How are policies implemented?
The mandate of the MOH ends at policy formulation. By law, policy
implementation is for the agencies and especially the GHS. The GHS is
responsible for preparing the implementation plan. However, this is a
major challenge as a big lacuna is created between formulation and
implementation. Participants in the MOH and GHS all see this as a major
issue. A participant at the MOH stated;
You know, since the ministry’s mandate ends at formulation, the agencies
are then supposed to, you see the word I am using, supposed to, fix the
implementation aspect and do the implementation plan and work with it.
That is where the gap is, policy and practice. You see, how can the MOH
formulate a policy and does not do much in implementation. The
implementation drops and there is a bridge and that link is weak
Probing revealed that representatives of the MOH are invited when the
implementation plan is being done by the GHS. However, MOH participants
believe this is not sufficiently helpful since it takes place outside
their jurisdiction and their representatives can only advise on
implementation issues. Implementation is therefore seen as a GHS
activity by various agencies. The MOH therefore monitors the
implementation of the policies. According to participants, the issue
here is whether officials have enough data coming out of that
implementation to do proper monitoring. Stakeholders involved in this
study believe that implementation of hypertension and diabetes policies
is a major challenge in Ghana. Policy implementers themselves confirmed
to the research team that Ghana is yet to implement its NCD policy. A
participant added:
By now we should all be aware and some behavioural changes should have
been noticed and we should be seeing some improvement so that at least
if the burden is going up at all, the rate would have slowed a bit or
may be it would have plateaued and stagnated but the bottom line is that
it is still rising. As we speak, 30% of the adult population has one
NCD or the other. So what it means is that implementation should be
looked at again. It should not be seen as one agency’s headache. It
should be seen as a holistic and national issue that all other agencies
including the private sector must be involved
Common comments from participants on issues of implementation have been
summarized in table 2
Table 2: Key comments on implementation of diabetes and hypertension
policies