Table 6 Limitations of a rational and linear approach to policy-making
From: Human resources for health policies: a critical component in health policies
• Conflicts of power and interest in decision-making. Those in the policy arena have different levels of power and varying abilities to influence policy decision-making, depending on their resources (financial, cultural, symbolic), their legitimacy, and to their visibility. |
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• Uncertainty inherent in decision-making and the limited rationality of the participants. It is unrealistic to imagine that decision-makers possess all information on all possible options when confronted with a given problem. The choice of objectives and priorities occurs in a context of limited rationality and it is difficult to predict with certainty the outcome of a policy. In the health sector there is a great deal of ambiguity of cause-and-effect relationships between policies and health status. |
• Divergences and ideological biases. The arena in which the policy agenda is defined is laden with emotions, conflicting interests and diverging values. Perceptions of the problems and of the policy to be implemented differ from one group to another. Objectives highlighted by the decision-maker are not totally unrelated to his own values and may collide with some powerful interests. Technically perfect plans may fail because they have not inspired commitment in those who must implement them. |
• The dynamic nature of policy. The policy process is not cast in stone and a policy is not drawn up once and for all. Results obtained may be different from those expected and may lead to policy adjustments in order to produce the desired effects. |