Few would dispute the claim that South Africa is both policy-rich and implementation-poor.
If there is a political graveyard located somewhere in the country, it would be littered with well-written but otherwise poorly implemented policies. Moreover, it would not be uncommon to find that most of these policies were buried without proper autopsies having been performed. Not knowing the causes of past failures makes it difficult to ensure the future success of policy implementation.
In a recent article titled“How to develop an HIV and TB plan that has greater impact?”, Marcus Low presents some reasons for our inability to implement policies in South Africa. While this article attempts to provide additional information along the same lines, it also suggests actions that, if taken, could help remedy the situation.
Policies often fail due to a phenomenon that can be called policy surfing. It is characterized by continuous substitutions of policies due to various factors such as a change in administration, change in leadership, donor requirements, expiration of a period of time or change in the public opinion. The next wave of policies is usually developed without properly considering the impact of the previous wave, thus giving up the opportunity to learn and improve.
To illustrate this point, one need only look at the evolution of policies in the economic sector. In a very short time, we have gone from the Reconstruction and Development Plan (RDP) to Growth, Jobs and Redistribution (Gear) to the Accelerated and Shared Growth Initiative for South Africa (AsgiSA) and now to the Plan National Development (NDP). It is unclear whether proper reviews were carried out before moving from one policy to the next.
This does not mean that policies should remain static, but rather that they should not be changed for some arbitrary reason such as a change of administration.
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Disconnect between decision makers and policy implementers
The policies formulated at the central level are in many cases too generic to take into account the differences encountered at the different levels of decentralized implementation.
A cursory analysis of the annual reports submitted by provincial ministries will indicate that provinces are achieving varying levels of success in implementing nationally formulated policies. This reflects a centrally formulated “one size fits all” policy requiring additional customization that would take into account the unique conditions at each point of implementation.
The disconnect between policy development and implementation also manifests itself when implementers are required to fund the implementation of policies developed elsewhere.
Policy makers are often blinded by the quantum of resources available at the implementation level. This could lead to a situation where the plans are developed with a Rolls Royce in mind while the implementers only have the resources to build a VW Beetle.
This is amplified in a scenario where you have different spheres of government each with their own mandate and budget. So, while the health department formulates policies at the national level, the provincial departments have the latitude to decide how much money they allocate to their health programs. This has serious implications for the implementation of national policies at the provincial level and is often a source of frustration for policy makers.
A separation of lines of responsibility can also contribute to a disconnect between policy making and policy implementation. Policy makers find it difficult to implement their policies when the implementers are outside of their responsibilities. In the case of the Ministry of Health, provincial ministries develop their own service delivery plans with budgets that they are accountable to their provincial legislatures. They are only accountable to the national department when funds have been made available through conditional grants. This limits the extent to which the national department as decision-maker can hold provincial departments to account as implementers.
Credible implementation plans
Policies can be considered dead in the water until they are backed by credible implementation plans.
Recognizing the importance of credible implementation plans, the Department of Provincial and Local Government (now CoGTA) embarked in 2006 on a process of reviewing Integrated Development Plans (IDPs) with a view to establish its credibility. Noting that the municipalities were obtaining poor results compared to the planned objectives, the ministry wanted to understand the reason. Suspecting that the problem might be embedded in the plans themselves, the ministry began the process of reviewing the plans for credibility. Based on this, the department developed a tool called “IDP Credible Assessment Framework” for use by municipalities to promote credibility and thus minimize implementation failures.
It is unclear whether the national Ministry of Health has a framework or similar processes in place that would enhance the credibility of plans developed in its area. What is clear, however, is that the credibility is questionable considering the findings of a recent survey exam of the National strategic plan (PSN) for the prevention and control of non-communicable diseases (DTM). One of the main conclusions of this report is that a significant part of the expected results will not be achieved, seriously compromising the implementation of the Strategic Plan and therefore its feasibility. This stems from the fact that many of the planned activities did not contribute to the expected results.
It is common practice in many jurisdictions around the world for government agencies to present the financial implications of new policies or legislation as part of policy-making or legislative processes. The advantage of providing detailed costs alongside policy objectives is that it forces decision makers to think about a practical level of implementation. It also forces them to be realistic in terms of what is executable given the prevailing financial constraints. Bidirectionally, the costing process impacts the planning process in that plans are often adjusted or reprioritized to align with financial constraints.
It is not common practice in South Africa for policies to be costed and this could explain why so many policies are dropped.
Ensuring enforceable policies
While many causes of policy implementation failures cannot be addressed without tinkering with the structure of government in South Africa, there are low-hanging fruits to be had with minimal intervention. It doesn’t take much to insist that policies be accompanied by credible implementation plans. This includes developing frameworks that would help policy makers and planners test the credibility of their plans or adjust existing frameworks to do the same.
For example, the district health planning and monitoring framework used in the development of district health plans can be easily adjusted to allow the credibility of the plan to be tested.
Insisting that the implementation plans are costed will be a major asset for its implementation. Given that the Treasury is currently considering revamping the budget process with a view to introducing zero-based budgeting, this presents an ideal opportunity to make this practice mandatory.
Ultimately, to ensure policy implementation, the goal should be to ensure that the policy is enshrined in law. Unlike policy statements which typically focus on high-level values, principles and outcomes, Acts of Parliament assign powers, rights and obligations. Acts of Parliament are binding while policies are non-binding. Therefore, policies, when enacted into law, are much more likely to be executed.
“Think globally, act locally” is a popular principle that promotes a bottom-up approach to addressing societal challenges. It is therefore essential that policymakers constantly remember that policies must find expression in local conditions, each characterized by its own set of challenges and realities. SM/MC
*Botha is an independent health economist.
*This article was published by Projector – health journalism of general interest.