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Abstract
How and why policy-practice gaps come about: a South African Universal Health Coverage context
Highlights
South Africa, like many other countries is currently piloting National Health Insurance (NHI) reforms aimed at achieving Universal Health Coverage (UHC)
In addition to the the core constructs of CIT (Information, Motivation, Power, Resources and Interactions) our research revealed changing epidemiological profiles, dysfuntional processes and systems, human factors, national vocational training regulations and an overall lack of systems thinking as factors contributing to the policy practice gap in UHC policy implementation
Our findings revealed that secondary factors, referring to shortcomings in processes or systems in the form of supervision support systems 38, bureaucracy, employee management and development system (EPMDS) 38, lack of systems that take changing epidemiological profiles 10, 37 into account, disconnect between those who award contracts and those held accountable for service and transition states that are not planned for, were all contributing to policypractice discrepancies
Summary
Qualitative data were collected during three phases: 2011-2012 (contextual mapping), 2013-2014 (phase 1) and 2015 (phase 2). Inductive and deductive data analysis approach was utilized. A qualitative, exploratory case study design utilizing a theory of change (TOC) approach was followed to explore universal health coverage policy implementation experiences. Inductive and deductive data analysis approach guided by contextual interaction theory was utilized. Ten pilot districts were identified by the department of health and selected as national health insurance (NHI) pilot sites. The national department of health (DoH) selected these sites based on poor performance on key health indicators like high maternal and child mortality rates. The case was the district (X), conveniently selected as the only NHI pilot district in that province at the time. Managerial support and willingness to participate in the study guided site selection
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