IFMSA Toolkit | National and International Policy-Making Usage and Implementation by International Federation of Medical Students' Associations

IFMSA TOOLKIT

National and International Policy-Making Usage and Implementation

SWG Coordinators José Ganicho

External Affairs Regional Assistant for Europe 2019/2020

Matteo Cavagnacchi

Policy Assistant 2019/2020

Meriem Benazzouz

External Affairs Regional Assistant for EMR 2019/2020

SWG Members Erica Clemente (SISM-Italy) Ieva Berankytė (LiMSA-Lithuania) Maria Inês Francisco Viva (ANEMPortugal)

Maryam Amged (IFMSA-Egypt) Mohamed Hichem Smaali

(Associa-Med Tunisia) Yahya Lablad (IFMSA-Morocco)

Contributors Gita Mihelčič, RD Europe 2019/2020 Aamr Hammani, RD EMR 2019/2020 Omnia El Omrani, Liaison Officer for

Public Health Issues 2019/2020 Tammy Yu, Liaison Officer for Human Rights and Peace Issues 2019/2020 Saad Uakkas, Liaison Officer to Student Organizations 2019/2020

AMSA - Australia Blanca Paniello Castillo (SCOPH Development Assistant 2019/2020) Diogo Martins (IFMSA Alumni)

IFMSA The International Federation of Medical Students’ Associations (IFMSA) is a non-profit, non-governmental organization representing associations of medical students worldwide. IFMSA was founded in 1951 and currently maintains more than 140 National Member Organizations from more than 129 countries across six continents, representing a network of 1.3 million medical students. IFMSA envisions a world in which medical students unite for global health and are equipped with the knowledge, skills and values to take on health leadership roles locally and globally, so to shape a sustainable and healthy future. IFMSA is recognized as a nongovernmental organization within the United Nations’ system and the World Health Organization; and works in collaboration with the World Medical Association.

TO Reviewers Alaa Dafallah, Liaison Officer for

Medical Education Issues 2019/2020 Omnia El Omrani, Liaison Officer for Public Health Issues 2019/2020 Tarek Ezzine, Vice-President for External Affairs 2019/2020

Layout Designer Paula Kenz (IFMSA-Egypt)

Publisher IFMSA Norre Allé 14, 2200 Kobenhavn N., Denmark

Email: gs@ifmsa.org Homepage: www.ifmsa.org

vpprc@ifmsa.org

This is an IFMSA Publication

Notice

All reasonable precautions have been taken by the IFMSA to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material herein lies with the reader.

Disclaimer This publication contains the collective views of different contributors, the opinions expressed in this publication are those of the authors and do not necessarily reflect the position of IFMSA. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the IFMSA in preference to others of a similar nature that are not mentioned.

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Contents

Abbreviations

Introduction

Definitions

Policy Documents: Why, How and What

• Why • How • What

How do we develop Policy Documents? Step 1. Problem identification and Issue recognition • Needs Assessment Step 2. Policy Formulation and Legitimation • Stakeholder Analysis

www.ifmsa.org

• Strategies of Policy Making • Policy Documents Structure • Who should make Policy Documents? • Should Policy documents be broad or specific? • Inputs, Feedbacks and Adopting Process Step 3. Policy Implementation • Internal Initiatives • External Initiatives Step 4. Policy Evaluation and Progress monitoring • Evaluation vs. monitoring • The Evaluation Framework

Challenges and Recommendations • Lack of Members Involvement • Lack of resources or background data • Unresponsive stakeholders • Questionable Impact or Lack of Impact

7 7 7 8 10 10 11 11 12 15 17 20 21 23 23 24 25 25 26 28 28 28 29 29

Contacts

Bibliography

ABBREVIATIONS EMSA GA IFMSA IPSF LC MoU NGA NMO PD SC SWG TO WHO WMA

European Medical Students Association General Assembly International Federation of Medical Students’ Associations International Pharmaceutical Students Federation Local Committee Memorandum of Understanding National General Assembly National Member Organization Policy Document Standing Committee Small Working Group Team Of Officials World Health Organization World Medical Association

INTRODUCTION Policy Documents are undoubtedly a key aspect in our Federation’s advocacy efforts and initiatives. By definition they are described as “the position of IFMSA on a global health issue that the Federation wants to take a stance on, which is in line with the IFMSA Vision and Mission and is bound to by its Constitution and Bylaws.” IFMSA develops policy documents to reflect key stances of the Federation on globally relevant topics and all of them are available on the ifmsa webpage (https://ifmsa.org/policy-documents/). Members and students all over the world are invited to take part in this ever evolving process, empowering themselves with knowledge and capacity that can improve their advocacy skills. However, Policy Documents and Policy Making are not only important for IFMSA as a Federation but to NMOs at a National and Local Level. In past terms, a Policy Document overview was developed as the European Toolkit on Policy Making and Usage; However, upon review, we believe that this toolkit should be updated and include a key aspect that is Policy Implementation at an International and National Level. With this update, we aimed at improving this tool, making a more comprehensive resource that NMOs could use at a national level, therefore further increasing theirs our overall advocacy efforts. With all this in mind, the Small Working Group on National and International Policy-Making, Usage and Implementation was created with the following goals:

Reviewing the European Toolkit on Policy Making and Usage

Developing a section on Policy Implementation at an International and National Level

Raise awareness on Members towards the importance of this topic

Build capacity on Policy Making and Implementation amongst students

Finally, we would like to thank all the people that contributed to this toolkit that we hope to be a very comprehensive and helpful tool for NMOs and medical students who are advocating for a better tomorrow and promoting change in the world.

DEFINITIONS Advocacy the most basic meaning of advocacy is to represent, promote, or defend some person(s), interest, or opinion. Such a broad idea encompasses many types of activities such as awareness campaigns and external representation, but the focus of this manual is on the approaches adopted by organizations and coalitions in trying to change or preserve specific government programs, that is, approaches focused on influencing decisions of public policy. In order to distinguish this from other types of advocacy activities, it is often referred to as “policy advocacy.” This is also the term we use throughout the guide to make this distinction clear.

Campaigning a planned group of especially political, business, or military activities that are intended to achieve a particular aim.

Diplomacy the established method of influencing the decisions and behaviour of foreign governments and peoples through dialogue, negotiation, and other measures short of war or violence. Modern diplomatic practices are a product of the post-Renaissance European state system. Historically, diplomacy meant the conduct of official (usually bilateral) relations between sovereign states.

Lobbying any attempt by individuals or private interest groups to influence the decisions of government; in its original meaning it referred to efforts to influence the votes of legislators, generally in the lobby outside the legislative chamber. Lobbying in some form is inevitable in any political system.

Policy a policy often comes in the form of general statements about priorities, written regulations or guidelines, procedures and/or standards to be achieved. At its simplest, policy refers to a distinct path of action which is suitable for the pursuit of desired goals within a particular context, directing the decision making of an organization or individual.

Policy Cycle Policy development is an iterative process, affected by interests, linking a variety of key players (such as institutions, individuals and agencies) through their involvement. In order to understand the policy process itself we can break it into a series of steps.

Policy Document IFMSA Policy Document describes the position of IFMSA on a global health issue that the Federation wants to take a stance on, which is in line with the IFMSA Vision and Mission and is bound to by its Constitution and Bylaws. It is to be used by the relevant IFMSA Team of Officials members within the external and internal activities of IFMSA. Policy documents are approved during the IFMSA General Assembly March Meeting and August Meeting and are valid for a period of three years and/or until their renewal. (https://ifmsa.org/policy-documents/) It is composed of: • Policy Statement • Position Paper

Policy Statement:This first part contains the position of the Federation on the document topic, some background and the information needed to understand the importance of the issue. It consists of: A- Introduction B- IFMSA Position: A paragraph where the stance IFMSA is taking on the matter is made explicit and clear. C- Call to Action: A list of relevant stakeholders and the actions IFMSA asks them to take in order to achieve the goal of the document. They need to be SMART and concrete steps to be taken in the 3 years of the document’s validity. Position Paper: The second part of the document doesn’t have a specified length and contains all the references, scientific data and background analysis supporting the position the Federation is advocating for with a bibliography containing all the papers mentioned. A- Background Information B- Discussion C- Bibliography

Policy Framework a policy framework is a broad set of policies that governs the actions of groups and organizations. The broad set of policies forms a web and impacts new policy development and policy amendments. The presence or absence of a policy affects all other policies within the web (both existing and new).

Policy Makers those who make policies in organizations such as central or local government, multinational companies or local businesses, clinics, or hospitals.

Policy Process the way in which policies are initiated, formulated, developed, negotiated, communicated, implemented and evaluated.

Stakeholders A person, group or organization that has interest or concern in an organization. Stakeholders can affect or be affected by the organization′s actions, objectives and policies. Some examples of key stakeholders are creditors, directors, employees, government (and its agencies), owners (shareholders), suppliers, unions, and the community from which the business draws its resources. However, not all stakeholders are equal. While for some matters, the Dean of your faculty can be the most relevant stakeholder (for example, when addressing Mental Health in the medical curriculum), for others, it can be a professor, a governmental organization or a ministry. For instance in an NMO, some members aren′t satisfied with something happening in the NMO. So they informed the TO and they didn′t consider their complaint. So they can contact the LC Presidents as nearly stakeholders to raise the issue to the NMO TO.

POLICY DOCUMENTS: WHY, HOW AND WHAT WHY? Both in IFMSA and on a national level, Policy Documents reflect the official stance on a defined issue/ topic of importance. They represent the positions of IFMSA and its members on global health related issues and as such, have a primary role in all the advocacy processes of the Federation. Policy Documents allow IFMSA and NMOs to have an official, evidence-based, representative, credible, collective and united opinion of more than 1.3 million medical students on key issues, thereby promoting meaningful youth participation and engagement in global discussions with external organisations and partners. Policy Documents also embody a call to action, engaging stakeholders and addressing what IFMSA, NMOs and health students in general believe they should take action on.

HOW? IFMSA Policy Documents are used by the IFMSA Team of Officials Members within the external and internal activities of the Federation. Nationally, Policy Documents are used by the NMO members to guide the NMO advocacy activities, interaction with external partners and internal work. On both levels, Policy Documents have a fundamental role in three main fields: • External Presence and Consultations: Policy Documents provide the basis for the diverse stances that IFMSA and its members will take on a certain topic, assuring that the statements are realised according to the NMOs’ views and beliefs. They are primarily used to reflect the opinion of the federation in key global meetings, conventions, consultations and processes. • Partnerships: as Policy Documents clearly express call to actions and analyse what various stakeholders should do about precise issues, they represent a guide to IFMSA and its NMOs while establishing new or advancing existing partnerships. • Internal Development: the call to action expressed by Policy Documents regards also the NMOs themselves: it can help them with guiding and implementing their own activities and work. Policy Documents about certain topics ensure that the activities related to the same issues are reflective of the official NMO opinion.

WHAT? Policy Documents need to be precisely developed, structured, implemented and evaluated. • Development: Policy Process and Cycle describe how a Policy Document should be realised. The IFMSA Policy Making process is based on three main pillars: Research, Stakeholder-Analysis and Strategy-Thinking. The Policy Documents of the Federation are structured in two parts: Policy Statement and Position Paper. • Implementation: Policy Documents Implementation Strategies make Policies actually impactful. They’re based on internal and external initiatives like activities, press releases, external meetings and public demonstrations. • Impact Assessment and Evaluation: every Policy Document needs to be monitored and evaluated to ensure the desired impact is achieved and guide its further development and use. Note: Every aspect of these will be addressed in the following paragraphs.

HOW DO WE DEVELOP POLICY DOCUMENTS? An introductory overview of the Policy Process and Cycle

The Policy Process refers to the way in which policies are initiated, formulated, negotiated, communicated, implemented and evaluated, ending up balancing different solutions that address the different aspects of a cluster of problems (1, 3). Policy development is an iterative process, affected by interests, linking a variety of key players (such as institutions, individuals and agencies) through their involvement. In order to understand the policy process itself we can break it into a series of steps. (1, 2, 3, 4).

1. Problem identification and Issue recognition • Needs Assessment • Locate any existing documents within your NMO that will be impacted or that could be amended to address policy gap

2. Policy Formulation and Legitimation • Stakeholder Analysis • Consider consulting Stakeholders on draft document • Consolidate all relevant feedback and redraft document • Write the Policy Document using templates • Identify any legislative or regulatory requirements

3. Policy Implementation

4. Policy Evaluation and Progress monitoring

• Take into account: »»Policy style and political culture »»Organizational Culture »»Context of the problem: timing, range of actors involved, likely targeted audience response • Identify networks of decision-makers and external partners that can support the policy and bring about desired change; • Involve Stakeholders; • Promote public

It is also important to acknowledge the existence of contextual factors that can affect the policy making process, such as:

SITUATIONAL FACTORS also referred to as temporary conditions (e.g. droughts), may influence policy

STRUCTURAL FACTORS

CONTINUOUSLY: FEEDBACK LOOP

these are the relatively unchanging elements of the society (e.g. demographic features, technological advance). They may include the political system, and extent to which it is open or closed and the opportunities for youth to participate in policy discussions and decisions

CULTURAL FACTORS In societies where formal hierarchies are important, it may be difficult to question high officials. The position of ethnic minorities or linguistic differences may lead to certain groups receiving services that do not meet their needs. Religious factors can also affect policy making.

1. PROBLEM IDENTIFICATION AND ISSUE RECOGNITION NEEDS ASSESSMENT It is critical that policies stem from a perceived need/problem either at a national or global level. In the absence of a planned and systematic approach, the allocation of time and resources can be biased and subject to personal preferences, experiences and political pressures. Ending up not fully reflecting the vision of the NMO and its members. A Needs Assessment is a systematic and transparent process that can be used to help to guide strategic decisions and determine priorities, providing valuable guidance for tactical decisions, ensuring that policies are truly responsive to the NMO needs. Furthermore, a Needs Assessment can also provide baseline data (which refers to the initial collection of data which serves as a basis for comparison with the subsequently acquired data) that can be used in the Evaluation Stage (5 ,6 ,7 ,8). What are the benefits to conducting a Needs Assessment? • Better quality and effectiveness of policies through ensuring that they are comprehensive, address the full scope of the issue, relevant and context sensitive; • Evidence-informed approach: the understanding of NMO needs as well as the diverse roots and consequences of the topic provides an evidence-based foundation for a policy; • Support evaluation: through developing an understanding of the status quo regarding an issue as well as NMO needs monitoring and evaluation of the data obtained can help measure whether impact has been achieved; • Stakeholder involvement: Understanding the full scope of the problem is not possible without involving perspectives of those involved or affected. The process of needs assessment can build relationships among stakeholders and build support for action; • Capacity building and empowerment: NMO members involvement a in the policy development process from the beginning is empowering and contributes to building awareness, which is essential for strong advocacy; • Policy Renewal: The needs assessment can be continuously referred to, to ensure that the current policy is specific and addressing the most important needs. An assessment collects information that identifies the various complexities around an identified problem and the gaps between the current situation versus the desired situation. It appraises those needs to determine possible solutions and advocacy priorities. This approach to collecting and analyzing information takes place before the policy process is conducted. Next, are some basic steps that can be included in your plans for a successful needs assessment. We also present you some key questions to guide you during the needs assessment process: • Scope the Needs Assessment: What is the key problem ? What is the purpose of this policy document? Who are we targeting with this policy document ? How will you involve your NMO members? Who will be the decision-makers? • Determine Assessment Criteria: Develop a list of criteria that are meaningful for your context: These criteria will enable you to evaluate and prioritise needs.

• Plan how to collect the information: Identify the data you will need; Whose opinions need to be explored ? Develop a plan/set of questions for collecting the data and accumulate sufficient evidence. Examples: literature review, quantitative or qualitative methods such as surveys or group discussions respectively. • Analyze: Analyze and synthesize the useful information you have collected about the needs; Synthesise and present data to your decision makers (for example to your NMO members). • Decide: Apply the criteria previously defined and prioritize needs; Summarize your recommendations in a needs assessment report. • Identify next steps and report back Identify issues for the prioritised needs: risk/protective factors, causes and consequences; Explore the evidence for effective interventions/approaches; Report on your findings.

2. POLICY FORMULATION AND LEGITIMATION STAKEHOLDER ANALYSIS Policy-makers can use a stakeholder analysis to identify the key actors and to assess their knowledge, interests, positions, alliances, and importance related to the policy. This allows Policy-makers to interact more effectively with key stakeholders and to increase support for a given policy. When this analysis is conducted before a policy is implemented, policy-makers can detect and act to prevent potential misunderstandings about and/or opposition to the policy (4 ,9). Overall, when a stakeholder analysis is used to guide the implementation, the policy is more likely to succeed. What is Stakeholders Analysis? Stakeholder Analysis is a process of systematically gathering and analyzing information to determine whose interests should be taken into account during policy development and implementation. • Primary function: identify all possible partners that might have an interest in your policy topic. This also includes those who contribute to the topic, are affected by it or might (initially) oppose such efforts. • Second function: examine the role and the strengths and weaknesses of each Stakeholder. Next are some key topics: • Stakeholders in a process are actors (persons or organizations) with interest in the policy being promoted, that can be positively or negatively impacted by the outcomes (check the complete definition above). It may be necessary to identify groups within organizations which may have different interests. The idea is to discover independent actors who wield considerable influence while keeping the number sufficiently small to make the analysis manageable. Identifying an initial set of stakeholders can be conducted through a brainstorming session with knowledgeable informants.

• The Analysis includes: knowledge of the policy, interests and expected outcomes related to the policy, position for or against the policy, potential alliances with other stakeholders, and ability to affect the policy process (through power and/or leadership). Particular importance needs to be devoted to individuals or organizations which can either block policy adoption or implementation. Assess the power of each actor. The context will often determine the precise value of any particular Stakeholder. Each actor’s interests, position and level of commitment to a particular policy issue will determine how they will deploy their (political) resources and hence allow you to develop accurate call to actions. • It is important to identify Stakeholders in at least two dimensions: horizontally across sectors and vertically down through the different levels of responsibility and government. Potential Stakeholders include the state and governments at all levels, academics, civil society (non-governmental organizations and not-for-profit entities), Media, formal or informal interest groups and private for-profit entities. After conducting the Analysis decide how to involve your Stakeholders (nature, form and mode of their participation).

STRATEGIES OF POLICY MAKING Many existing models of policy making are increasingly inappropriate in a world of decentralised services and complex policy problems (10). The starting point is that there are certain fundamentals of good policy making which need to be observed in the policy making process, no matter the strategy you adopt: • Clarity on goals; • Open and evidence-based idea generation; • Rigorous policy design/formulation; • Responsive external engagement; • Thorough appraisal; • Clarity on the role of stakeholders and accountabilities; • Establishment of effective mechanisms for feedback and evaluation.

IFMSA POLICY-MAKING PROCESS How does the policy process within IFMSA work? We will give you an overview regarding the IFMSA Policy-Making Process. As NMO, you can adoptIFMSA’s process as an example to develop your own Policy-Making Process within your NMO. For each stage of the IFMSA Policy-Making Process there are deadlines, which are previously defined (some of them are regulated by the IFMSA Constitution and Bylaws). 0. IFMSA Policy Documents

1. IFMSA Policy Documents Coordination

2. IFMSA Members involvement

3. IFMSA Policy Document Drafting

4. IFMSA Policy Document Review and Quality Assurance

5. IFMSA Policy Document Adoption

6. IFMSA Policy Document Expiry and Revision

0. IFMSA Policy Documents Policy topic definition, which is in line with the IFMSA Vision and Mission and is bound to by its Constitution and Bylaws. 1. IFMSA Policy Documents Coordination One coordinator is appointed for each proposed Policy Document. It can be the respective Liaison Officer or appointed IFMSA member. 2. IFMSA Members involvement There are two ways of participating in the IFMSA Policy Making Process: a. Small Working Groups: are open to IFMSA members and they have to work on each proposed Policy Document, after they are selected by the coordinator. b. Policy Commissions work on each proposed Policy Document after the first draft is produced by the SWG and are open to IFMSA members. Once again, they are selected by the coordinator. 3. IFMSA Policy Document Drafting a. The SWG works with the respective Coordinator to draft the IFMSA Policy Document and the draft proposal is shared with all medical students, IFMSA Liaison Officers and NMOs for input. The call for input is sent to NMO, SCs servers. It is also shared on IFMSA Facebook groups. b. During the first round of input, a Call for a Policy Commission is opened to general members and after the members are selected they are responsible for: i. Ensuring that the content of the Policy Document is evidence-based, that the resources are reliable and has no instance of plagiarism ii. Collecting, tracking and incorporating NMO feedback if deemed appropriate and necessary after the call for input 4. IFMSA Policy Document Review and Quality Assurance The Policy Reviewing Committee is a group of people, selected through an open call, before each General Assembly, responsible for reviewing the proposed Policy Document, giving recommendations and highlighting points of improvement. Afterwards, Policy Commissions, in collaboration with NMOs, can propose amendments to the Policy based on these recommendations.

5. IFMSA Policy Document Adoption IFMSA Policy Documents are presented to NMOs and voted upon during IFMSA GA Meetings. If adopted, the Policy Document describes the position of IFMSA on a specific issue and will be the basis that IFMSA will rely on to express its stand. Adopted IFMSA Policy Documents are made available for everyone on https://ifmsa.org/policy-documents/.

6. IFMSA Policy Document Expiry and Revision a. IFMSA Policy Documents expire after 3 years, unless otherwise voted by the General Assembly. b. Re-proposal of IFMSA Policy Documents follows a process that is very similar to drafting a policy. Usually, the starting point for the new IFMSA Policy Document Draft is the original Policy. c. Revision of IFMSA Policy Documents is done regularly by respective officials. In some instances policy documents can be revised and re-adopted before the 3 years interval to ensure constant, up to date evidence and stances.

POLICY DOCUMENTS STRUCTURE IFMSA Policy Documents General Structure

In this section, we will go through an overview of the Policy Document structure in IFMSA. The structure of Policy documents doesn’t make a consensus amongst organisations, each organisation has their own structure, in IFMSA, Policy Documents are organised by two main parts:

Policy Statement The policy statement highlights the position of IFMSA – in other words, the stance of IFMSA. The Policy Statement also has a Call to Action that targets the stakeholders of the topic (some examples are healthcare institutions, non–governmental organizations, etc.). Calls to action specify the measures IFMSA urges the stakeholders to take in the field described in the Policy.

*Requirements for the Policy Statement: The maximum length is 2 pages The statement is comprised of: • Introduction • IFMSA position • Call to Action

Position Paper This part of the policy has supporting arguments from reliable resources in order to provide a better understanding behind the IFMSA position on a certain topic. The Position Paper has three parts: the background, discussion and references.

*Requirements for the Policy Statement: A thorough compilation of supporting evidence; Outside sources must be cited; It must include a bibliography (i.e. the references).

Drafting policy documents can be confusing, each section has its specificities. This table is a walkthrough of the drafting process with the tips and description relevant to each section. Section:

Description:

Policy Statement (not more than 2 pages) Introduction Shortly state the problem/topic to inform the reader, what this policy paper will be about. IFMSA position

General tips: The introduction is objective, in the present and allows any reader to grasp and understand the subject. It briefly presents the subject through a general definition, summarizes the current situation of the topic and its relevance

Highlights IFMSA/NMO The position must be in line with the vision, position and stance on mission and is bound to by its Constitution the topic and Bylaw. It has to be in line with the call to action.

Call to action

Highlights the actions that each stakeholder must take.

The purpose of this part is to provide recommendations and solutions to the issue from the perspective of students/youth. Your recommendations should reinforce important actions, stress on neglected or ongoing actions and point out new ideas for actions that various stakeholders can take to address the problem. It must also be ensured that the majority of the points mentioned are supported by relevant evidence in the position paper. Examples of stakeholders to be addressed are: NonGovernmental Organizations, Governments and Public Institutions, Medical Schools, Local, National or International institutions. However, please note that this is largely dependent on your stakeholder analysis in the previous step.

Position Paper (compiled evidence of considerable length with a bibliography) Background

Discussion

Referencing

Addresses the definitions This part must present to the reader an idea and origins of the topic on the scope of the subject by detailing the addressed. historical references, national and / or global context, and the main actions of the major players. Remember that not all people reading the policy document will be familiar with the topic so this section is essential. Provides a holistic and The Discussion section contains bibliography argumentative narration and resources that support the argument of the key points related you are trying to make. With this said, all the to the topic supported by references you use should be referred to at the compiled evidence. end of the document, by the most convenient method for you: you can use the Vancouver system, for example. This discussion helps to develop the subject further while justifying the policy statement. Donâ&#x20AC;&#x2122;t forget to use inclusive language when drafting. State all the literature you Vancouver system example: each reference is used for the policy paper. assigned an Arabic number according to the You can use the method order of appearance in the text, it is then cited at you see fit. the end of the document as follows: 11. Reference of a scientific article: The first letter of the authorâ&#x20AC;şs name in capital letters / Initial of the capital first name and not followed by a period. Articles must be cited with, in order, the authors, the name of the journal, the year of publication, the volume, the number, the first and the last. (Karimi A, Seddiqui B, Benomar R. How to write a scientific article (J Clin Epid 14( ).33-124 :54 ;1999). 22. References to internet publications should include the full URL and the date of last access (UNICEF. Information by country and program http://www.unicef.org/infobycountry/morocco_ statistic s.html # 87. (Accessed ))2014/10 / 29 15(). 33. The references of a book must include the names of the authors, the title of the book, the city, the name of the publishing house and the year of publication (Bensouda B. Analysis of the Moroccan health system. Casablanca: Marocmed, 16( 2001)

IMPORTANT ALERT:

PLAGIARISM

When developing your Policy Document, the last thing you want to be accused of is plagiarism, which is basically taking someone else›s work or ideas and passing them off as your own. This will not only undermine all your efforts but will also hinder your credibility. While the discussion is based on resources without any form of plagiarism, you should paraphrase, and avoid copying / pasting. Make sure to include the reference and use quotes. With this said, you can use as many references as you want in your document, but make you sure you mention all of them in the Bibliography section. This will not only avoid any kind of accusation of plagiarism but will also make your document more comprehensive, evidence-based and professional. Take a look at this flowchart and online course from Bridgepoint Education (17). Who should make Policy Documents? Two entities within IFMSA can propose a Policy Document: • Members of the IFMSA Team of officials • 2 NMOs from 2 different regions Four entities within IFMSA can draft a Policy Document: • Small Working Groups • International teams • NMOs • Liaison Officers In the drafting process that we will be emphasizing, members are to be involved in every step of the policy making process through: Small Working Groups Small Working Groups are open to IFMSA members and provide the opportunity to gain experience in policy writing. The coordinator for a certain proposed Policy Document can be an appointed IFMSA member with experience in Policy writing. A call for Small Working Group members is shared on IFMSA servers (NMO and SC servers as well as social media groups), the selected members will contribute in every step of the policy drafting process ( Position Paper, the policy statement ….) Policy Commissions When submitting a Policy Document, the proposer needs to appoint a policy commission of individuals who have already accepted the responsibility. A policy commission is composed of three people, with 2 representatives of the NMOs and one Liaison Officer or the VPE. The proposer of the policy is a part of the commission and appoints its members. The call is shared on the NMO server and every member of IFMSA can apply. The members selected to be part of the commission will be responsible of : • Proposing changes with the approval of and after consultation with the proposer to ensure the quality of the Policy Document. An amendment can be incorporated if 2 NMO representatives agree. • Ensuring that the content of the Policy Document is evidence-based, that the resources are reliable and has no instance of plagiarism. • .Collecting, tracking and incorporating NMO feedback if deemed appropriate and necessary after the call for input. • Coordinating the discussion during the General Assembly if needed

Call for inputs After the end of the drafting process ensured by the SWG, the Policy Document will be shared. A call for inputs will be sent to NMO, SCs servers and Facebook groups. IFMSA members will, therefore, have the opportunity to: • Contribute to the Policy Documents submitted • Help to ensure the quality of the Policy Document • Ensure the content is based on global evidence. • Suggest a call/calls for the relevant stakeholders • Contribute to the Position Paper NMOs The most recurrent question asked by members is who should be making and proposing Policy Documents. The answer cannot be one option or one work body, there are different options or combined ones that can be used, no approach is superior or better than the others, and each methodology has its own advantages . Members

Local Committees

The policy making process can be left to the members alone to independently write and propose Policy Documents, but if the members are the only ones taking initiative, it may end up with a paper that only reflects the perspective of a few members, leading to a less inclusive process .

The local committees are the ones responsible for writing and proposing Policy Documents but, similarly to the case of members drafting, it may end up with priorities only reflecting a specific committee’s perspective and risks not representing the organization as a whole .

Team of Officials

Small Working Group

Team of Officials or certain Officials can be responsible for developing Policy Documents. For example, your Standing Committee Officers could be responsible for developing Policy Documents related to the work of their Standing Committee, or have a certain Official be responsible, but again the main disadvantage would be ending up with a top-down approach that will be missing the knowledge and the perspective of the members.

A small working group can include members, Local Committees and representatives of the Team of Officials and is therefore the most inclusive option to develop Policy Documents.

It is primordial to be aware of these different advantages and disadvantages and take them into account when developing the NMO policy making process.

Policy Documents Structure from other Organizations European Medical Students Association (EMSA)[12] • • • •

Executive Summary Definitions Introduction & Background Discussion

• Recommendations • Conclusion • References

Policy : organ donation across Europe You can check more examples here

International Pharmaceutical Students Federation (IPSF)[13] They 5 have different policy-related documents: • Policy statement (Introduction Body Recommandation/call to action) • Joint statement ( Policy statements developed with other organisations ) • Position paper ( They are similar to our policy papers, they aim to briefly describe the issue) • Green papers ( They Describe an issue and the responses that can be generated, they do not include any stance or position) • White papers ( They are the combination of both policy statements and green papers, generating an educational document. They include the position of the organisation and the solutions to the specific issue.)

World Medical Association (WMA) They have shorter policy statements with various structures : • WMA statement on sustainable development: Preambule Policy priorities Recommandations and commitment • WMA Statement on gender equality in medicine: Preambule Recommandations

SHOULD POLICY DOCUMENTS BE BROAD OR SPECIFIC? Since national Policy Documents vary in their structure, you will find that they can be either more broad (for instance tackling all affected groups in one Policy Documents and having a large research part) or specific (for instance, tackling only one affected group or having the policy statement only). There is no single approach, as both broad and specific Policy Documents have their own pros and cons. To make it easier to decide on a beneficial structure for your NMO, the main differences are summed up in the table below:

HAVING BROAD POLICY DOCUMENTS

HAVING SPECIFIC POLICY DOCUMENTS

Easier to tackle an issue with covering all of its different aspects

The stance of your organization is clearer, as the document is very focused on a few aspects of an issue

Easier to create policy briefs, as the specific concept you need will probably be covered in the document

Less work needed to create a policy brief, but the specific topic you need may not be in the policy document

Harder to keep information updated as time passes

Easier to keep information updated as time passes

Takes more time to do research and draft

A larger number of different Policy Documents are needed to address different issues

Can have a larger number of stakeholders in call to action

Can have a smaller number of stakeholders in call to action

INPUTS, FEEDBACKS AND ADOPTING PROCESS Policy documents are supposed to represent the voice of all members of an association. Therefore, it is really important that during their writing process the consultation of members is constant and that their inputs are taken into consideration. IFMSA has its strategies for members› involvement (SWGs, Policy Commissions, NMO inputs) allowing everyone to make changes and improve the final document. Often, general members don’t have easy access to IFMSA platforms or may feel they aren’t supposed to give inputs to IFMSA Policies. It is then the duty of NMO Presidents and NMO Representatives to share the calls and submissions with their members and explain the relevance of anyone’s involvement. Also, respecting timelines and sharing amendments before the General Assemblies may allow both other NMOs and TO to read them and make an informed decision about them. At a national level it is just as important to have all members involved in the process of developing new Policy Documents or renovating expiring ones. Many NMOs have detailed strategies in the Bylaws and Regulations about the steps that a Proposal needs to go through before being approved. In the following few points, we’re highlighting some possible ways to have as many members as possible involved in your national work. These are just some tips and recommendations, and we advise you to adapt them to your needs and context. Policy Documents Topic Consultation The start of it all. When it comes to deciding on which topics you are going to work on, it might be useful to consult your LCs or general members to see whether they support the ones you selected or have other proposals. Your bylaws may require for you to align your Policy Documents to your National Priorities or NMO Strategy, so always make sure that your proposals respect the needs of your NMO, the requirements of your regulations and the will of your members

Small Working Groups/Task Forces The actual workforce of the document. Having a group of active members concretely working in the writing and developing of the draft under the supervision of a TO Representative is most of the times the easiest way to improve the quality of the document, to build the capacity of the participants, to reduce the workload of National Officers and generally involve members

Call for input and submission timeline Once your draft proposal is ready, it is recommended to share it with your members way before the voting will happen. That’s to allow them to read your document carefully, give their inputs or submit their amendments and make an overall well informed decision when approving the new Policy Document. Since Policy Documents are the backbone of an NMO political and external work, it is preferable to have a discussion that leads to a final solution shared by as many members as possible than a document approved with no real participation from them! So whether you’re a TO member, a LC President or a general member, never refrain from making your voice heard: those Policy Documents are speaking also on your behalf

Webinars and Policy Document Sessions To further build your members’ capacity both on Policy Documents in general and on the specific topics you decided to work on, it can be useful to organize some webinars/OLMs to discuss them together, introduce your proposals and collect the feedback members have on the Documents. Also, if you’re voting on your Policy Proposals during your NGA, it might be beneficial to have a session before the voting to finalize any last minute amendments and resolve remaining doubts.

Now your proposal is ready, it has been presented, discussed and amended, what is left is for you to have it approved! There are various ways you can have your motions and documents voted upon according to your national bylaws and regulation, but the most common is a vote during a plenary in the NGA, just as IFMSA does in its General Assemblies. Policy Documents have to represent the vast majority of your Organization, therefore they are usually approved with a reinforced voting majority of two thirds. This allows you to be sure most of you members are backing your stances and are agreeing with your position. Why not require unanimity, then? Even though having a nemo contra on a policy is surely something to wish for, it can sometimes be really hard to have the totality of your members agreeing. That would mean that any vote against your proposal basically has the veto power to the direct negatives.

3. POLICY IMPLEMENTATION The end goal of developing a Policy Document is about more than just providing a document, but it is also about offering an opportunity to create an impact and to promote change. In fact, it is paramount to develop Implementation Strategies, which are basically a plan with a set of initiatives and objectives revolving around concretely implementing your Policy Document. In order to make sure that you manage to develop a comprehensive strategy and that all the efforts you put into developing the Policy Document are impactful, you should draft your plan based on two main pillars: Internal Initiatives, with a focus on your members, and External Initiatives, with a focus on stakeholders, external partners and the general public.

INTERNAL INITIATIVES Having the interest of members in mind, all the while working towards ensuring capacity building opportunities, Policy Documents are paramount to ensure the success of these internal initiatives. Workshops and trainings In the efforts to ensure that members grasp first hand the policy making process, many IFMSA workshops offer participants the chance to learn more on how to draft Policy Documents and highlight their importance in the advocacy work related to the particular workshopâ&#x20AC;˛s topic. Training sessions on an NMO level are also valued in order to ensure that more members are knowledgeable regarding policy making usage and implementation.

IFMSA/NMO Strategies and Priorities In the hopes of aligning the NMOs or IFMSAâ&#x20AC;&#x2122;s strategies with their own priorities, Policy Documents can come in handy. In fact, they represent one aspect of the implementation of these strategies in order to reach the specific goals already set.

Membersâ&#x20AC;&#x2122; involvement Involving the members in the Policy Document process is not only beneficial to their personal growth and knowledge regarding the general Policy Document process and its final aim but it also the best way to represent the views of all the members, making the document as representative as possible.

EXTERNAL INITIATIVES As previously mentioned, Policy Documents are particularly important for external initiatives: from external meetings, to creating partnerships and to developing campaigns. Ultimately, the goal of a Policy Document is to advocate for a particular topic, to promote change and to have an impact on the decision-making process. External Meetings As stated, a Policy Document represents the stance of a group of people or of an organization regarding a particular matter. In the case of IFMSA, Policy Documents represent a key tool used by Officials during external meetings that portray IFMSA and National Member Organizationâ&#x20AC;&#x2122;s beliefs and stances. Without Policy Documents, approved at General Assemblies by members, Officials would not be able to reflect the holistic and evidence backed stances representative of all medical students and could state things that are not what medical students stand or fight for during external events.

Campaigns and Media Advocacy Media advocacy can be defined as a strategic use of mass media (social media networks, newspapers, television, radio) to advance public policy initiatives. When developing your campaigns on any of these platforms, a Policy Document can be an instrumental tool. For example, they can be very helpful when developing press releases, giving interviews, writing articles for newspapers and journals. Taking advantage of all the research and bibliography you searched for, you can develop evidence-based campaigns with the goal of spreading your message, reaching new partners and raising awareness amongst members and the general public.

Partnerships When developing a Policy Document, part of the process is the stakeholder mapping, knowing who has a stake on the topic and might be interested in supporting and partnering with you. Furthermore, if you decide to include a Call to Action, you already have a clear set of goals in your agenda to achieve. Taking into consideration your goals and the stakeholders related to the topic of your Policy Document, one of the things you can do is establishing partnerships with stakeholders that can support your advocacy efforts and increase the overall impact of your advocacy efforts.

Public Consultations Throughout the year, stakeholders such as the World Health Assembly, United Nations and European Commission conduct public consultations in order to get the public and organizations views and stances. With this in mind, you can look for national and international consultations, further increasing the reach of your Policy Documents and of your advocacy initiatives.

4. POLICY EVALUATION In this chapter, we will address how assessing the impact of your Policy Documents is an important part of implementation. Keep in mind that this is always an ongoing process orcycle - you need to monitor and evaluate the situation in order to adapt your efforts to achieve maximum impact.

EVALUATION VS. MONITORING There is no single way to assess impact. In this section, we will briefly summarize monitoring and evaluation and the steps to take in assessments. Before you start coming up with an assessment plan, here are some questions to ask [1] : • What are the goals for the policy? • Who are the beneficiaries of this policy? • What kind of information do I need to assess the impact of the policy? Do I need to collect it myself or is there pre - existing evidence that could assist in the evaluation? • Is there an opportunity to add to an existing evidence base? • How can I involve stakeholders in the assessment process? Evaluation and monitoring are necessary for the success of a policy and are recognized as a key part of the policy cycle. It is important to note that although similar in practice, the concepts of evaluation in monitoring are different. Monitoring is a regular process of collecting data during the implementation, analysing the progress of the implementation plan against the indicators put forward and it can be used to take action or make changes in the present moment to our plan.

Meanwhile, evaluation is focused more on a comprehensive review of compiled data, comparison to baseline data and identifying what has been achieved or not to guide strategic planning. Unlike monitoring, which is a continuous process, evaluation is a checkpoint, ie: is done at allocated times. The purpose behind evaluation is to make sure that the issues identified in the policy are addressed. Both monitoring and evaluation are vital to learn lessons as well as adapt to changing situations (2).

E.g. monitoring would be done periodically after the adoption of the policy and evaluation would be done before the Policy Document expires. Evaluation would allow you to know if the Policy Document has achieved its impact and is still relevant; meanwhile, monitoring would allow you to refine advocacy strategies based on different opportunities as they are constantly changing. Next we describe the evaluation framework used in assessing the impact of Policy Documents. Keep in mind that this is not the same thing as a Needs Assessment done before drafting the document (as mentioned above) but rather evaluating how the Policy Documents contribute to change in regards to the issues the document focuses on.

THE EVALUATION FRAMEWORK There are five key steps to monitoring and evaluation (2):

ORIENTATION The preparatory phase where you identify why and what should be evaluated in order to measure the impact of the policy. Having specific goals for your policy implementation process is vital, as it shapes the rest of the steps of evaluation. Moreover, it is important to assign a unit or individual that will be responsible for the evaluation process. Having a baseline assessment of the current situation is also extremely useful, as it allows you to evaluate your impact in a comparative manner (e.g. knowing if medical schools in your country address LGBTQIA+ needs in the medical curricula).

DEFINITION OF INDICATORS Indicators of success are concrete criteria that, in this case, showcase the impact of the policy. They should be concrete, clearly stated and bound in a specific timeframe. Indicators can be qualitative (e.g. The policy has reached the relevant ministry, conducting new legislation) and quantitative (e.g. the number of actions taken by the stakeholders) depending on the things you want to achieve in implementing your policy. They can range from simply defining on where and how many times you want to use the Policy Document (e.g. the addressing LGBTQIA+ needs in healthcare Policy Document is used in at least one nationally relevant meeting) to the impact you want to see depending on a certain call to action (e.g. at least 3 medical schools add LGBTQIA+ needs in the curricula in the span of 2 years).

DATA COLLECTION This step is done depending on the available resources, accessibility of data and the frequency of how often the data needs to be collected. Data collection can be primary (i.e. conducting your own research) or secondary (using already existing data conducted by other parties through a review of literature). For example, you could collect input from the medical students regarding the quality of LGBTQIA+ needs being addressed in the curricula

ANALYZING THE DATA This is where your indicators of success come in. While looking over the data collected, you have to reflect on the progress or its insufficiency. Identify the “why’s” behind both achieved goals and the ones that are not doing so well. Ask yourself what action was taken and how it can be improved; identify whether there are gaps in your policy that are not addressing certain issues. For example, if your survey showed that the medical curricula did not include the mental health of LGBTQIA+ individuals, this could be specified in a call to action when you re - adopt your Policy Document.

TAKING FURTHER ACTION Action starts with a concise report of your findings in the steps mentioned above. This can later be used to propose specific changes to your policy (e.g. adding a new call to action or removing irrelevant information) and implementation process as well as practice organisational learning.

Examples for tracking how you implement your Policy Documents: • Mark down meetings where the Policy Document was used • Write down the press releases, campaigns where the Policy Document was used • Marking down internal efforts that had benefit from the Policy Document (i.e. capacity building events and activities) • Don’t forget to summarize all of this data at the end of your term! While drafting your Policy Documents, you should always keep in mind its impact and implementation, Policy Documents being a tool to achieve a goal, not an end. Now that you know more about evaluation strategies and monitoring, here is a walkthrough towards two approaches aiming to improve policy and Policy Documents implementations, by closing the gap between the Policy Documents goals and their impact (11). Top-down

Scale

Common ground

Tips to succeed

Con’s

From international, governmental scale to local governmental and non-governmental level

• • • •

Bottom-up From local governmental nongovernmental level to international, governmental scale

Define your objectives Define the stakeholders (central and subordinate scale) Define your implementation process Evaluate your impact by the end of the validity of the

• Structured Policy Document and • Satisfy local decision-maker clear objectives and actors to ensure the • Defined adequate actions to implementation of policy implement the Policy Document • Include local actors in the policy • Support from local actors and elaboration stakeholders • Too much weight and responsibilities to the central decision makers • Less accurate evaluation • No specific responsible • Can be unrealistic

• Losing the balance between central and local actors • Smaller impact

When evaluating your Policy Documents, you can use the 5 dimensions of impact :

CHALLENGES AND RECOMMENDATIONS Policy Documents and their overall process are not as simple as they may seem. There’s many things that can go wrong that you may need to proactively consider and avoid.. Here’s a list of possible struggles you could be facing both while writing your Policy Documents and implementing them:

LACK OF MEMBERS INVOLVEMENT Members’ Involvement is one of the key elements in all this process, from developing the Policy Document and getting their input and feedback to implementing the document in your internal and external initiatives. There are a number of reasons for this lack of involvement: • Members are not aware of the process or don’t know how to be involved; • Members are afraid of giving their input or don’t think they are knowledgeable enough; • Members do not feel their involvement can be impactful; • Members don’t understand how they can contribute to the implementation. Evidently, there is not a short-term one fits all solution, however, there are a number of initiatives that you can develop to increase members involvement: • Develop capacity building initiatives, such as workshops and trainings, that tackle Policy Documents and Policy Making, empowering and raising awareness on your Members about this topic; • Promote raising awareness campaigns, focusing on the timelines and regulations of developing Policy Document and providing input; • Develop joint campaigns with your members, collaborating with your Local Committees, when promoting and implementing the Policy Document. Assure you establish an impact assessment framework of your Policy Documents and present to your Members how and when do you use them and what is the impact; As previously said, there is not a single initiative that can increase members› involvement and the results of your efforts can take some time, however, all of these initiatives can help you reach your goals.

LACK OF RESOURCES OR BACKGROUND DATA As previously mentioned, when developing your Policy Document, a key step is looking and searching for evidence in literature, data and overall resources to support your statement. It is important for you to balance international and national data, trying to focus your Policy Document to your national setting, however, sometimes, and especially at a national level, this data is not available or doesn’t exist at all, which can undermine your advocacy efforts. For example, you are advocating at a national level for the importance of a comprehensive mental health strategy targeting medical students and physicians, but you don’t have any articles in literature referring to your own country. Although having data on the international level is relevant, national data can further support your advocacy strategy. But what can you do when you don′t have any? 11. Develop your own research: although this can be a difficult task, try to design your own study that can be scientifically validated, with the help of professors, doctors and researchers. For example, you need data on the mental health status of medical students. With the help of a professor you can develop your own questionnaire and ask medical students to fill it. Afterwards, you can use that data to support your Policy Document and your statement.

22. Partner with stakeholders that work on the same topic: when looking for data at a national level, you will probably find some organization working on it. Partnering with an organization working on the same topics can be the start of a fruitful collaboration where, for example, you can develop some studies together. 33. Talk to the Deans or someone in your University/ Faculty to develop their own research: finally, another option is talking to your deans and raise awareness on the importance of developing a comprehensive study on the topic you are tackling. This can have two major outcomes: from one side, you are collecting data with the help of experts, from another side you are already advocating on the topic and raising awareness on it among your deans.

UNRESPONSIVE STAKEHOLDERS Stakeholders are not always easily accessible nor quick to respond to your inputs. It is important to develop personalized strategies for each one of them, adapting the way you interact with your targets to their structure, communication channels and overall responsiveness. One important tool you have is stakeholder analysis. There are various ways you can conduct this analysis, but all of them utilize three criteria: • How much power a stakeholder has • How much can they contribute to your advocacy efforts? • How accessible they are These three factors will give you a general idea of how to approach your stakeholders. If, after you tried to contact them, they still don’t seem to be giving you any feedback, you can think of various way to overcome being stuck: • Get some allies: you can reach your stakeholders - especially political ones (ministries, deputies, law makers) - having someone else introduce you to them. Some of your partners that have previously collaborated with them, one of your contacts, anyone that can get you in touch with your stakeholders will do! • Find opportunities: go to conferences, meetings, public hearings, anywhere you can meet your stakeholders and introduce yourself and your organization to them. A handshake is sometimes more valuable than a thousand emails! When informally meeting a stakeholder it is important to be concise and straight to the point, bringing with you a copy of your Policy Document and your business cards for them to read an contact you afterwards; • Go public: social media campaigns and press releases are your best weapon! Make your stances known and public, spread them around and make sure to reach as many outlets as possible, as this would proportionally increase the opportunities to be noticed by the stakeholders you are aiming to.

QUESTIONABLE IMPACT OR LACK OF IMPACT When implementing a Policy Document through external and internal initiatives (see chapter X), sometimes it’s hard to highlight what kind of impact they have or if they have any impact at all, despite your efforts. In fact this can happen a lot of times and once again it is not easy to provide one solution to this problem. Here is a list that could however help you tackle this issue: • Develop an Impact Evaluation Framework that can help you and your Members see your impact; • Discuss what went wrong with your Implementation Plan and brainstorm new strategies on how you implement your Policy Document; Assess your stakeholders and look for new ones that you can partner with; Develop a campaign focused on not only medical students but the general public, raising their awareness on the topic you address in your Policy Document; • Make sure you and your members continue to be motivated despite the struggles you are facing.

CONTACTS

If you have any question or need any assistance, feel free to contact the following:

External Affairs International Team Vice President for External Affairs vpe@ifmsa.org

Policy Assistant pa.ea@ifmsa.org

General Assistant ga.ea@ifmsa.org

Capacity Building Assistant cb.ea@ifmsa.org

Regional Assistant for EMR ra.ea.emr@ifmsa.org

Regional Assistant for Asia-Pacific ra.ea.asiapacific@ifmsa.org

Regional Assistant for Europe ra.ea.europe@ifmsa.org

Regional Assistant for Africa ra.ea.africa@ifmsa.org

Regional Assistant for Americas ra.ea.americas@ifmsa.org

Liaison Officers Liaison Officer to WHO lwho@ifmsa.org

Liaison Officer for Medical Education

Liaison Officer to Student Organisations loso@ifmsa.org

Liaison Officer for Sexual and Reproductive Health and Right Issues, incl. HIV and AIDS

Liaison Officer for Public Health lph@ifmsa.org

Liaison Officer for Human Rights and Peace lrp@ifmsa.org

lme@ifmsa.org

lra@ifmsa.org

Regional Directors Regional Director for EMR rdemr@ifmsa.org

Regional Director for Asia-Pacific rdasiapacific@ifmsa.org

Regional Director for Europe rdeurope@ifmsa.org

Regional Director for Africa rdafrica@ifmsa.org

Regional Director for Americas rdamericas@ifmsa.org

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