Concluding remarks

With our case studies we intended to contribute to a better understanding of factors that influence drug policy decision making and shape the governance of drug policy. Using the Health Policy Triangle as a heuristic to unravel and order the factors of influence we discerned between content, process, actors or stakeholders and context. We combined this somewhat static approach with elements of Kingdon’s Multiple Streams Model, another heuristic that helped us to better understand the dynamic processes of drug policy making and implementation, the relationships and influences between these factors of influence. This model allowed us to ‘compose the picture’.

Combining elements of both models was a useful approach for capturing the complexity and dynamic of the drug policy trends we were focussing on (see 2.2.4).

The question is of course what are practical implications of our case studies? Are there any lessons to be learnt from these analyses? In this last part we will look into this. We will limit ourselves to pointing out some general practical conclusions.

7.6.1 The context

The context of policy making and implementation: the historical, political, economic and social-cultural factors influencing policymaking are given circumstances. They define the room for manoeuvre at a certain point in time. There is not much one can do about these factors except taking them into account. It is the context which determines for an important part whether the chosen aims and objectives of policy measures are realistic and achievable, whether there are barriers or facilitators for achieving aims and objectives. Examining the context, including a risk analysis, should be an integral part of exploring drug policy alternatives. One option here is a SWOT analysis by experts. One particularly useful format to do this are expert focus groups, which can help to identify strong and weak points of a policy measure and contextual opportunities and threats as regards its implementation. Such an exercise can also help to identify possible unintended consequences.

139 7.6.2 The content

The policy content, generally laid down in a policy paper or plan, describes the underlying reasons for developing a specific policy, its objectives and the measures to be taken. Important factors determining the policy content are the context and the perception of the problem that requires policy interventions.

A useful tool or format for systematically developing a policy plan is a LogFrame matrix (see Appendix 9), which allows for splitting the plan into logically linked constituents, including overall objectives, specific objectives, expected results and activities to realise objectives and results. It describes the logic of the interventions along the line of these four constituents. It sets the indicators to measure the achievements, defines the sources of information and means which will be used to verify the indicators and, finally, elaborates assumptions. The latter includes a risk analysis, or – even better – a full SWOT. A reflection on unintended consequences is also worth consideration here. To facilitate the feasibility and evaluability of a policy plan the objectives should be SMART⁹⁴. The feasibility of the objectives depends for an important part on contextual factors, as they determine the ‘play area’ of policymaking.

A LogFrame matrix helps to reflect on all relevant elements of a policy plan in a specific and structured way. This systematic presentation of all elements also facilitates the evaluability of a strategy. It is particularly helpful for assessing the internal logic and consistency of a policy paper. Are the objectives formulated in in a SMART way? Do the expected results represent a realisation of the objectives? Are the selected activities the most appropriate way to reach the objectives and to realise the expected results? Are the selected indicators indeed proof for having achieved the expected results? These are all questions which can be checked in a critical reflection by experts involved in a specific field of policy making and implementation. For this exercise focus groups are again a useful method to critically check all relevant elements and their logical connections. Through focus groups one can consult experts, compare their views and work towards consensus.

By including a division of tasks among stakeholders, defining who is responsible for which activity, a LogFrame also can facilitate accountability.

7.6.3 The process

The process of policy making and implementation lies at the core of governance. Here the concept of good governance comes in again. UKDPC's work on this subject provides guidance here (see 7.5). Key theme in the work of UKDPC was ‘how to make drug policy better’, which is also the title of its legacy publication (UK Drug Policy Commission 2012). In this report the authors list characteristics of good governance and provide seven recommendations how to improve policy making and implementation. It may look a bit like a moral appeal to the ones responsible for policy making.

Nevertheless, it is an excellent checklist of or standard for good policy making, covering the following areas: stakeholder engagement, clarity of overarching goals, strong leadership, coordination of policy efforts, policy design, use of evidence base, implementation and accountability and scrutiny (Hamilton et al. 2012).

94 SMART stands for Specific, Measurable, Appropriate, Realistic and Timely.

140 7.6.4 The stakeholders

From UKDPC's definition of good governance follows that involvement of all relevant stakeholders in the process is essential for effective policy making and implementation. Therefore it should be standard procedure to identify all stakeholders either affected by or with a professional interest in a certain problem. There may be cases where this exercise will result in a rather long list. In those cases one could decide to produce a shortlist of the most important stakeholders involved.

There are various examples of token involvement, which in some cases is nothing more than simply informing stakeholders and at the most asking a number of questions without taking the input on board. Evidently this 'token involvement' will cause frustration and not result in active commitment and feelings of ownership. Effective stakeholders’ involvement consists of active involvement, consultation of and discussions with relevant stakeholders. One important step at the start of the process is to identify the interests of the different stakeholders in order to get a clear picture where the discrepancies and commonalities lie. This analysis is important for identifying possible win-win situations between stakeholders with different interests, which might be combined for a certain purpose, namely forming as broad as possible stakeholder coalitions. The example of the successful implementation of drug consumption facilities in the Netherlands shows the importance of broad coalitions, combining different interests for one specific purpose (see 7.3). Breaking ground for consensus and building coalitions is an essential part for successful policy making and implementation.

7.6.5 The policy window

This brings us back to a key heuristic from Kingdon’s Multiple Streams Model for understanding policy changes: the policy window or window of opportunity. Building stakeholder coalitions, looking for win-win situations can be understood as pushing for a policy window. The concept of a policy window provides a convincing picture, which helps to understand the conditions or requirements for a policy change. The coming together of the three streams (problem, policy and political stream) is a decisive condition for policy change to happen. These policy windows can of course not be constructed. There are too many variables and stakeholders involved in it. The best one can do is try to support factors in favour of a window of opportunity. In these concluding remarks various points have been mentioned which should be considered when thinking how to facilitate policy changes.

A paradigm change reflecting a wider consensus among stakeholders can also be understood in terms of a policy window. Stakeholders’ consensus plays a crucial role in all three streams: in the problem stream a consensus concerning the urgency of a problem; in the policy stream a consensus on the ‘solution’ of the problem, i.e. a feasible and effective policy proposal; and lastly in the political stream a majority of politicians supporting this policy proposal.

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