Enforcement of speed limits via mobile cameras has been shown to be the single most effective strategy for reducing fatality from RTC (Chisom and Naci 2008). It is thus most rational among other rational strategies but has to muddle its way through the policy process. Hence the nature of change follows the mixed scanning model. For better understanding of the complex multifaceted nature of policy making, the proposed policy change is seen as passing through a process taking place in a particular context influenced by the participants/actors (the policy analysis triangle) (Buse et al 2005). THE POLICY PROCESS: The policy process can be broken down into series of stages called the ‘stages heuristic (Sabatier and Jenkins-smith cited in Buse et al. 2005).It provides a theoretical framework for understanding the times and places where tactical approaches can be applied to influence policy change (Buse et al 2005). Before going on with the policy process, it will be worthwhile understanding the countrys policy context as this will assist in shaping the process. THE NIGERIAN POLICY CONTEXT: The proposed health policy change can be affected by the following contextual factors (Leichter 1979): Situational factors: This includes the increasing wide spread public awareness and burden caused by RTA in the country as stated above. Cultural factors: There are about 250 ethnic groups (Hausa, Igbo, Yoruba been the major ethnic groups) in Nigeria. The major religions are Christianity, Islamism, traditional beliefs. These major religious and ethnic groups are the most politically influential and most populous in the country (CIA 2009). Most people believe that road accident is spiritual and is caused by evil spirits (Sarma 2007). Hence the religious leaders, traditional/ethnic group leaders will play an important role in convincing their followers and improving ownership for community support and policy implementation success. International factors: Road safety issues have increased in momentum on the global agenda (termed the decade of action) with an ambitious target to reduce road fatalities by year 2020. It is supported by international bodies such as WHO, WB, DFID, FIA foundation and other UN organisation (Commission for global road safety 2009). These bodies will thus have an impact on the formulation of policies, funding, dialogue, planning, and advocacy guidelines for any country embarking on a road safety policy initiative. Structural Factors: (a) Political system: Nigeria is a democratic federation with levels of authority expressed at the federal, state and local government areas. There are 36 states and the federal capital territory, 774 LGAs further divided into 9555 wards (the lowest political unit in the country). There are 3 arms of government, the Executive arm, Judiciary and the Legislature at the federal and state levels. The legislative arm comprises of the upper house (the senate) and the lower house (the House of Representatives) elected from the state senatorial districts and the constituencies respectively. Each state has an elected governor, the house of assembly, an executive council with powers to make laws. Each local government area has an elected executive chairman and an elected legislative council of members from electoral wards. The state government has substantial autonomy and control over the allocation and utilization of their resources (WHO 2009b). The Federal Road Safety Commission: This is the lead agency that regulates, enforces and coordinates all road safety management activities at both the national, state and LGA level through their special marshals (Volunteer arm) and regular marshals (Uniformed). They play a major role in determining and enforcing speed limits for various types of roads and vehicles (FRSC 2010). They receive assistance from the police, civil defence corps, NGOS etc. (b) Civil societies, NGOs form e.g. RAPSON, APRI, SAVAN, and interest groups are key actors in public policy making and can participate at the committee stages of how a bill becomes a law. (c)Socio economic situation: Nigeria is classified as a low income group country with a gross national income per capital of $930 (WHO 2009a).This can affect getting the road safety policy on the agenda among many other competing health issues. To the ease the policy issue from the agenda setting to implementation and evaluation, a stakeholder analysis is very important. STAKEHOLDER ANALYSIS: It helps to key Actors; assess their interest, power, alliance, position and importance in relation to the policy. It will help to identify and act to prevent misunderstanding and opposition to the policy (Schmeer 2000). AGENDA SETTING: This step involves getting the issue onto the policy agenda from among other issues that can potentially be of interest to policy makers (Buse et al 2005). Kingdon (1984) proposed that policies get on the agenda through 3 independent streams (problem, politics and policy stream) which converge at a point called the policy window. This is the point a policy change is most likely to occur. Mobilising the Media: McCombs and Shaw (1972) first developed the agenda setting theory, showing a strong correlation between media agenda and the public agenda on US presidential campaigns in 1968, 1972 and 1976. The media, been successful in telling the public what to think about (University of Twente 2004), will be mobilised to influence the publics opinion and consequently the government through TV and radio programmes/ News, News papers and articles from professional bodies with emphasis on the magnitude and possible solution to reducing the mortality from road traffic accidents. Restriction can also be made to misleading adverts which will encourage speed. Personal experience of RTC (direct or indirect) could be a more powerful teacher than the media (University of Twente 2004) but both will complement each other in improving the public agenda and subsequently the policy agenda. POLICY FORMULATION AND ADOPTION: This involves the steps taken after the issue is placed on the agenda up till when it is implemented. This part of the process strongly lies in the domain of the legislators which determines how a bill becomes law and is implemented as shown below: Formulation Strategies: To keep the issue on the agenda through this stage, there is need for: Continuous campaigns and Advocacy: Grassroots lobbying (mobilizing the public to contact legislators or other policy makers about the problem) and Direct Lobbying (Phone calls, writing of letters, face to face interactions), Mass Support by attending committee meetings, Informing international stakeholders that the issue is on the agenda, Bargaining for supporters from the legislators to improve Alliance. POLICY IMPLEMENTATION: This involves the process by which a policy is turned into practice (Buse et al 2005). The bottom -up approach (Lipsky 1980) will be a very good approach for the implementation such that there is flow of information from the implementers to the policy makers. However, attempt will be made to include the top-down approach in order to minimise deviation from the intended policy outcome. The implementation process would require time and resources and should be a gradual process. It would be worthwhile having a pilot project in an area identified by researchers to have a high mortality from RTA before implementation at a National level. Initial rapid needs assessment: The road safety system would be assessed to find out what is needed. The team should include; the police, road safety commission, researchers, health economist, NGOs, the NURTW, Volunteers, medical teams, Health policy analyst, the media, ministry of transport, support from developmental partners, community/religious leaders and involving the government at all levels. The assessment will provide scientific, managerial and technological functions of the policy from planning to evaluation. On identification of the specific needs, the implementation work plan will be drawn. Community/religious leaders will play a key role in advocating within their communities/religious groups in convincing their followers that RTC can be prevented and is not spiritual. Implementation schedule: Legislation to specify speed limits applicable to different types of roads. Identifying strategic check points which should be areas identified to have a relatively high RTC resulting from high speed. Random positioning of the team to monitor vehicle speed with the mobile speed cameras Fines to be paid by violators will be fixed and revenue generated be used for maintain and purchase of speed cameras. License suspension of violators who violates the law over a specific number of times as will be stated. The use of publicity to inform the public on the new law, its benefits and penalties. EVALUATION AND FEEDBACK: Buse et al (2005 p) defines evaluation as research designed specifically to assess the operation and or impact of a programme or policy in order to determine whether the programme or policy is worth pursuing further The engineering model suggests that ideally there should be a direct relationship between research findings and policy decisions but however this is completely not applicable as there tends to be gaps between the two communities. Advocacy coalition is needed to reduce this gap and should include improving the knowledge of policy makers by providing a range of different research reports via the media, conferences and seminars, ensuring that major policies have evaluations built into their budgets and implementation plans and establish intermediate institutions to review research and determine its policy implications e.g. NICE in England and Wales (Buse et al 2005). The evaluation process will involve the use of the formative evaluation (qualitative-observations, semi-structured interviews, focus groups, progress reports) at the early stage to provide advice to policy makers. It may then be used to modify and develop the program. It will also involve the use of a summative evaluation (quantitative- morbidity and mortality rates) which measures outcome and the extent to which the programme has met its objectives. Evaluation of the performance: Speed limit enforcement will also be done at the micro, meso and macro levels. The micro level will include accessing performance of the teams at the district levels, the effectiveness of the enforcement protocols used, the level of corruption and any implementation gaps. The meso level will include accessing performance at the organisation level which will include the time taken to attend to offenders when referred to the road safety centres, and their role assisting and supervising the team at the district level. The macro level: this involves accessing financing of the programme and its function at the national or international level. CONCLUSION: The policy process is a cyclical process occurring in the environment of a changing political context. There is thus the need for continuous advocacy coalition networking, monitoring and evaluation at all times. However, other causes of RTC such as bad roads, drinking and driving which are not fully implemented in the country should not be neglected as future plans should be made to further reduce the burden of RTC to the barest minimum. 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