South Asia Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Sri Lanka.
Health Res Policy Syst. 2010 Jun 17;8:19. doi: 10.1186/1478-4505-8-19.
Policy analysis is often retrospective and not well suited to helping policy makers decide what to do; in contrast prospective policy analysis seeks to assist in formulating responses to challenging public policy questions. Suicide in Sri Lanka is a major public health problem, with ingestion of pesticides being the primary method. Previous policy interventions have been associated with reduced mortality through restricting access to the most toxic pesticides. Additional means of reducing access are still needed.
The prospective policy analysis comprised two stages. The first used a consensus activity within a well defined policy community to generate and frame policy options. The second broadened the analysis to include other stakeholders. We report the consensus activity with seven actors from agriculture, health, and academia. Policy options were identified through two rounds of discussion along with ratings by each participant on their degree of support for each option. Data were analysed quantitatively and discussions analysed with Nvivo 8 to code prominent and recurrent themes.
The main finding was the strong support and consensus for two proposals: further regulation of pesticides and the novel idea of repackaging pesticides into non-lethal doses. Participants identified several factors that were supportive of future policy change including a strong legislative framework, good links between agriculture, health and academia, and a collaborative relationship with industry. Identified barriers and potential threats to policy change included political interference, difficulties of intersectoral collaboration, acceptability of options to the community, difficulty of implementation in rural communities and the challenge of reducing mortality.
The development and consideration of policy options within this epistemic community reflected an appreciation and understanding of many of the factors that can facilitate or thwart policy change. The understanding of context, evidence and ideas, implementation and impact influenced how the participants considered and rated the options. Use of epistemic community actors identified the level of support for each option, helped elaborate the particularities of context, as well as the power and influence of ideas. Further examination of the potential barriers and opportunities for these options will determine if broader consensus, involving a wider range of stakeholders, can be achieved and policy change promoted.
政策分析通常是回顾性的，不太适合帮助政策制定者决定做什么；相比之下，前瞻性政策分析旨在协助制定应对具有挑战性的公共政策问题的对策。自杀是斯里兰卡的一个主要公共卫生问题，摄入农药是主要自杀方式。以前的政策干预措施通过限制最有毒农药的获取途径，与降低死亡率有关。仍然需要采取其他方法来减少获取途径。
前瞻性政策分析包括两个阶段。第一阶段在一个明确界定的政策界内使用共识活动来生成和制定政策选择。第二阶段将分析范围扩大到包括其他利益攸关方。我们报告了来自农业、卫生和学术界的七名行为者之间的共识活动。通过两轮讨论以及每位参与者对每个选择的支持程度进行评分，确定了政策选择。对数据进行了定量分析，并使用 Nvivo 8 对讨论进行分析，以对突出和反复出现的主题进行编码。
主要发现是对两项提案的强烈支持和共识：进一步规范农药和将农药重新包装成非致命剂量的新想法。参与者确定了一些有利于未来政策变革的因素，包括强有力的立法框架、农业、卫生和学术界之间的良好联系，以及与行业的合作关系。确定的政策变革障碍和潜在威胁包括政治干预、部门间合作的困难、社区对选项的接受程度、农村社区实施的困难以及降低死亡率的挑战。
在这个知识共同体中制定和考虑政策选择反映了对许多可以促进或阻碍政策变革的因素的理解和认识。对背景、证据和想法、实施和影响的理解影响了参与者对选择的考虑和评分方式。利用知识共同体行为者确定了每个选择的支持程度，有助于详细说明背景的特殊性，以及思想的力量和影响力。进一步研究这些选择的潜在障碍和机会将确定是否可以实现更广泛的共识，涉及更广泛的利益攸关方，并推动政策变革。
