Network Policy Making within the Turkish Health Sector: Becoming Collaborative

This book is aimed at extending the study of network collaboration beyond the context of advanced democracies through the exploration of policy networks in Turkey – a country with statist policy style and authoritarian political culture. The focus here will be on cross-sectoral collaboration taking place within the Turkish health sector – a policy area that has been steadily improving with the initiation of the Health Transformation Programme (HTP) in 2003. To date, many scholars have studied the outcomes of the HTP reforms on the healthcare system including indicators such as healthcare access, health insurance coverage and healthcare services. However, despite the transformative nature of the program, a limited number of studies have assessed the impact of HTP reforms on changing policy and governance patterns in Turkey. Considering this gap in the literature, the aim of this book is to empirically examine the context, capacity and consequences of cross-sectoral collaboration within the health sector in Turkey through a micro- and meso-level investigation of policy networks developed in the sub-areas of public health, medical industry, and health tourism covering the years between 2011 and 2015. Furthermore, this book provides an account of those factors that impede cross-sectoral arrangements from turning into venues of policy collaboration. Such juxtaposition is designed to enhance the understanding of policy networks as conceptual devices and practical tools of collaboration in public policy.

This chapter provides a comprehensive, yet, concise overview of the existing debates on policy networks. The aim of the chapter is to identify those mechanisms that encourage network collaboration among several stakeholders with different motivations, interests, and preferences throughout different stages of policy making from agenda setting to policy evaluation. A systematic review of previous studies on policy networks across various countries highlights the achievements and missing links in the literature, and at the same time, reveals three sets of causal mechanisms, which are crucial to understand Network Collaborative Capacity (NCC) along the structural, relational, and institutional dimensions. Structural and relational mechanisms explain the internal dynamics of a policy network; whereas institutional mechanisms consist of all those external factors in the broader political and economic environment within which the network is embedded. Structural, relational, and institutional mechanisms are further classified into constituting elements that serve as a blueprint for organizing and managing collaborative efforts at the network level. Ultimately this chapter contributes to the existing governance debates by offering an integrated framework for the study of NCC across country cases and policy sectors. Turkish health sector represents a case study to assess the applicability of this framework beyond the context of advanced industrialized economies and democracies with a tradition in collaborative policy making. Finally, the added value of comparative network analysis at the national and sub-national levels will be discussed.

This chapter investigates the origins of cross-sectoral collaboration by exploring when and why policy networks form within the Turkish health sector – a least likely case for network formation. The analysis presented here draws on information collected from a number of official documents, semi-structured interviews with professional experts, and two multi-stakeholder meetings. Timewise, networks entered the policy jargon during the introduction of the Health Transformation Program in 2003. Yet, the years between 2011 and 2015 were ground-breaking in producing concrete cross-sectoral collaborative instruments of policy making. The findings of the analysis reveal that policy networks form as a result of central government’s choice to devolve responsibility and expand the policy space with new issues and actors. Moreover, policy networks emerge not only during the times of policy change which has a reactionary, abrupt, and nature but also during the times of policy stability and legitimacy. These contextual factors are crucial in maintaining an atmosphere of trust among stakeholders, particularly between state and non-state actors. The refugee crisis and spreading securitization discourse in the post-2015 period explain the shifting policy and political agenda leading to public sector retrenchment from cross-sectoral projects within the field of health. This chapter intends to contribute to the literature of comparative public policy by examining the link between policy networks and policy change in addition to adding to the debates on network governance by exploring the processes of network formation. Finally, this chapter contributes to Turkish studies by examining the process of network formation within the Turkish health sector.

This chapter examines factors that maximize collaboration among various stakeholders with the purpose of health policy making in Turkey. The field research reveals that policy networks have been formed in the sub-areas of public health, healthcare construction, and health tourism in the years between 2011 and 2015. Content analysis of 24 semi-structured interviews with policy and professional experts is conducted to assess Network Collaborative Capacity, built upon three dimensions, namely, structural, relational, and institutional. The findings reveal that networks differ in their capacity to collaborate as well as their impact on policy making resulting in three distinct models of network policy making. In the cases under investigation, network impact takes the form of (a) policy innovation through expertise sharing and evidence-based policy making associated with particularly high levels of relational capacity; (b) policy effectiveness through contract enforcement within a clear legal framework associated with particularly high levels of institutional capacity; and (c) policy coherence through organizational-knowledge-sharing and actor coordination. Findings also suggest that institutionalization in the form of network embeddedness in the surrounding political and economic environment is crucial for maintaining a collaborative momentum as well as achieving policy effectiveness at the stage of policy implementation. Based on these findings, further studies should focus on the institutionalization of policy networks, particularly in those middle-income countries such as Turkey that aim and often fail to address various policy challenges through short-lived practices of multi-stakeholder action. Finally, this study emphasizes the importance of incorporating neo-institutional approaches to network analysis.

While Chapter 3 highlights contextual conditions that foster the formation of policy networks, Chapter 5 highlights contextual conditions that impede the formation of policy networks. The overarching question of this chapter is the following: What are the factors that hinder cross-sectoral arrangements from becoming collaborative in complex policy settings such as low- and middle-income countries with a tradition in centralized policy making? In an attempt to address this question, this study provides a detailed assessment of all cross-sectoral arrangements within the Turkish health sector focusing on the post-2003 period. Within this framework, three types of networks will be examined including (a) consultative networks where stakeholders come together primarily to legitimize certain government policies within national level health policy platforms; (b) cluster networks where stakeholder interaction falls short of becoming collaborative due to diverging interests and persistent competition at the regional level; and (c) patronage networks where governmental actors and a selected number of NGOs linked by clientelism serve as a bridge between the ruling party and its constituency at the community level. Unlike policy networks, these actor constellations observed at different levels of governance do not serve the purpose of policy collaboration. On the contrary, they have the potential to trigger politicization, fragmentation, and even polarization at the social level, especially through the distribution of selective benefits. Ultimately, this chapter aims to rise to the challenge of policy collaboration by assessing the impediments to network collaboration based on insights from the Turkish case.

This study is an attempt to (a) introduce Turkey as a country case with statist policy tradition and authoritarian political culture, yet, a growing importance of cross-sectoral collaboration in various policy areas, as an opportunity to conduct network research beyond advanced democracies (Chapter 1); (b) develop an integrated framework for the study of policy networks across country cases and policy settings at the sub-national level through the utilization of Network Collaborative Capacity Index (Chapter 2); (c) trace the contextual conditions that led to the formation of policy networks within the health sector from 2011 to 2015 in Turkey (Chapter 3); (d) examine those mechanisms that maximize collaboration along the structural, relational, and institutional dimensions of networks (Chapter 4); and (d) assess the cultural and structural impediments that inhibit cross-sectoral arrangements from becoming collaborative and influencing policy processes and outcomes (Chapter 5). This concluding chapter focuses on the theoretical significance as well as the practical effectiveness of the policy networks under consideration in an attempt to link the local practice of network collaboration with more general theories of governance.