Rapid appraisal methodology for 'health for all' policy formulation analysis

Although in the last 20 years, the WHO 'Health for All' principles have been widely used in national, regional and local health policy documents, there is still a gap in the literature regarding how to appraise or compare them, which weakens the social accountability process.

A new, rapid approach to analyse the formulation of health policies is proposed. It is based on the selection of a small number of tracers and the development of a gold standard to be completed with input from a review of the literature, and opinions of expert panel members. This methodology has been empirically applied to the health strategies of two Spanish regions (Catalonia and Valencia).

A framework for analysis was produced containing three dimensions: timing (early or late policy options), action level (individuals or social focus) and equity (social class, gender and ethnic groups). The health problems selected as tracers were HIV/AIDS, traffic injuries and ageing-related disabilities. In the two regions studied, the policies formulated for HIV/AIDS and age-related disabilities provide interventions late in the evolution of the health problem. The strategy established in the region of Valencia is more community-oriented than in Catalonia. Neither region had implemented specific policies regarding social class, gender or ethnic groups.

The methodology proposed here makes it possible to map the formulation of Health Strategies, compare different geographical areas and even forecast the policies' usefulness. The simplicity of the method, together with the fact that citizens and politicians alike can easily understand its results are major advantages. For the framework to be fully useful, it will be necessary to build evidence-based policy databases.