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

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.