Advocacy Coalition Framework (ACF)

This report is formulated for conducting the review and evaluation of a public health policy of Australia. The public health policy will be chosen in the area of healthy ageing. The analysis of a contemporary Australian public health policy will be done by using Advocacy Coalition Framework or ACF. This report will focus on analyzing the detailed understanding about selected public health policy including the origin. It will facilitate different details about the selected public health policy like influence of previous policies, political context and identification of different stakeholders. Further section of this report will focus on summarizing that what has been implemented under the selected policy, along with the comments on its effectiveness for meeting the health and wellbeing of local residents of Australia. Final section of this report will provide the alternative strategies that have been recommended by different stakeholders. It will also summarize and elaborate the possible outcome and impact of these alternative strategies on public health. Moreover, the report will help to understand usefulness and limitations of selected theoretical framework selected in this report.

The Advocacy Coalition Framework was originally propounded in 1980s. This is a methodological and theoretical tool that can be taken into account for the study of policy processes. There are mainly 3 principal theoretical domains of ACF such as policy change, policy subsystems and the advocacy coalitions. According to advocacy coalition framework, policy subsystems and advocacy coalitions are highly efficient techniques for organizing the actors that have interest in the policy processes. The ACF is considered as an actor based framework that focuses on analysis of policy change over a period of time (Ingold, Fischer & Cairney, 2017, p. 461). Advocacy coalition can be explained as a belief system that comprises of normative convictions and diverse collective actors and individuals including private companies, journalists, scholars, government agencies and NGOs. The core focus of CF approach is on carrying out policy debate and detailed analytical description on the policy processes. This framework (i.e. ACF) has been planned to use in this report for the detailed analysis of Health Service Framework for Older People 2009-2016.

Main aim of application of advocacy coalition framework is to explain policy changes. It is quite helpful to develop knowledge about policies and priorities that exists in a dispute management. These policies and priorities may result from the interaction of multiple actors and government bodies in the policy formulation procedure. ACF framework is helpful to understand different stakeholders and actors that played role in the formation of a particular health policy (Ingold et al., 2017, p. 450). In other words, the ACF framework helps to understand the subsystems of the policy such as group of actors and the knowledge resulting from their interaction in the policy formation. In Australia, the policies related to healthy ageing are highly influenced by role of political parties in active domination in country and stakeholders like NGOs and private healthcare organizations. The change in political parties and government has been seen in the Australia from time to time. The new government comes with new opinions and beliefs and makes changes in the health policy for ageing policy.

Broader Policy Context of Healthy Ageing in Australia

Broader Policy Context of Healthy Ageing in Australia:

The department of health and human services in Australia is taking initiatives for promoting the healthy ageing in Australia. It is taking into account the broader healthy ageing approach rather than just funding the discrete programs on any specific health issue. This department also provides the education, support and assistance to staff and the organizations for working on the healthy ageing approach in productive manner. The person centered approach is followed in the Australia for ensuring the healthy ageing in Australia. Example of different programs that are part of broader healthy ageing framework in Australia includes Count us in!, Making a Move, HACC Active Service Model (HACC – Home and Community Care) and the Well for Life (Victoria, 2018). These all programs are aimed at enhancing health and well being for older people. Capacity building and service improvement is also an important approach that is followed by the health and regulatory bodies of Australia for ensuring healthy ageing in country. Under this approach, the focus is on enabling community, staff and organizations for improving the health of older people across the Victoria state of Australia (Victoria, 2018, p. 4). The department also provides financial support to different active and healthy ageing advisors across the state of Victoria for promoting healthy ageing.

In the broader aspect, National Strategy for an ageing Australia was designed and implemented by the government of Australia. The structure of national health strategy consists of different components like world class care, healthy ageing, community support, life style and altitude and the independence and self provision for older people. This strategy also emphasizes on availability of employment for mature age workers (Andrews, 2018, p. 3). There are different principles that are guiding the national strategy of Australia, the detail of which is as below:

• The ageing is a common element in the population of Australia. This element needs to be addressed by the community, businesses and government.
• All the people of Australia should have access to appropriate care services, recreational opportunities, cultural, transport, housing, learning, training and the employment opportunities irrespective of their age.
• All the Australians should have access to opportunities for making a lifelong contribution to the economy and society.
• The contribution is required from both private and public sectors for meeting the aspirations and needs of older people.

“Health Service Framework for Older People 2009–2016” has been mainly designed for purpose of improving the health and well being of older people in Australia. This framework is anticipated to provide plan investment and strategies in a way that the future health service needs in entire South Australia will get improve. The vision statement of this health framework is to ensure presence of healthy lives to the older people at their homes, to ensure functional and wellness independence of older people, to enhance resilience, to ensure availability of high quality of care with respect and dignity till the end of life (Gov AU, 2018, p. 4). The purpose of this health policy framework is also to ensure presence of access to right healthcare services, at right place and at right time with all the old age people in country.

There are different objectives of Health Service Framework for Older People 2009–2016. One of the objectives of this framework is to enhance time duration, in which the old age individuals can maintain good health and well being. The purpose of this health framework is also to minimize the length of time period, in which the old age people becomes dependent on others due to ill-health. It is also a core purpose of this health policy and framework that the offered health care services is delivered to all the old age people in need (Gov AU, 2018, p. 7). It aims to help old people to avoid any need of hospitalization through better life style and better level of health and well being programs for healthy lifestyle. The main goal of this health service framework is also to minimize the reliance on old aged care sector and health sector for living a high level of healthy life at the stage of old age.

Chosen Public Policy Framework: Health Service Framework for Older People 2009–2016

In simple words, the ageing can be explained as the stage of life, in which an individual or a person starts to face problem of body balance and mobility, motor sensory skills, memory loss, problem in hearing skills, and the impact on sights of person (Allen, Hutchinson, Brown & Livingston, 2014, p. 350). It is also a medical/ healthcare fact that increased symptoms of old age comes with the problems of chronic disease like cancer. The old age is influenced by different factors like surrounding environment of the person, behavior and the family genes. The environmental factors and socio economic disadvantages also impacts the disability and disease at later stage of people. The risk of occurrence of some other disease also increases in the human body in old age like Parkinson’s disease, dementia and cancer (Allen et al., 2014).

According to the selected health service policy or framework, there are different service delivery enablers (i.e. enabling factors and opportunities) in the stepped health system of Australia. Example of these enablers includes capacity of individuals and community for their health and well being, community and other health facility settings, community and aged care services and the specialized health services for older people. The overall purpose of these healthcare enablers is to optimize the health and well being of older people across Australia (Gov AU, 2018, p. 6). The core focus of the Health Service Framework for Older People 2009–2016 is on implementing the state ageing plan that is termed as “Improving with Age” in order to meet the strengthen healthy ageing goal of Government of Australia. The goal of this public health framework is also to improve the positive image of senior citizens and older people residing across the Australia.

The Health Primary Prevention Plan of the South Australia has included the primary prevention strategies for the old age people. According to this plan, the base for healthy ageing can be developed at the initial stages of life and is continued throughout the further stages of life. This plan consists of early intervention strategies, health promotion and the secondary/ tertiary prevention strategies in order to achieve the health and well being of older people in association with their potential capacity (Lawless et al., 2018, p. 521). It is also pointed out by the framework that health cannot always be fixed in the childhood. Small improvements in the health initiatives can be ensured in different stages of life through appropriate preventive steps.

Example of different stakeholders includes the older people residing across South Australia, as they are the core customers or beneficiaries of this public health framework. In addition to this, the healthcare agencies, regulators and carers are also the stakeholders of this policy framework. These include the health service carers, the aged community service sector firms, leading clinicians and the health regions of South Australia (Pinto, Molnar, Shankardass, O’Campo & Bayoumi, 2015, p. 180). The NGOs playing important role in the development, improvement and promotion are also the major stakeholders of this health policy framework. Apart from this, the political parties governing in the countries are major stakeholders of this policy, as passing and implementation of this health policy in country is an achievement for their government for the next election in country.

Describing Policy Areas

The successful launch and implementation of the Health Service Framework for Older People 2009–2016 has occurred in South Australia due to full support from the political party in domination. The Commonwealth government of Australia has provided support for passing the new healthcare framework for ensuring healthy ageing in country (Baum, Freeman, Lawless, Labonte & Sanders, 2017, p. 6). There is huge influence of previous health care policies and framework in the field of healthy ageing sector on the Health Service Framework for Older People 2009–2016 (Baum et al., 2017, p. 8). Example of these policies includes the SA Health Reconciliation Action Plan 2008–2010, South Australian Aboriginal Cultural Respect Framework, SA Aboriginal Health Policy and National Strategic Framework for Aboriginal and Torres Strait Islander Health 2003–2013.

The implementation of this health care framework is done in different ways. It has focused on implementation of prevention and health promotion strategies in order to help older people with the issues of dementia. With the implementation of this policy, the diagnosis and management of dementia among older people have improved. This has been carried out in partnership with society based health professionals and general practitioners (Gov AU, 2018, p. 3). Implementation of this health policy is also visible in the form of adoption of delirium prevention and management tactics among old age people for better treatment of health issues of deteriorating brain function.

The implementation of selected old age health policy or framework has proved to be quite effective in order to improve the health and wellbeing of older people across South Australia. For example, the improvement have been observed in the health service responsiveness towards health and well being need of older persons with the issues of dementia. Application of selected health framework has also resulted in improvement in the early diagnosis and treatment of dementia across South Australia (Gov AU, 2018, p. 5). In addition to this, the implementation of indicated health framework can also resulted in improvement in access of the older people towards treatment of Parkinson’s disease in the form of psycho-geriatric medical services and specialist geriatric medicine. It has also resulted in enhanced uptake of advance directives and advance care planning.

There are different approaches adopted for evaluation of the outcomes of implementation of the Health Service Framework for Older People 2009–2016. The evaluation of the implementation is anticipated to occur at different points like ongoing adaption and piloting of the innovations, service level reforms and system, analysis of the midpoint report of progress of 2012 of the health framework, and the development of new statewide strategic plan for 2017 (Knight, Bryan, Wilson, Hodgson & Murphy, 2015, p. 63).

There is positive impact of the implementation of Health Service Framework for Older People 2009–2016 on different public health principles like social justice, equity and addressing social determinants. It is supporting the principle of social justice. For example, this health framework has been designed and implemented for valuing the older people, promoting respect of personal choice and independent decision making for older people, promoting a value based culture for older people in society and promoting the healthy ageing (Gov AU, 2018, p. 4). In context of equity principle, the current health policy or selected health framework has emphasized to ensure fair and equitable health opportunities to all people irrespective of their gender and religion. The health framework is focused to avail access of every person in need to full health opportunity in South Australia.

Main Groups Involved in Policy Development

Example of alternative strategies suggested by different stakeholder groups includes transition care program, short term nursing care and personal care program (Delany et al., 2014, p. 701). These all programs can be funded by the state and commonwealth government of Australia. Transition care program can be highly effective for the older people that require long term health care service for the recovery from serious illness (Delany et al., 2014, p. 710). The positive impact will be seen from these alternative strategies on the public health and effectiveness of selected health framework.

One of the limitations of ACF framework is that it has roots to American pluralism. In this context, the ACF framework cannot be applied in the countries that have democratic corporatist traditions (Nohrstedt and Olofsson, 2016, p. 20). In other words, the ACF framework cannot be applies in Europe and other countries of the world. But this model has helped to understand the development of health policy framework in this report.

Conclusion

On the basis of above analysis, it can be concluded that Health Service Framework for Older People 2009-2016 is an effective health framework of the government of Australia for promoting healthy ageing in country. It has resulted in improvement in healthcare service responsiveness towards needs of older people with different disease like dementia and Parkinson’s disease. It has also resulted in enhanced uptake of advance directives and advance care planning. One of the limitations of this framework is that it is not much effective for availing healthcare services for older people for long term for serious intermittent episodes.

References

Allen, J, Hutchinson, AM, Brown, R & Livingston, PM 2014, ‘Quality care outcomes following transitional care interventions for older people from hospital to home: a systematic review’, BMC health services research, vol. 14, no. 1, pp. 346-360.

Andrews, HK 2018, National Strategy for an Ageing Australia. [Online]. Available at: https://www.ifa-fiv.org/wp-content/uploads/2012/11/062_Australia-2001-National-Strategy-for-an-Ageing-Australia.pdf 

Baum, F, Freeman, T, Lawless, A, Labonte, R & Sanders, D 2017, ‘What is the difference between comprehensive and selective primary health care? Evidence from a five-year longitudinal realist case study in South Australia’, BMJ open, vol. 7, no. 4, pp. 01-20.

Delany, T., Harris, P., Williams, C., Harris, E., Baum, F., Lawless, A., Wildgoose, D., Haigh, F., MacDougall, C, Broderick, D & Kickbusch, I 2014, ‘Health impact assessment in New South Wales & Health in all policies in south Australia: Differences, similarities and connections’, BMC public health, vol. 14, no. 1, pp. 699-720.

Gov AU (2018) Health Service Framework for Older People 2009-2016. [Online]. Available at: https://www.sahealth.sa.gov.au/wps/wcm/connect/cd478e804278955d8b07ab182b8de443/hsframeworkolderpeople09-16-clincalnetworks-sahealth-0905.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE-cd478e804278955d8b07ab182b8de443-lBkSXwM 

Ingold, K, Fischer, M & Cairney, P 2017, ‘Drivers for policy agreement in nascent subsystems: an application of the advocacy coalition framework to fracking policy in Switzerland and the UK’, Policy studies journal, vol. 45, no. 3, pp. 442-463.

Knight, A, Bryan, J, Wilson, C, Hodgson, J & Murphy, K 2015, ‘A randomised controlled intervention trial evaluating the efficacy of a Mediterranean dietary pattern on cognitive function and psychological wellbeing in healthy older adults: the MedLey study’, BMC geriatrics, vol. 15, no. 1, pp. 55-70.

Lawless, A, Baum, F, Delany-Crowe, T, MacDougall, C, Williams, C, McDermott, D & van Eyk, H 2018, ‘Developing a framework for a program theory-based approach to evaluating policy processes and outcomes: Health in All Policies in South Australia’, International journal of health policy and management, vol. 7, no. 6, pp. 510-540.

Nohrstedt, D & Olofsson, K 2016, ‘A review of applications of the advocacy coalition framework in Swedish policy processes’, European Policy Analysis, vol. 2, no. 2, pp. 18-42.

Pinto, AD, Molnar, A, Shankardass, K, O’Campo, PJ & Bayoumi, AM 2015, ‘Economic considerations and health in all policies initiatives: evidence from interviews with key informants in Sweden, Quebec and South Australia’, BMC public health, vol. 15, no. 1, pp. 171-190.

Victoria 2018, Healthy Ageing Program. [Online]. Available at: https://www2.health.vic.gov.au/ageing-and-aged-care/wellbeing-and-participation/healthy-ageing/healthy-ageing-program