Some stray observations on the policy process spurred by arm-chair wannabe-activists who can string together all the right
words (and sentiments) to stoke people’s emotions, but clearly lacking the perseverance required to participate in a process where all shades of actors (whether we like them or not) have their (un)equal influences.
Policymaking is not often evidence-based (and this is by design – it is after all coming from a political establishment). I guess most of our efforts is (or should be) towards an evidence-influenced policy, just like several other politico-social considerations (among others) influence policy. And even if we use the broadest possible definition of evidence (where we can include reports, beneficiary experiences and general opinion of lay public even – not necessarily limited to the “evidence” from scientific publications which is often lacking), policy process is seldom based on this. We have to face it that it is a political process of engagement with actors who are often picked not always having the interest of “evidence” or indeed even public-orientation in mind. This is a reality we have to work with (if not accept and sit back).
Contrary to this, I see activists of all sorts beating their chests about a sell-out when private sector is consulted. Sure, private sector in health is “evil” – I get that and there is both “evidence” and plenty of empericism that supports it (if not plain hate). But, why do some of this lot accord themselves some moral high-ground? Is it because they were not a part of these committees or consultations? I am quite tired of people who do not understand the complexity involved in a consultative policy process, who go around undermining the very process of consultation. In an economic reality that we live in, power relationships of the private sector cannot be ignored.
There is often never a direct correlation between the end-result of a policy/document and the members of the committee that went into making it. Often, the commitee formation and meetings are part of a consultative process that may or may not ultimately incorporate all of bits of what these members did and said in the meetings. And of course, we know that such inclusion in these committees is often by “cherry-picking” and other times not – but this is by design! In any case, the only fair thing in this would be to strive for the largest possible representation of all interests, ideologies and communities.
Committee members are required to act in public interest, even if they themselves are involved in “private” enterprises (be it NGO or for-profit private sector). I don’t really know how conflicts of interest can be avoided by better “cherry-picking”. Because, after all every private citizen walking into these bodies has in some way a conflict of interest (in my opinion). Can we trust an Anna Hazare or a Baba Amte to not have a “vested interest”. Is there really any non-state actor who can be involved in policymaking who can claim to be free of any interest? I guess the idea is to what extent diverse interests/identities could be represented given the power-reationships among such actors (recommendations of some people carry more weight than others, and this is not necessarily because they bring “better” evidence). How does one avoid this, I am not really sure. However, it is expected that these members should be acting in public interest when they sit on these committees. At least, having people with “some” credibility or integrity helps. It is hoped that these people will broaden the base of the consultation; that they will represent the weak and the voiceless….or at least those who carry the voice of those who carry the voice of these people. And what if they don’t?…
In any case, engaging with these ad-hoc cherry-picked “stakeholders” in policy is very important and we must – instead of cynically brushing the process aside. And we should share whatever evidence there is (or is not) with these groups. Now, whether they apparently represent private interests inimical (in our opinion) to public health or not, being bodies vested with public responsibility, we should engage with them.
Of course, much of this is self-evident to most involved in this. But, why do we still see such naivite? Or is this just an easy way to seek an identity? What can I say? Perhaps this will help?