How the divide between policy formulation and implementation is affecting healthcare delivery in Low and middle-income countries: a meta-analytical view.

Policy formulation is important for health care planning and service delivery. However, the process is not an end in itself. The relevance of formulated policies can only be justified upon implementation. The two are antecedents of each other as they share a cyclical in-put-output relationship.  The current hiccups that are commonplace in the healthcare settings in Low and Middle-Income Countries (LMICs) arise due to a lack of coordination and low capacity to manage the policy formulation and implementation see-saw balance. At the theoretical level, it is less clear and many factors engender the obscurity that has ravaged LMIC healthcare systems.

Service providers work within policy frameworks and gaps in policy have impacts on the consumers of policy progeny.  Policies that are isolated in implementation undermine the overall health and well-being of the citizens. For instance, environmental decisions that affect health negatively are implemented because the health policies lack frameworks for their regulation.  A case study of some African countries has shown that there are huge forest tracts that are harvested to produce charcoal despite the health consequences.

In some countries, policies on plastic management cannot be enforced sustainably because there is a lack of supporting policies to promote enforcement (Plastic Crisis in East Africa, 2020).

Asbestos remains a problem in Southern Africa despite many years of technological advancements. Overall, The disconnects that exist relegate relevant policy to the periphery of contemporary health decisions. This is evident in the approaches that are employed in addressing health issues which take on an episodic view without any connection to the health care system dynamics. Therefore policy formulation should be conducted in an environment that is cognizant of the intervening factors that may undermine or make the policy irrelevant or less effective. Some environmental factors are anthropogenic, yet many are natural and require insight and policy formulation as well as management acumen.

 

In some instances there are policies, however, they lack the relevance and elasticity that is necessary for their operationalization in real life. This view of the policy environment is informed by the experiences from the Covid-19 era. For instance, there are policies on how to receive donations and donor aid, however, the policies on the utilization of such support are either very feeble and ineffective or lack an activation mechanism thereby consigning them to academics and rhetorical applications. Such policy gaps and mishaps work in concert to sustain and fuel corruption during the handling and management of health resources.

Impacts of policy weaknesses are manifest in a perpetual health crisis and disease endemicity that is a characteristic of health care in Low and Middle-Income Countries (LMICs). Some diseases are endemic due to their political economy and ecology. There is a motley of scenarios that demonstrate the foregoing argument on endemicity. In many LMICs, some diseases are maintained as endemic yet they can be addressed and eradicated. From Ebola to flooding and humanitarian activities. This scenario is self-perpetuating due to the jobs that are created and the livelihoods that are supported. This scenario is compounded by the funding that is provided from the High-Income countries.

Overall, policy formulation and implementation must always work in concert to deliver the intended health outcomes. At the same time, they should operate in a fashion that permits regular reviews and be adept to function during crisis such as Covid-19 and global climate disasters.      

 

 

 

 

Further reading

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