IMPLEMENTATION GAPS, POLICY CHANGE AND HEALTH SYSTEM TRANSFORMATION IN THE WESTERN CAPE PROVINCE, SOUTH AFRICA

Ubanesia L. Adams-Jack

doi:10.25159/0256-8845/1518

Authors

Ubanesia L. Adams-Jack

DOI:

https://doi.org/10.25159/0256-8845/1518

Keywords:

policy implementation, implementation gap, policy change, failure, interpretation, health policy

Abstract

Implementation gaps tend to be interpreted as a sign of failure. The argument in this article is that implementation gaps do not only signal failure, but can be interpreted as a sign of policy change. The tendency to interpret implementation gaps as a sign of failure is linked to rational beliefs, which shape the normative expectations of the relationship between policy and implementation. But implementation scholarship suggests that other relationships exist between policy and implementation. These other relationships suggest other ways to interpret implementation gaps. A case study of the implementation of health system transformation at a sub-national government level is used to demonstrate when policy change offers a more insightful interpretation of an implementation gap than failure. The case is discussed within a political-legal context, which comprises the constitutional provisions on powers and functions of the respective spheres of government in South Africa. The argument shows the value of critical reflection on the meaning of implementation gaps as this can help us to deepen our understanding of the complexities of policy implementation and the practical dynamics of policy change.

References

African National Congress (ANC) (1994) Reconstruction and Development Programme. Johannesburg: Umanyano Publications.

Bacchi, C. L. (1999) Women, Policy and Politics: the construction of policy problems. London: SAGE Publications.

Barrett, S. (2004) 'Implementation Studies: time for a revival? Personal reflections on 20 years of implementation studies.' Public Administration 82: 249-62. https://doi.org/10.1111/j.0033-3298.2004.00393.x

Barron, P., Asia, B. (2001) 'The District Health System.' In South African Health Review 2001, edited by Ntuli, A, 17-48. Durban: Health Systems Trust.

Bossert, T. (1998) 'Analysing the decentralisation of health systems in developing countries: decision space, innovation and performance.' Social Science Medicine 47: 1513-527. https://doi.org/10.1016/S0277-9536(98)00234-2

Community Health Service Organisation (CHSO) (2003) Annual Report 2002-2003. Provincial Government of the Western Cape, Department of Health. [Online]. Available: http://www.capegateway.gov.za/Text/2004/3/chso_annual_report_2002_3.pdf [Accessed 14 February 2005]

Colebatch, H.K. (2006) 'What work makes policy?' Policy Sciences 39:309-21. https://doi.org/10.1007/s11077-006-9025-4

deLeon, P. (1999) 'The missing link revisited: contemporary implementation research.' Policy Studies Review 16:311-338. https://doi.org/10.1111/j.1541-1338.1999.tb00887.x

deLeon, P. and deLeon, L. (2002) 'Whatever happened to policy implementation? An alternative approach.' Journal of Public Administration Research and Theory 12: 467-92. https://doi.org/10.1093/oxfordjournals.jpart.a003544

Department of Health and Social Services (2000) Report of the Bi-Ministerial Task Team on the implementation of a municipality-based District Health System. Provincial Administration of the Western Cape. [Online]. Available:http://capegateway.gov.za/eng/publications/reports_research/R/3186 [Accessed 21 September 2009]

Department of Provincial and Local Government (2002) Ministers Authorisations to Category B municipalities for water, sanitation, electricity and municipal health in terms of the Municipal Structures Act (as amended) 2000, 7 November 2002. [Online]. Available: http://www.info.gov.za/speeches/2002/02111814461004.htm [Accessed 19 November 2006].

Galvin, M., and Habib, A. (2003) 'The politics of decentralisation and donor funding in South Africa's rural water sector.' Journal of Southern African Studies 29: 865-84. https://doi.org/10.1080/0305707032000135860

Hicklin, A., and Godwin, E. (2009) 'Agents of change: The Role of Public Managers in Public Policy.' The Policy Studies Journal 37: 13-20. https://doi.org/10.1111/j.1541-0072.2008.00292.x

Hill, M. and Hupe, P. (2002) Implementing Public Policy. London: SAGE Publications.

Hill, M. and Hupe, P. (2009) Implementing Public Policy. 2nd Edition. London: SAGE Publications.

Howlett, M., Ramesh, M. and Perl, A. (2009) Studying Public Policy: policy cycles and policy subsystems. 3rd Edition. Ontario: Oxford University Press.

May, P.J., and Winter, S.C. (2007) 'Politicians, managers and street-level bureaucrats: influences on policy implementation.' Journal of Public Administration and Research Theory, doi:10.1093/jopart/mum030 https://doi.org/10.1093/jopart/mum030

McCreadie, C. Mathew, D. Filinson, R., and Askham, J. (2008) 'Ambiguity and cooperation in the implementation of adult protection policy.' Social Policy and Administration 42: 248-66. https://doi.org/10.1111/j.1467-9515.2007.00595.x

MDHS. (2004) Metropole District Health Services Annual Report 2003/2004. Provincial Government of the Western Cape. Cape Town: Department of Health.

Ministry of Health (1997) White paper on the transformation of the health system in South Africa. [Online]. Available: http://www.info.gov.za/whitepaper/1997/health.htm [Accessed 18 November 2004]

Mosse, D. (2004) 'Is good policy unimplementable? Reflections on the ethnography of Aid policy and practice.' Development and Change 35: 639-71. https://doi.org/10.1111/j.0012-155X.2004.00374.x

Nakamura, R. T. (1987) 'The textbook policy process and implementation research.' Policy Studies Review 7:142-54. https://doi.org/10.1111/j.1541-1338.1987.tb00034.x

O'Toole, Jr., L.J. (1986) 'Policy recommendations for multi-actor implementation: an assessment of the field.' Journal of Public Policy 6: 181-210. https://doi.org/10.1017/S0143814X00006486

O'Toole, Jr., L.J. (2000) 'Research on policy implementation: assessment and prospects.' Journal of Public Administration Research and Theory 10: 263-88. https://doi.org/10.1093/oxfordjournals.jpart.a024270

Owen, C. P. (1995) A policy for the development of a District Health System in South Africa. Pretoria: Department of Health: Health Policy Coordinating Unit.

Pillay, Y. (2001) 'The Impact of South Africa's new constitution on the organisation of health services in the post-Apartheid era.' Journal of Health Politics, Policy and Law 26: 747-66. https://doi.org/10.1215/03616878-26-4-747

Pillay, Y., Leon, N., Wilson, T., Asia, B., Barron, P., Dudley, L. (2003) Guidelines for functional integration: a key strategy towards the full implementation of the District Health System. South Africa Department of Health. [Online]. Available:

Pretorius, L. (2003) 'Six contributions for understanding gaps between policy and implementation: an overview.' Politeia 22: 6-21.

Republic of South Africa (1996) The Constitution of the Republic of South Africa, 1996. Act 108 of 1996, Pretoria: Government Printer.

Republic of South Africa. (2004) National Health Act. Act 61 of 2003. Government Gazette: 23 July 2004. No. 26595 (Number 869)

Saetren, H. (2005) 'Facts and myths about research on Public Policy Implementation: Out-of-Fashion, Allegedly Dead, But Still Very Much Alive and Relevant.' The Policy Studies Journal 33:559-82. https://doi.org/10.1111/j.1541-0072.2005.00133.x

Schofield, J. 2001. 'Time for a revival? Public policy implementation: a review of the literature and an agenda for future research.' International Journal of Management Reviews 3: 245-63. https://doi.org/10.1111/1468-2370.00066

Schofield, J. (2004) 'A model of learned implementation.' Public Administration 82: 283-308. https://doi.org/10.1111/j.0033-3298.2004.00395.x

Sustainable Livelihoods in Southern Africa Team (2003) 'Decentralisation in practice in Southern Africa.' IDS Bulletin 34 (3): 79-96. https://doi.org/10.1111/j.1759-5436.2003.tb00079.x

Tummers L. (2011) 'Explaining the willingness of public professionals to implement new policies: a policy alienation framework.' International Review of Administrative Sciences 77: 555-81. https://doi.org/10.1177/0020852311407364

Van Rensburg, HJC. and Pelser, AJ. (2004) The transformation of the South African health system. In Health and health care in South Africa, edited van Rensburg, HJC, 110-166. Hatfield, Pretoria: van Schaik.

Western Cape Department of Health. (2003) HealthCare 2010. Provincial Government of the Western Cape: Department of Health.

Western Cape Department of Health. (2005) Provinces to take over primary health care facilities run by municipalities. Statement by Department of Health: Western Cape Provincial Government: 11 March 2005. [Online]. Available: http://www.capegateway.gov.za/eng/pubs/news/2005/mar/101417 [Accessed 15 January 2007]

World Health Organisation (1978) Alma Ata Declaration. [Online]. Available: http://www.who.int/hpr/NPH/docs/declaration_almaata.pdf [Accessed 23 April 2005)]

Yanow, D (1993) 'The communication of policy meanings: implementation as interpretation and text.' Policy Sciences 26:41-61. https://doi.org/10.1007/BF01006496