Bridging the Implementation Gap in Poor Areas: A Study of How Municipal Socio-economic Characteristics Impact Intergovernmental Policy Implementation

2017 ◽  
Vol 52 (1) ◽  
pp. 408-433 ◽  
Author(s):  
Flávia Galvani
Keyword(s):  
Policy Implementation ◽  
Implementation Gap ◽  
Intergovernmental Policy

scholarly journals A Narrative Synthesis Review of Out-of-Pocket Payments for Health Services Under Insurance Regimes: A Policy Implementation Gap Hindering Universal Health Coverage in Sub-Saharan Africa

2021 ◽  
Author(s):  
Abigail Nyarko Codjoe Derkyi-Kwarteng ◽  
Irene Akua Agyepong ◽  
Nana Enyimayew ◽  
Lucy Gilson
Keyword(s):  
Policy Implementation ◽  
Universal Health Coverage ◽  
Health Sector ◽  
Sub Saharan Africa ◽  
Narrative Synthesis ◽  
Health Coverage ◽  
Implementation Gap ◽  
Street Level ◽  
Sub Saharan ◽  
Universal Health

Background: "Achieve universal health coverage (UHC), including financial risk protection, access to quality essential healthcare services and access to safe, effective, quality and affordable essential medicines and vaccines for all" is the Sustainable Development Goal (SDG) 3.8 target. Although most high-income countries have achieved or are very close to this target, low- and middle-income countries (LMICs) especially those in sub-Saharan Africa (SSA) are still struggling with its achievement. One of the observed challenges in SSA is that even where services are supposed to be "free" at point-of-use because they are covered by a health insurance scheme, out-of-pocket fees are sometimes being made by clients. This represents a policy implementation gap. This study sought to synthesise the known evidence from the published literature on the ‘what’ and ‘why’ of this policy implementation gap in SSA. Methods: The study drew on Lipsky’s street level bureaucracy (SLB) theory, the concept of practical norms, and Taryn Vian’s framework of corruption in the health sector to explore this policy implementation gap through a narrative synthesis review. The data from selected literature were extracted and synthesized iteratively using a thematic content analysis approach. Results: Insured clients paid out-of-pocket for a wide range of services covered by insurance policies. They made formal and informal cash and in-kind payments. The reasons for the payments were complex and multifactorial, potentially explained in many but not all instances, by coping strategies of street level bureaucrats to conflicting health sector policy objectives and resource constraints. In other instances, these payments appeared to be related to structural violence and the ‘corruption complex’ governed by practical norms. Conclusion: A continued top-down approach to health financing reforms and UHC policy is likely to face implementation gaps. It is important to explore bottom-up approaches – recognizing issues related to coping behaviour and practical norms in the face of unrealistic, conflicting policy dictates.

scholarly journals The Cop21 Agreement: A Giant Illusion?

2016 ◽  
Vol 2 (1) ◽  
pp. 34
Author(s):  
Jan-Erik Lane
Keyword(s):  
Economic Growth ◽  
Energy Source ◽  
Renewable Energy ◽  
Policy Implementation ◽  
Greenhouse Gases ◽  
Policy Sciences ◽  
Implementation Gap ◽  
Aaron Wildavsky

<p class="Standard"><em>The policy sciences, enquiring into the making and implementation of public decisions, has made several stunning findings that are highly relevant to the COP21 Agreement or Treaty if you so wish. They constitute the so-called “implementation gap” or the “hiatus of policy implementation”, analysed by late American Aaron Wildavsky and also Paul Sabatier. The enormous enthusiasm for the COP21 framework must be dampened when confronted with the lessons from policy implementation, especially in such an extremely decentralised approach taking place over so many years. But the signatories have to decide now how to halt the increase in greenhouse gases (GHG), especially the CO2:s in order to start decreasing them, hopefully (naively) to zero in 80 years. As the emergence of economically viable renewable energy is slow, the only quick solution is to remove coal as an energy source. That would resolve the star economist Jeffrey Sachs dilemma that decarbonisation would result in negative economic growth.</em></p>

Implementation

2019 ◽  
pp. 268-298
Author(s):  
Bruce Mitchell
Keyword(s):  
Environmental Management ◽  
Policy Implementation ◽  
Coastal Management ◽  
Water Policy ◽  
Successful Implementation ◽  
Implementation Gap ◽  
Effective Implementation ◽  
Paulo State ◽  
The Difference

Policies and plans for resource and environmental management are needed, but if not implemented, or implemented poorly, their value is reduced. Experience suggests that we often struggle to achieve effective implementation. In this chapter, the implementation gap is examined, with the aim being to identify what are known expectations for successful implementation of policies and plans, which obstacles frequently hinder implementation, and what capacity is required for effective implementation. Subsequently, the difference between programmed and adaptive implementation is examined, followed by discussion of the role of different partnership and stakeholder arrangements to facilitate implementation. Detailed case studies of coastal management in Japan and of water policy implementation in the São Paulo state in Brazil provide further insights. Bakti Setiawan and Dwita Rahmi, in their guest statement, review the role of bureaucracy, politics, and leadership in establishing a protected agricultural area in Yogyakarta, Indonesia.

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