Reinterpreting the implementation gap: a case based analysis of District Health System implementation in the Western Cape Province in South Africa

Adams, Ubanesia Lolita (2011) Reinterpreting the implementation gap: a case based analysis of District Health System implementation in the Western Cape Province in South Africa. Doctoral thesis (DPhil), University of Sussex.

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Abstract

This dissertation examined an implementation gap through a case study on
implementing a District Health System (DHS) in the Western Cape Province of South
Africa between October 2001 and April 2006. The research project explored why this
implementation gap existed and what could be learnt about public policy
implementation from studying this implementation gap. The main data collection
methods included interviews, public and other documents and observations on the
public health system in the Western Cape Province.

I argue that implementation gaps could be interpreted as a signal of policy change
instead of implementation failure. The key finding is that the Provincial Government of
the Western Cape shifted its intentions regarding DHS implementation. The initial
intention was to decentralise primary health care services to a metropolitan
municipality. The decision, which was actively implemented, however centralised these
services within the provincial government and started the process of the
provincialisation of personal primary health care services in the Western Cape
Province.

This dissertation contributes to public policy implementation and public policy process
literatures. It demonstrates why policy change is an alternative interpretation of
implementation gaps to implementation failure and how policy change occurs during
implementation. Policy change and public policy implementation are commonly two
separate research themes within Public Policy Studies. The persuasion framework
developed through this research project is an analytical tool that may be applied in
research on implementation processes to examine whether an implementation gap is
signalling policy change. The central theoretical elements in this framework that link
policy change and implementation processes are the interactive effects of ideas and
interests and the role of argument as a persuading factor that leads to policy change.
The dissertation emphasises the role of language in public policy processes and
argument and persuasion were deemed important elements in public policy processes.

Item Type: Thesis (Doctoral)
Schools and Departments: Institute of Development Studies
Subjects: R Medicine > RA Public aspects of medicine
R Medicine > RA Public aspects of medicine > RA0001 Medicine and the state. Including medical statistics, medical economics, provisions for medical care, medical sociology
Depositing User: Library Cataloguing
Date Deposited: 13 Jun 2011 13:49
Last Modified: 14 Aug 2015 13:40
URI: http://srodev.sussex.ac.uk/id/eprint/6921

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