Towards understanding power and agency in policy implementation: A stakeholder analysis of a primary care NCD policy in the Philippines

Abstract

Abstract The growing NCD burden of demands collective action from many stakeholders. This is often difficult to achieve, largely due to the limited understanding of how actors interact and shape policy processes, especially in LMICs. CVD accounts for a third of deaths in the Philippines, where a national primary care policy for NCD control has been enacted. We describe how we assessed the capacities, power and level of stakeholder engagement in implementing the programme within the Philippine health system and identified ways to support implementation. A scoping review developed an analytical framework for stakeholder analysis, peer reviewed by health policy experts. Four characteristics were identified: level of knowledge, interest, power, and position of stakeholders. Interviews and a consensus building exercise were used to operationalize it. Respondents were purposively sampled via document review and a snowball technique. National government has high power but offers moderate support for implementation. Decentralized local governments also have high power but offer varying degrees of support for implementation given competing priorities and limited resources. Frontline health workers and civil society are both supportive but have little power. Professional societies have only moderate power but are an important conduit to reach private providers. The capacities of some actors are not fully mobilized. Understanding of the power and capacity of actors facilitates approaches to control NCDs in the Philippines. Engagement with national and local governments must be strengthened to improve uptake of the NCD control policy. Frontline health workers, if empowered, can make a key contribution to policy implementation. Professional societies can play an important facilitating and convening role to build collaborations across public and private sectors. Finding the optimal balance and synergies between these diverse roles may be critical for NCD programme implementation.