Health Policy Implementation

Policy Implementation
Prof. Dr. Muhammad Mushtaq Khan
Policy Implementation
• Implementation process is an interactive
process performed and influenced by various
networks, actors, stakeholders, individuals and
groups.
Policy Implementation
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Models and Approaches of Implementation
Top-down approach
Bottom-up approach
Policy Action Model
Top-down approach
• Derthick, Pressman & Wildavsky are the main
advocates of this approach
• Policy making as a linear process with a clear
division between policy formulation & policy
implementation
• Policy formulation: values, goals, ought to be
Top-down approach
• Implementation: technical and managerial
process
• Policy formulation at national or international
level and implementation by managers at
lower levels
• Ideal model of perfect implementation
Bottom-up approach
• Wetherley and Lipsky
• Contrast to the Top down (linear view) of
the policy process
• top down model lacks effective
implementation in practice
Bottom-up approach
• Implementers often play an important
part in policy implementation, not
merely as managers of policy towards
down, but as active participant in an
extremely complex process that inform
policy upwards too.
Bottom-up approach
• This process needs to take account the
interaction of bureaucrats with their
clients /users/ beneficiaries at grass root
level
• It should be seen as much more
interactive process characterized by
bargaining, negotiation and conflict
Bottom-up approach
• Implementers may change the way of
polices implemented, are even redefine
the objectives of the policy because they
are closer to the problem and the local
situation.
Policy Action Model
• Lewis and Flynn developed a behavioral
model that views implementation as
action by actors which is constrained by
the world outside their organizations
Policy Action Model
Implementation is an interactive
bargaining process taking place over time
between those who are responsible for
enacting public policy and those who
have control of resources
Policy Action Model
• More emphasis is placed on issues of
power & dependence , interests,
motivations & behavior than in either the
top down or bottom up approaches.
Implementation Tools
• Authority (fine, punishments)
• Incentive
Implementation in practice
• Impact of Contextual Factors upon
Implementation
• Political Context
• Economic Context
• Socio-cultural Context
• Demographic Context
Implementation in practice
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Political Context
Wars
Civil wars
Violent political conflicts
Political instability resulting in frequent
change of governments
• Political energy that is needed for the effective
implementation of policies
Implementation in practice
• E.g. population-planning program during
Bhutto and Zia regime. India Indira Gandhi
• Local bodies election, Motorway, Peoples
program
• Central local relationship (legislative control,
budget)
• Accountability
Implementation in practice
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Economic Context
Overall economic conditions of a country
Govt priorities
Less resources (Social welfare policies)
Donors (local knowledge, passive, terms
&conditions, flow of resources, dependence)
Socio-cultural Context
• Literacy rate
• Level of awareness
• Cultural values (smoking, drink driving, guns
and weapons)
Demographic Context
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Rapid growth in population
Law & Order
Urbanization
Pressures (employment, housing, services,
traffic, welfare sectors)