Policy Process Improving American Healthcare System


The Government has a great responsibility of coming up with the right decisions and policies that are aimed making the life of its people better. Public policies affecting the citizens directly like those related to HIV/AIDS are very sensitive and all the necessary procedures should be strictly followed before their enactment. The policies on HIV/AIDS are supposed to help the government in rendering the necessary aid and protection to those affected by the HIV/AIDS pandemic (Dorey, 2005). Government policies undergo quite a number of processes before they are officially adopted. This is to make sure that all the regulatory mechanisms are put in place to avoid problems after implementation. This paper will highlight all some of the major stages of policy formulation and implementation

Policy Formulation Stage

Before the process of policy formulation begins, there must be a major problem in existence calling for the intervention of the government (Dorey, 2005). According to the case in this study, the number deaths occurring due to HIV/AIDS have been on the increase forcing the government to take the necessary action to address the situation. This problem sets the agenda for policy makers to give it some serious thought. The policy makers evaluate the policy topic with an aim of coming up with the right strategy of addressing the problem (Huber, 2006). The formulation stage should involve all the stakeholders for a more inclusive approach to be attained. Interest groups, court representatives, Congress representatives, the executive and policy experts come together with an aim of coming up with the right proposal of addressing the problem. After the necessary proposals have been made, a bill is drafted and sent to the Congress for approval (Huber, 2006). If any of the stakeholders is against the proposal, the verdict is subject to the Supreme Court ruling after the appeal has been made.

The Legislation Stage

The legislation process is always very long and can last for even a year depending on the sensitivity of the pieces of legislation to be passed. The bill has to be discussed extensively in the Congress before being formally approved (Huber, 2006). The bill may be initiated by a member of the Congress or by the president as a representative of the executive. The bill can undergo some changes while still at the congressional committee level where some factions in the congress, the executive and interest groups are engaged in some bargaining. After approval at the committee level, the bill is further discussed at the plenary sessions before final approval. Incase the bill is not approved during the congressional period; the process is re-stated with new submissions being tabled (Dorey, 2005). After fresh presentation, the bill is sent to the chamber once again to go through the same process. If the bill is approved in the first chamber, is then sent to the second chamber for further discussions and bargaining. The second chamber has three options to take incase the bill is tabled for the second time. The second chamber can decide to improve the bill into a law and further submit it to the executive for formal approval and issuance. The other option the second chamber can take is to make some recommended changes to the bill and sent it to back to chamber one for fresh discussions (Dorey, 2005).

The final resolve by the second chamber is to completely disapprove the bill and in the process stop any future presentation of the bill. Once the bill has been filed by the second chamber, there is no way it can be presented again for discussion (Dorey, 2005). The approval of some bills in congress is normally influenced by the self-interests of the legislators rather than the contents of the policy under debate. The executive plays a major role in policy legislation because of the influence it has over the legislative process. There are some provisions issued by the Congress for the executive to take the necessary actions in some special policy areas without having to go trough the extensive discussions in the congress (Sidlow, 2002). Public policies touching on critical issues like HIV/AIDS need comprehensive involvement of all the interest groups in the legislation process.

The policy agenda of the president is normally formulated by a team of political and technical experts appointed by the president (Huber, 2006). The technical expertise of this team of policy makers helps the president to put forward his or her agenda on the necessary policies to be approved by the congress. The bill on HIV/AIDS policy has many components that require approval for successful fight of the HIV/AIDS pandemic. The laws governing the formation of bodies and organizations to help in the fight against HIV/AIDS are very critical since the government uses the organizations to implement the necessary measures to fight the disease (Huber, 2006). The congress also needs to approve the amount of funding allocated to the fight against HIV/AIDS. Laws governing the use of HIV/AIDS funds should be put in place to tame any misappropriation.

The Implementation Stage

Policy formulation and legislation stages set the pace for the implementation process. Good policies can end up not making any difference in the society due to poor implementation by the players involved (Huber, 2006). The process of making public policies can only be labeled successful if the passed laws are fully implemented according to the original proposals. There is a general perception that the majority of domestic policies rarely meet their goals due to poor implementation programs. The stakeholders end up having conflicting opinions which depends on the political structure of the country. Bureaucrats play a very influential role in the implementation process but are not necessarily in charge of the whole process. The method of implementing public policies depends on a number of factors such as the social purpose of the policy and the decentralization structure of a country (Huber, 2006). The implementation actors should ensure that policy goals are achieved by taking the necessary actions for effective implementation of the recommended programs.

The bureaucrats in collaboration with other actors have to carry out a number of duties to ensure successful implementation of the public policy. To begin with, the actors in the implementation process should acquire the required resources for the government and other donors. The next step is the planning of implementation activities based on the laid down statutes and laws. Those charged with the responsibility of implementing public policies should ensure that the whole process is organized and moves according to plan (Sidlow, 2002). The policy benefits or restrictions are finally extended to the people affected according to plan. The main actors in the implementation process often have divergent opinions and expectations because of the complex nature of implementing government programs and initiatives. This complexity ends up bringing many actors in the implementations stage. The federal, state and local levels of government are actively involved in the process of implementing public policies.

The implementation stage has got private actors that play some important roles in the implementation process (Sidlow, 2002). Private actors consist of interest groups that have some influence in the implementation stage just like the formulation and the legislation stages. Advisory groups form part of the private actors that ensure successful and professional implementation of government policies. The courts are responsible for making decisions that guide and regulate the implementation process. Incase those in charge of implementing public programs fail, the court can act as program administrator (Huber, 2006). A good hierarchy ensures quick and efficient implementation of public policies because it minimizes bargaining and too much bargaining. The actors at the implementation stage should be ready for to deal with some unexpected cost and consequences. The economic and social changes have a considerable effect in the process of implementing public policies.These factors should be factored in the implementation plans and programs to avoid a conflict of interests. Public policies are prone to distortion because the people involved in the formulation and adoption process are not necessarily the same people who implement them (Huber, 2006). The policy implementation stage is a very crucial stage since it connects the establishment stage and the real impact the policies have on the lives of the people affected. Those responsible for implementing public policies have to enforce directives, collect the necessary data on the ground, sign contracts, acquire and disburse funds together with disseminating information to the affected people. Some of the important activities at the implementation stage include problem analysis, proactive planning and creation of organizational units (Huber, 2006).

Effective implementation of the public policies like the one on HIV/AIDS needs good communication amongst all stakeholders, the required resources together with an effective bureaucratic structure (Huber, 2006). All policy implementation orders and decisions must be consistent and accurate so that all the personnel involved in the implementation process are well informed of what they are supposed to do. Obstacles are common at the implementation stage due to varying opinions and the many bureaucratic layers on the way. Lack of clarity at the implementation stage can be caused by competing goals, development of new programs that are not familiar and unclear court decisions (Dorey, 2005). The hired staff should have the relevant skills to implement the programs. This is done by offering quality training to the staff.


The process of formulating and implementing public policies is very involving and needs professionalism and accountability for it to be successful. Formulating a policy from a topic needs through problem analysis. The magnitude of the problem should draw the attention of the government for it to come up with the necessary policies to control the situation. HIV/AIDS is an example of challenges the American government is facing therefore necessitating the formulation and implementation relevant policies to put the situation under control.


Dorey, P. (2005). Policy making in Britain: an introduction. New York, NY: SAGE.

Huber, D. (2006). Leadership and nursing care management. New York, NY: Elsevier Health Sciences

Sidlow, E. (2002). America at odds. New York, NY: Wadsworth/Thomson Learning.

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