Introduction
Policy breakdown is a critical concern that most researchers, policy makers, and mangers have been focusing on in most organizations. Most researchers do not point out clearly why some organizational policies fail.[1]Ineffectiveness in policy execution in health sectors negatively impacts the lives of human beings in the bracket. The work of Kaplan and Bush marked the beginning of research into policies, with more weight given to policy implementation.[2] Well-formulated plans only fail when there is substantiation of poor effecting. A handicapped policy implementation is due to what is termed to as “missing links” during policy psychoanalysis. Therefore, there is an urgent need to importantly understand issues behind every policy failure.
Nature of Policy Problem
Poor strategy execution in critical sectors such as education, health, sanitation, energy supply, and security directly affects the population under concern and restructures the social-economic lifestyle negatively.[3]The provision of these basic but essential services improves their living standards. In the effort of translating health policy into practice, the aspect of service delivery becomes a major concern. Inefficient service delivery, especially in the third world countries, is a major setback in health sector development.[4] For these reasons, international organizations such as the World Health Organization (WHO), World Bank, and the Inter-American Development Bank (IDB) have chipped in with a stressing factor on how to improve the provision of essential services, especially in health sectors, to the public at large.[5] According to the World Health Organization, failing in delivering quantity and quality of services is a major hindrance in achieving Millennium Development Goals (MDGS).[6] Most international organizations have, therefore, made an appeal to all governments in concern, to make a step and address appropriate health service delivery since it directly impactsthe well-being of the people. Using evidence from Kings Fund case studies in Australia, Torbay (UK) and Netherlands, this paper seeks to critically illustrate, analyze, and discuss the key factors involved in the translation of health policy into practice successfully.
To reduce child mortality rates, improve mother’s health, battle with killer diseases such HIV/AIDS, and malaria, implementation of health care policies should be made easy.[7] The positive impacts of health reforms involve the incorporated and excellently performing health systems and also the ability of patients to get qualitative service delivery at any time of need. For instance, in Australia, according to the King’s Fund report by Goodwin, Dixon, Anderson and Wodchis, the health policy on the care of elderly is well-implemented through the help of the federal government.[8] Availability of community nursing services as part of the hospital care services have been made it easy in delivering services to over 65 years old both able and disabled. The Australian government has financially helped the funding of home-based health services for the aged, providing substantial long-term care and also giving pensions. Strategies to motivate caregivers have also been enumerated hence ensuring smooth workflow the health sector. This is a perfect example of how the government is a key factor in implementing health policies.
Health Insurance schemes are also critical factors in aid of policy implementation.[9] According to Goodwin et al., Netherlands has successfully provided integrated care for elderly people with complications, through a compulsory subscription to national insurance scheme. People are stimulated to hand fully contribute some insurance premiums that will curb short term and also long term medical complications. This policy has been successful in that assessment of individuals has been carried out easily and determination of hours and type of special care branded.[10] This is a clear indication that health insurance scheme is a strengthening factor in that it tends to pool resources together making the health access easier and affordable. It has been also acknowledged that implementing social health protection is one of many critical ways that will aid to the achievement of the MDGs (millennium development goals) and collective health coverage. Provision of access to health care, including evenhanded health assurance mechanisms, are crucial factors that contribute to eradicating poverty and susceptibility. Such mechanisms address poverty and vulnerability on several levels.
Another key factor in translating health policy into practice is the simplicity of ideas, the interdependence of sectors, and giving thoughts to a potential problem. Health agenda inequalities at both national and local level are still alarming. Complex ideas and great partnership make the whole system a snag and unpredictable. The health sector is so broad and therefore coming up with a target population on a particular topic will make execution a ride through.[11] Goodwin et al. posit that the Australian government selectively targets to finance the delivery of integrated care only for elderly above 65. A realistic schedule is set to provide home based care following the scale of urgency. Programs have also been on ground to assist individuals who need residential care, without necessary moving them from the community to care centers. This substantially supports the fact that lack of a clear distinction between policy formulation and policy implementation terms everything as failure.[12] The failure of different health policies can be because of blanket assumption, by not giving thoughts on how the community will perceive and receive the system. In this situation, a balance should be strictly stricken between the bottom up and top down approach. An oversight on either would not make a significant impact unless perfect rationalism is given consideration.[13] Policy implementation is all about tradeoffs, making tough compromises, giving all to the local level, and most importantly securing the effectiveness of the system. Therefore, policy initiators should keenly note that policy formulation and implementation are dependent; therefore, it should be treated in combination by involving all the stakeholders necessary for implementation.[14]
Political Goodwill
A political approach is the most critical approach to health policy implementation. In most countries, any policy implementation cannot be successful if it does not meet the demands of the state’s power. A good example to this is whereby some policies diminish due to lack of real leadership. Political power over the implementation of health policies can be at times disadvantaging in that the authoritative imbalances the defenseless. This is an unfair way that deems the powerless less human, hence, their ideas not implemented. A willing and supportive government largely influences the transition of health policy into execution. The government can chip into health policy implementation in different ways such as funding through donations and taxation. Goodwin et al. show that in the United Kingdom and Australia, health policy has been successfully put into action by help of government taxation funds. The way the government and general health practitioners are working hand in hand to ensure efficient delivery of integrated care to the aged ones is amazingly unmatched. Therefore, unless people come into agreement with the power of influence and that of an organization and intellectuals agree that the aspect of getting this done is as crucial as that of figuring out what needs to be done, most policies will forever remain formulated but not executed. [15]
Machinery to Implement Policy
Availability of machinery ready to implement health system is as useful as any factor when it comes to policy execution. Primary health care physicians are the core factors or components in policy implementation.[16] The coordination of the primary care doctors and the wider health teams brings effectiveness in policy execution. The role of other stakeholders such as health care providers, community health workers, and community health volunteers adds value to the bigger picture. Goodwin et al. give an example on how the United Kingdom health and communal care panel maneuver in localities connected to the registered
Populations of local general practices, general practitioners in these cases are involved indirectly as part the ‘main team’ in taking care of patients in the society. In different cases, all GP practices have commitment and are paid to give total support and care to patients. The existence of national standard charter for eligibility determines the cognitive and functionality of long-term caregivers thus providing them with co-payments studies. [17]
Actors Involved in the Implementation
The role of stakeholders in handling health disparities at local and national levels impact the way health policies are conceptualized. Different stakeholders have diverging perceptions of the local systems. Some speakers view the local system as nature bound highlighting the importance of the neighborhood replenishment and the next initiative; for instance, a New Deal for Communities and Health Action Zones, which specifically targets the worst cases in national and local areas.[18] In this context, more weight is given to the developmental approach whereby acquiring information, dealing with evidence, encouraging experimentation and applauding new ideas contributes much to the general change.[19] In such cases, a command-and-control loom to strategy and its delivery is undertaken through upright orderly administration and scrutiny preparations may be totally unsuitable leading to the developmental philosophy. On the other hand, local system organization is perceived as a net worth relationship. A partnership, in this case, is seen as an effective way to deliver services .strategically local partnership and the involvement of the neighborhood management system have a vital role in the implementation of health policies. Government system, political power, power imbalances, and accountability have a direct impact on this matter. The aiming of the local strategic partnership is not to only bring together the health agendas together, but also merging the independent decision-making bodies of local authorities in conjunction with other sectors such as business and education. [20] However, according to Goodwin et al., actors of health policy implementation start right from government, professional, functional systems and later on to personal level. Arguing on the case studies, in United Kingdom, the government gives a hand by funding the healthy policies, the GPs take in their roles and by using local authorities, health coverage is widened
Putting handful evidence into practice is another key factor in translating health policy into practice. Interventions that specifically focus on the vulnerable groups does necessary not mean that the gap between the well-off and the destitute will be reduced.[21] Unless this intervention significantly improve the health status of those living in subjective poverty, higher that the health of the affluent, the gap will remain wider. For these reasons, owing to the case study in Australia, it is evidenced that the aged suffer most from multiple complicated disorders making them less productive, a major cause of poverty. The health systems in Australia has taken this information and translated it to action by providing the integrated care at their residential home successfully. This has in turn helped in bridging the gap existing in health sector in Australia. This case study is subjective in that directly suggest for a critical approach of policies with evidence if at all there is need for implementation. While conducting research, the whole process of transformation and exploration should be well understood rather than giving a quantified eye to the expected outcome.[22] Action research can be used in numerous ways to generate knowledge that will aid in policy implementation.[23] For instance, through action research, knowledge on existing gaps is easily identified and those services underused are brought to the light.
Top-Bottom Approach
Practical key approaches to reducing health inequalities are another essential factor in ensuring health policy realization.[24]Health care system does necessarily not mean quality health services to the sick. The reliability of this approaches further raises eyebrows, and the question on the possibility of reliable integrated health care system remains unanswered. [25] In the runway of making health policy a reality, the bottom –up approach is the most efficient in ensuring policy implementation. The input of team integration in this perspective is viewed as a consequence rather than the cause. It makes extreme sense on how the health system of Sweden, Netherlands and United Kingdom’s embraces integrated health care from the primary local level, thus taking less consideration in the inclusion of organizations’ ideas.[26] This means that the local implementers need to work extra miles to outshine the effect of organizational systems. However, it does not harm when it comes to buying ideas of the clear budget lines and trusted accountability of some organization, provided that they won’t be an interference of bottom-up approach. The whole concept of the bottom-up approach in a sensible manner suggests that national policies will only be effective if; they embrace stimulation through financial support to give a shoulder to local initiatives in an attempt of improving health care for the target population. The Top-down approach is said to cause disorganization and upheaval in different organization thus health policies should avoid using this strategy since it calls for governmental mergers.[27]
The overall influence of the above factors on implementation and delivery of services in the health sector is paramount. Gleen et al. assert that an essential aspect of integrated care is how care is perfectly harmonized by caregivers meeting people’s needs, and the workability of certified teams to make certain that the health policy on the ground is implemented.[28]Another influence clearly seen is that implementation process is more likely to be approved within integrated organizations of health care deliverance. [29] This means that, in a situation where health caregivers are working under standard and fair governance and same enticement protocols facilitated by reasonable reorganizational corporation links, the more likely the integrated health policy will be supported.
Conclusion
In addressing effective health policy implementation, there is hope in achieving this goal only if the health inequality gap is considered as a serious impediment to equitable care. There is a strong appeal to take the real opportunity in addressing what matters most to health systems and access to health care services. The productive partnership between the need for better care and goodwill to provide it makes implementation of health policy a success. However, it depends on the nature of the organization, stakeholders, political factors, and availability of resources to help in policy implementation. A health policy will only be effective if the bottom-up approach is embraced and the top down approach does not manipulate the delivery of quality health services to end users.Lastly, the political aspect in any state should be in line with the health policy implementation, failure to which, it will forever remain a formulation, which is equal to failure.
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