How and why policy-practice gaps come about: a South African Universal Health Coverage context
# Background South Africa, like many other countries is currently piloting National Health Insurance (NHI) reforms aimed at achieving Universal Health Coverage (UHC). Existing health policy implementation experience has demonstrated that new policies have sometimes generated unexpected and negative...
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| Format: | Article |
| Language: | English |
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Inishmore Laser Scientific Publishing Ltd
2019-12-01
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| Series: | Journal of Global Health Reports |
| Online Access: | https://doi.org/10.29392/joghr.3.e2019069 |
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| author | Janet Michel Natsayi Chimbindi Nthabiseng Mohlakoana Marsha Orgill Till Bärnighausen Brigit Obrist Fabrizio Tediosi David Evans Di McIntryre Hans T Bressers Marcel Tanner |
| author_facet | Janet Michel Natsayi Chimbindi Nthabiseng Mohlakoana Marsha Orgill Till Bärnighausen Brigit Obrist Fabrizio Tediosi David Evans Di McIntryre Hans T Bressers Marcel Tanner |
| author_sort | Janet Michel |
| collection | DOAJ |
| description | # Background
South Africa, like many other countries is currently piloting National Health Insurance (NHI) reforms aimed at achieving Universal Health Coverage (UHC). Existing health policy implementation experience has demonstrated that new policies have sometimes generated unexpected and negative outcomes without necessarily explaining how these came about. Policies are not always implemented as envisioned, hence the importance of understanding the nature of policy implementation.
# Methods
Qualitative data were collected during three phases: 2011-2012 (contextual mapping), 2013-2014 (phase 1) and 2015 (phase 2). In-depth face-to-face interviews were held with key informants (n=71) using a theory of change interview guide, adapted for each phase. Key informants ranged from provincial actors (policy makers) district, subdistrict and primary health care (PHC) facility actors (policy implementers). All interviews were audio-recorded and transcribed. An iterative, inductive and deductive data analysis approach was utilized. Transcripts were coded with the aid of MAXQDA2018 (VERBI software GmbH, Germany).
# Results
Five groups of factors bringing about policy-practice gaps were identified. (i) Primary factors stemming from a direct lack of a critical component for policy implementation, tangible or intangible (resources, information, motivation, power); (ii) secondary factors stemming from a lack of efficient processes or systems (budget processes, limited financial delegations, top down directives, communication channels, supply chain processes, ineffective supervision and performance management systems); (iii) tertiary factors stemming from human factors (perception and cognition) and calculated human responses to a lack of primary, secondary and or extraneous factors, as coping mechanisms (ideal reporting and audit driven compliance with core standards); (iv) extraneous factors stemming from beyond the health system (national vocational training leading to national shortage of plumbers); and (v) an overall lack of systems thinking.
# Conclusions
South Africa needs to be applauded for adopting UHC. Noteworthy among factors fueling policy-practice gaps are human factors, perception and responses of actors in the system to a lack of resources, processes and systems, through among others, ideal reporting and audit driven compliance with core standards, bringing about an additional layer of unintended consequences, further widening that gap. Utilizing a systems approach to address challenges identified, could go a long way in making UHC a reality. |
| format | Article |
| id | doaj-art-63feb5a6d9fb4229a8b214a42df3e6c5 |
| institution | Kabale University |
| issn | 2399-1623 |
| language | English |
| publishDate | 2019-12-01 |
| publisher | Inishmore Laser Scientific Publishing Ltd |
| record_format | Article |
| series | Journal of Global Health Reports |
| spelling | doaj-art-63feb5a6d9fb4229a8b214a42df3e6c52025-08-20T03:45:27ZengInishmore Laser Scientific Publishing LtdJournal of Global Health Reports2399-16232019-12-01310.29392/joghr.3.e2019069How and why policy-practice gaps come about: a South African Universal Health Coverage contextJanet MichelNatsayi ChimbindiNthabiseng MohlakoanaMarsha OrgillTill BärnighausenBrigit ObristFabrizio TediosiDavid EvansDi McIntryreHans T BressersMarcel Tanner# Background South Africa, like many other countries is currently piloting National Health Insurance (NHI) reforms aimed at achieving Universal Health Coverage (UHC). Existing health policy implementation experience has demonstrated that new policies have sometimes generated unexpected and negative outcomes without necessarily explaining how these came about. Policies are not always implemented as envisioned, hence the importance of understanding the nature of policy implementation. # Methods Qualitative data were collected during three phases: 2011-2012 (contextual mapping), 2013-2014 (phase 1) and 2015 (phase 2). In-depth face-to-face interviews were held with key informants (n=71) using a theory of change interview guide, adapted for each phase. Key informants ranged from provincial actors (policy makers) district, subdistrict and primary health care (PHC) facility actors (policy implementers). All interviews were audio-recorded and transcribed. An iterative, inductive and deductive data analysis approach was utilized. Transcripts were coded with the aid of MAXQDA2018 (VERBI software GmbH, Germany). # Results Five groups of factors bringing about policy-practice gaps were identified. (i) Primary factors stemming from a direct lack of a critical component for policy implementation, tangible or intangible (resources, information, motivation, power); (ii) secondary factors stemming from a lack of efficient processes or systems (budget processes, limited financial delegations, top down directives, communication channels, supply chain processes, ineffective supervision and performance management systems); (iii) tertiary factors stemming from human factors (perception and cognition) and calculated human responses to a lack of primary, secondary and or extraneous factors, as coping mechanisms (ideal reporting and audit driven compliance with core standards); (iv) extraneous factors stemming from beyond the health system (national vocational training leading to national shortage of plumbers); and (v) an overall lack of systems thinking. # Conclusions South Africa needs to be applauded for adopting UHC. Noteworthy among factors fueling policy-practice gaps are human factors, perception and responses of actors in the system to a lack of resources, processes and systems, through among others, ideal reporting and audit driven compliance with core standards, bringing about an additional layer of unintended consequences, further widening that gap. Utilizing a systems approach to address challenges identified, could go a long way in making UHC a reality.https://doi.org/10.29392/joghr.3.e2019069 |
| spellingShingle | Janet Michel Natsayi Chimbindi Nthabiseng Mohlakoana Marsha Orgill Till Bärnighausen Brigit Obrist Fabrizio Tediosi David Evans Di McIntryre Hans T Bressers Marcel Tanner How and why policy-practice gaps come about: a South African Universal Health Coverage context Journal of Global Health Reports |
| title | How and why policy-practice gaps come about: a South African Universal Health Coverage context |
| title_full | How and why policy-practice gaps come about: a South African Universal Health Coverage context |
| title_fullStr | How and why policy-practice gaps come about: a South African Universal Health Coverage context |
| title_full_unstemmed | How and why policy-practice gaps come about: a South African Universal Health Coverage context |
| title_short | How and why policy-practice gaps come about: a South African Universal Health Coverage context |
| title_sort | how and why policy practice gaps come about a south african universal health coverage context |
| url | https://doi.org/10.29392/joghr.3.e2019069 |
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