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ORGANISING EFFECTIVE POLICY DIALOGUES FOR THE PREVENTION AND CONTROL OF CARDIOVASCULAR DISEASES A STEP-BY-STEP GUIDE World Heart Federation

ORGANISING EFFECTIVE POLICY DIALOGUES … EFFECTIVE POLICY DIALOGUES FOR THE PREVENTION AND CONTROL OF CARDIOVASCULAR DISEASES A STEP-BY-STEP GUIDE World Heart Federation 2 ABOUT THE

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Page 1: ORGANISING EFFECTIVE POLICY DIALOGUES … EFFECTIVE POLICY DIALOGUES FOR THE PREVENTION AND CONTROL OF CARDIOVASCULAR DISEASES A STEP-BY-STEP GUIDE World Heart Federation 2 ABOUT THE

ORGANISING EFFECTIVE POLICY DIALOGUES FOR THE PREVENTION AND CONTROL OF CARDIOVASCULAR

DISEASES

A STEP-BY-STEP GUIDE

World Heart Federation

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ABOUT THE GUIDE This guide is among the tools developed to support the implementation of the World Heart Federation’s (WHF) Roadmap to improve cardio vascular health. The roadmap process includes undertaking situation analyses in countries (consisting of health system appraisals and mapping of policies, stakeholders and assets), which partners undertake to identify the roadblocks to implementing the priority interventions of secondary prevention, hypertension or tobacco control to address cardiovascular diseases (CVDs) and their risk factors. The process further recommends policy dialogues, which build on in-country analysis to facilitate policy changes. This guide provides step-by-step guidance to organise effective policy dialogues, building on the situational analysis in countries.

GUIDE MAP

Preparing the ground for Policy Dialogues

What are policy dialogues?

What purpose do they serve?

Planning the Policy Dialogues

What background materials inform the dialogues?

What should the dialogue focus on?

What should its agenda include?

Who should be invited?

What should be the terms of engagement for the participants?

What operational details are to be addressed?

What needs to be communicated before and after the dialogues?

Organising the Dialogue

What type of meetings best serve the purpose?

How should they be structured?

How should the discussions be reported?

How can it be evaluated?

Post Dialogue Tasks

How should the WHF roadmap be adapted to country context?

What should be done to develop the strategic plan?

How will the strategic plan be resourced?

How will the plan be implemented?

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ABOUT THE POLICY DIALOGUES Policy dialogues provide a platform to bring together decision-makers and CVD stakeholders to share knowledge and experience and develop a plan to translate evidence to practice. Policy dialogues are intended to engage diverse stakeholders in a discussion to identify specific barriers and potential solutions for CVD-related policies. They are expected to lead to the development of a strategic plan to improve the policy scenario and further implementation. The specific objectives of the policy dialogues are to:

set priority goals and develop an implementation plan taking into account the strengths, weaknesses, threats and opportunities in the country

discuss the findings of the policy brief (Summary of the situational analysis and CVD Country Status Report) and identify strengths and weaknesses of the organisation of CVD services and tobacco control

discuss policy options/solutions based on the WHF Roadmaps and the findings of the policy brief

Set a clear path for the adaptation of the WHF roadmap to the country context with reference to achieving the targets in the Global Action Plan for the prevention and control of noncommunicable diseases (or higher national targets)

discuss the immediate steps for implementing the country plan, including its coordination, monitoring and evaluation.

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PREPARING THE GROUND FOR POLICY DIALOGUES

The WHF Roadmap recommends an initial situational analysis in countries to identify priority interventions that could improve the cardiovascular health in countries. This includes an appraisal of the health system to identify the organisation of CVD-related health services, a situational analysis to understand the policy gaps and political opportunities and the mapping of stakeholders and assets that are relevant to CVD prevention and control in countries. Please refer to guidance on situational analysis for hypertension, secondary prevention and tobacco control for details of these steps.

The Policy Dialogues are to be built on the insights from the above-discussed analyses. For instance, the results of the health system appraisal can indicate if access to CVD health services need to be considered a priority policy in the agenda of the policy dialogues and subsequent implementation plan. Likewise the policy mapping could help identify the specific gaps in tobacco control policies in the country and the political opportunities for advocacy, which the policy dialogues can consider. Therefore, the partners need to summarise the results in a “policy brief” of each of the various components of the situational analysis (health system appraisal, policy mapping, stakeholder mapping, asset mapping) for use at the Policy Dialogue meetings. The policy brief should start with the priority issue and not the research evidence. It should then use the best available evidence to clarify the problem (barrier) and its causes, and identify and frame policy options (solutions).

• Health system appraisal

• Policy mapping• Stakeholder mapping• Asset mapping

Situataionalanalysis

• Build a country roadmap

• Develop a strategic plan

Policy Dialogues • Resource the plan

• Share responsibilities• Monitor and evaluate

progress

Implement Strategic Plan

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PLANNING POLICY DIALOGUES Step 1. Prepare background materials The policy brief drawing on the multi-component situational analysis brings together critical evidence of the national CVD landscape to inform the policy dialogues in countries. The roadmap steering group would need it to define the framework for the dialogue and develop its agenda. The dialogue participants will be better informed if this evidence were available ahead of the meeting (at least one week in advance). An early task for the lead organiser(s) therefore would be to develop succinct summaries of the various mappings under the situational analysis. Thus a technical pack consisting of the followed should be prepared:

- WHF Roadmap - Policy Brief (25 pages max, with a three page executive summary and one page key

messages), containing o Summary of the health system appraisal o Summary of the policy mapping o Summary of the stakeholder mapping o Summary of the asset mapping o major road blocks in the CVD response in the country o policy options (strategies) for addressing them and, o implementation considerations

- Meeting report template that would help capture priority roadblocks, policy options and implementation considerations.

While preparing the summary documents mentioned above, it would be opportunistic to simultaneously develop PowerPoint slides summarizing the policy brief for presentation at the policy dialogue. Step 2. Define the framework for policy dialogues The roadmap steering group should draw on the results of the various components of the situational analysis in determining the response to the questions below and thus decide on the areas of focus for the policy dialogues. It is important to provide more than one option for each bullet to allow for joint prioritization, consensus building and buy-in from the various participating groups. These should be included in the policy brief.

As per the health system appraisal, which health system gaps are critical to improve the focus issue of the roadmap (secondary prevention, hypertension, tobacco control etc.)?

Which are the policies that the policy mapping identified as urgent and strategic?

According to the stakeholder mapping, which of the interventions and policies hold immediate political opportunities for advocacy?

Based on the asset mapping, which interventions enjoy broad support and match the capacity of the CVD/ NCD community in the country?

Should the focus be on national policies or those at the subnational jurisdictions, or both?

What should be the relative focus on Cardiovascular diseases versus their risk factors?

What weighting should be given to programmatic interventions as compared to policies?

Are there similar discussions/platforms in the country the CVD roadmap policy dialogues need to consider/engage with/draw on?

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Step 3. Develop the agenda for the policy dialogues The lead roadmap organisation(s) in the country should develop an agenda for the policy dialogues in consultation with the steering group. The agenda needs to reflect the scope of the policy dialogue as defined by the steering group. Across one or several meetings, the agenda needs to include:

Brief introduction of participants

Proposed agenda for the meeting

Scope and objectives of the policy dialogues

Brief orientation to WHF Roadmap on selected topic (secondary prevention, hypertension or tobacco control)

Summary results of the situational analysis components

Major road blocks to achieving optimal situation specific to the country

Selected interventions and policies to address the road blocks

Opportunities and threats to priority interventions/policies

Policy options (strategies) to counter these challenges

Adaptation of the roadmap to the country context

A strategic plan with priority goals and objectives to implement the country road map

Means to monitor and evaluate progress in the implementation of the strategic plan

Immediate steps to roll out the plan including division of responsibilities and roles A sample agenda can be found in Annex 1. Step 4. Identify stakeholder invitees to the policy dialogues Using the stakeholder mapping, the steering group members need to make strategic and collective decisions about potential participants of the policy dialogues. The steering group should consider:

Synergy of stakeholder’s work with the priority policies determined for discussion at the meetings

Expert participants whose work is aligned with the focus of the policy dialogues

Involvement of diverse sectors and disciplines (relevant Ministries of the Government besides health, CVD community-NGOs, medical professional bodies, community health workers and those affected by CVDs, country teams of relevant UN agencies/multilateral agencies, civil society working on issues closely linked to CVDs, medical/health professionals from allied disciplines)

Representation of national and subnational governments to bring perspectives across jurisdictions

Geographical representation to inform the priorities and opportunities of different regions

Limiting the number of participants to under 20 to facilitate in-depth and participatory discussions

Policy implementers e.g. providers and managerial staff

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Step 5. Develop Terms of Reference (ToR) for the Policy Dialogue participants Alongside deciding on the participants of the dialogue, the lead organiser needs to develop the terms for their engagement with inputs from the steering group. The ToR needs to clarify:

Tasks of dialogue participants

The time commitments required of the participants

Timeline of the policy dialogue process

Financial arrangements for participation

Potential role in the implementation of the strategic plan that the exercise produces Step 6. Determine the operational details of the policy dialogues Several operational details need to be considered while organising the policy dialogues. Number of meetings: As described in Step 3, the policy dialogues involve several agenda items that need detailed and focused discussion among participants. A meeting spread across two days could provide adequate time and continuity to the planning process. However, competing commitments of participants could make it challenging to spare multiple days. Alternatively, the dialogue could be conducted over multiple meetings in a pre-set timeframe within which there can be adequate continuity of work and participation. In some countries, a weekend retreat might work, where as in others a series of half-day discussions across one fixed day/week within the month might serve the purpose better. The number of policy dialogues and duration of meetings need to ensure the continuity of discussions, completeness of the tasks and full participation of all participants to the greatest extent possible. Location of meetings: The policy dialogues require the undivided and continued attention of its participants. The location should be such that participants are not distracted by other commitments. It would be helpful to host the meetings away from work environments and intrusive communication avenues. Geographical scope of meetings: The size of the country, potential stakeholders and finances need to be taken into consideration while determining the geographical scope of the policy dialogues. In countries with large population, geographical spread it might make sense to organise policy dialogues at the subnational levels, which then feed into the national discussion. Other means of facilitating subnational voices through telephone or virtual meetings may also be explored in large countries. On the other hand, in countries with very small populations, there may be a possibility to organise policy dialogues across multiple, homogenous countries. In such cases, attention needs to be paid to unique features of the CVD scenario specific to collaborating countries. Step 7. Communication before and after the dialogues: The lead dialogue organiser(s) need to have a range of communications with the participants of the dialogues. Apart from logistical details, it is important that participants receive the technical materials that inform the agenda at least two weeks before the meeting. Prompt post-meeting follow-up building on the momentum of the meetings is critical to translate its decisions to action. Key components of these communications are listed below.

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•Seek interest to participate in the policy dialogues

•Share the invitation and terms of reference of the dialogues to interested experts

•Provide details of the meeting date, time, venue, travel and lodging, registration and financial support (if any)

Logistics communication

•Preliminary draft agenda

•The brief stating the specific goals and objectives of the meeting, key facts on the problems to be addressed, proposed strategies for achieving them and implementation considerations

•Policy brief

•A review sheet with questions for participants to identify the top CVD gaps and strategies based on their preliminary review of the technical documents, and report to the organiser ahead of the meeting

Technical communication

•Thank you note

•Meeting report reflecting the discussions at the dialogue

•List of participants

•Evaluation form to provide feedback on the content, process and usefulness of the policy dialogues

•Steps for follow-up actions, specifying responsibilities

Post-meeting communication

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CONDUCTING THE POLICY DIALOGUES

The Policy Dialogues aim to facilitate discussion and careful consideration that would lead to the development of a well-informed strategic plan for CVDs in the country. While a standard format might not be suitable for different countries, the dialogues need to include a few elements and follow a few principles. Type of meeting: Face-to-face meetings provide the best platforms to achieve the objectives of the policy dialogues. Additional telephone or virtual meetings can complement these meetings or to include inputs of stakeholders from different parts of the country. Meeting facilitation- A facilitated, participatory discussion is best suited to the purposes of the CVD policy dialogues. Identify a neutral and experienced facilitator, with knowledge of CVD prevention and care. This is essential to efficiently run the policy dialogues. The facilitator needs to keep the discussions focused, create a neutral and free environment to express diverse views and create equal opportunities for all participants. Every participant should be encouraged to participate in the discussions. In countries where government or any others are treated with deference, the facilitator needs to establish principles of equality of all participants and acceptance of all ideas right at the start of the discussions. Any domination or restraint should be managed amicably to ensure that the best of the ideas inform the strategic planning. When selecting a facilitator, consider the following personal attributes:

Credibility/experience

Age (participants may not respect a facilitator who is in his/her late twenties)

Gender (female/male facilitators may not be accepted in particular contexts or

discussing certain health/policy issues)

Professionalism

Status/reputation

Rank (ideally equal to meeting participants)

Transparency

Self-confidence

Trustworthiness

Appearance (incl. attire)

Assertiveness

Meeting structure: The meeting could begin with the host organisation welcoming all the participants and stating the objectives of the meeting. A round of introduction of participants would help them get to know each other. The facilitator needs to be introduced, stressing on the person’s credentials as a neutral interlocutor. The facilitator takes over the dialogue from this point onwards. First, it would be good to go over the proposed agenda and time considerations and seek agreement on both. Next the expected outcomes of the meeting are to be established through a facilitated discussion. The facilitator then needs to propose the method of work comprising of interactive discussions with limited presentations (described in next paragraph) and see if it suits the participants. This can be followed by a discussion where the participants set the ground rules for their work together.

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The discussions are best focused on specific issues that are identified by the steering group based on the country situational analysis and summarised in the policy brief sent to the participants. The facilitator can encourage the participants to address each of the top CVD roadblocks, followed by a discussion on policy options to address them alongside implementation considerations. It is recommended to introduce key information from the roadmap and situational analysis at relevant stages of the meeting and to invite comments from participants. The facilitator needs to summarise the discussions on each of the CVD roadblocks identified, including their policy options and implementation considerations, before moving on to address the next gap. Once all the CVD road blocks and policy options are addressed, the facilitator needs to discuss the next steps of the process with the participants. This needs to include the meeting report, its dissemination, post dialogue tasks, and the roles the participants offer to play with regard to these steps. It is important to spare some time to complete the evaluation form through which participants can provide feedback on the policy dialogues. A sample can be found in Annex-2. As time permits, it will be useful to discuss the resourcing options for the strategic plan and identify someone to lead the effort. The meeting may end with due acknowledgement of the contributions of the participants, facilitator, organisers, the steering group and support services. Meeting report: The discussions need to be captured in detail in the meeting report template by a rapporteur. It is important to have a non-participant with note-taking skills as the rapporteur, so that the person can fully focus on capturing the discussions in an objective manner. The notes need to be more than just minutes of the meeting-they should reflect the whole discussion around the roadblocks, policy options and implementation matters, and not just decisions. See a report outline in Annex-3. However, the report is not a public document so the notes do not need editing and the style can be simple. The rapporteur should respect confidentiality and ensure that the policy dialogues participants all agree with the conclusions. The draft report with list of participants should be circulated with clear deadlines for participant feedback.

Prepare and disseminate the meeting report, including next steps based on the outcomes of the meeting, to participants as soon as possible after the meeting (suggestion: 5-7 days after the meeting).The report should include key views, opinions and insights relevant to the topic area. It should also be readable and understandable to readers who did not participate in the meeting.

Ensure that a feedback loop is in place for participants should follow-up be required. Participants should know that they have been listened to and their input is valuable, not least so that they will participate in further meetings. Policy-makers may also have to explain why certain views were not taken into account for a) transparency and b) to maintain reasonable relationships with stakeholders involved in certain policy issues).

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POST POLICY DIALOGUE TASKS These need to be identified and discussed in the concluding session at the dialogue that determines the next steps. The facilitator needs to encourage participants to identify how they would like to contribute to these tasks. These should be followed up and organised by the lead organiser through electronic means.

Adapt the WHF roadmap to the country context based on its discussions

Develop a concrete strategic plan to implement country CVD roadmap

Identify sustainable funding to resource the plan

Collaborate across the sectors to implement the plan

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ANNEXES ANNEX 1: DRAFT AGENDA OF THE POLICY DIALOGUE Sample agenda Day-1 Session1: Orientation to Policy Dialogues 8:30-9:00 Registration 9:00-9:15 Welcome remarks and objectives of the meeting (Host organiser) 9.15-9.30 Introduction of participants & facilitator 9:30-9:45 Method of work and Rules of the Dialogue (facilitator) 9:45-10:00 WHF Roadmap presentation (WHF representative) 10.00-10.30 Policy Brief presentation (Country roadmap lead and partners) Session 2: Country scenario and responses 10.30-11.30 Identifying the major roadblocks to CVD response in the country and prioritising those for immediate action (Facilitated discussion based on the situational analysis) 11.30-11.45 Health break 11.45-12:30 Current strategies, broader healthy system and political context, proposed targets (short, medium, long term) (Discussion based on policy mapping) 12.30-1.30 Lunch 1.30-3.30 Policy options to address identified roadblocks, improvising current strategies and considering the emerging political opportunities and stakeholder assets (Discussion in groups organised around major CVD road blocks identified in pre-lunch session) 3.30-4.00 Health break 4.00-5.00 Present to plenary the roadblocks discussed in the groups. Plenary to discuss and refine the policy options considering feasibility, costs, risks and implementation factors. (Facilitator to summarise the key proposals). 6.00-8.00 Reception Day -2 9.00-11.00 Continue group discussion on the policy options to address remaining roadblocks, improvising current strategies and considering the emerging political opportunities and stakeholder assets 11.00-11.30 Health break 11.30-1.00 Present to plenary the roadblocks discussed in the groups. Plenary to discuss and refine the policy options considering feasibility, costs, risks and implementation factors. (Facilitator to summarise the key proposals). 1.00-2.00 Lunch Session 3: Post Dialogue Tasks 2.00-3.00 Discussion on WHF roadmap for the country, development of the strategic plan, roles and responsibilities and other related matters. (Facilitated discussion) 3.00-3.30 Meeting’s follow-up actions (Facilitator summarises next steps) 3.30-3.45 Complete evaluation form 3.45-4.00 Closing remarks (host organiser and steering group)

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ANNEX 2: MODEL OF A POLICY DIALOGUE EVALUATION FORM Example Questions (WHO 2011)

1) What is your overall assessment of the policy dialogue? (1 = insufficient - 5 = excellent) 1 2 3 4 5

2) Which topics or aspects of the workshop did you find most interesting or useful? a. .. b. .. c. ..

3) Did the workshop achieve its stated objectives?

Yes No

If no, why:..

4) Knowledge and information gained from participation at this event

Met your expectations Yes No Somehow

Will be useful/applicable in my work Definitively Mostly Somehow Not at all

5) How do you think the policy dialogue could have been made more effective?

….

….

….

6) Please comment on the organisation of the event (from 1 = insufficient to 5= excellent)

1 2 3 4 5

7) Comments and suggestions (including activities or initiatives you think would be useful, for the future) …. …. ….

8) Further comments or suggestions

Thank you!

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ANNEX 3: OUTLINE FOR POLICY DIALOGUE MEETING REPORT (PER DIALOGUE) Executive Summary

I. Background

II. The Problem /roadblock addressed

III. Policy options

Policy Option 1

Policy Option 2

Policy Option 3

Policy Option 4

IV. Implementation considerations

V. Plan for multisectorial action

VI. Annexes

Agenda

List of participants

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ANNEX 4: FACILITATION GUIDELINES

Facilitation

Introduce participants or have them introduce themselves briefly.

Provide a clear introduction to the topic (based on the Policy Brief) – this is a crucial

element to set the scene and to ensure people’s engagement.

Be clear about the objectives and expectations of the meeting.

Clarify rules at the beginning (e.g. “Chatham House rule”1, equal freedom to

contribute, etc.).

Remember: the meeting is not necessarily about reaching consensus and making a

decision. Most policy-makers may not commit themselves to one approach/idea/option

after only a single dialogue, or without the opportunity to confer with policy-makers in

other parts of government or with other stakeholders. Similarly, some stakeholders will

need to return to their institutions to decide what actions to take. Although seeking

consensus and reaching a decision may not be an appropriate goal in most contexts,

consensus should be embraced and valued if it emerges spontaneously.

Interacting with participants

Contribute to a courteous, friendly atmosphere

Be motivated and motivating, friendly and polite.

Demonstrate neutrality to assist participants in expressing and developing their ideas.

Allow them to create and innovate. Do not influence the discussion. Counter-example:

If you as the facilitator agree with someone, it could prevent someone else from

disagreeing.

Engage participants

Make eye contact with everybody.

Call out of people to make sure everyone is heard.

Draw from individuals who are not able to articulate themselves well enough.

Make participants comfortable and confident, and encourage them to contribute to the

discussions.

Give people a sense of importance.

Listen

Listen and keep track of the conversation.

Think upon your feet quickly and move fast – even if there is “an elephant in the

room”, i.e. an important and obvious topic, which everyone is aware of, but which is

not discussed, as this would be considered uncomfortable.

1 The Chatham House rule prohibits the attribution of particular comments to create a safe environment to deliberate about potentially contentious issues.

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Intervene

Ask for clarification or examples.

Elucidate differences of opinion.

o Try rephrasing ambiguous statements and ask for elaboration as needed.

o Elaborate ways in which a policy issue could be framed and addressed.

o Extract as much information about peoples’ views as possible and identify when

views are convergent/divergent.

Encourage participants to use jargon-free, plain and person-first vocabulary.

Push towards and clarify where the group gets to in terms of informed judgement.

Push towards tangible formulation of next steps (i.e. action-oriented) while reminding

participants to be honest about what they can and cannot do.

o You could ask participants: “What do you think others should do to push this

issue? What can you do to push this issue?”

ACKNOWLEDGEMENTS

This guide was developed by the World Heart Federation. The inputs of WHF country partners/members helped to fine tune it to country contexts. The guide has drawn on the ideas and structure of SURE Guides for Preparing and Using Evidence-Based Policy Briefs.