Policy Implementation is the soul of Administration and Public Policy, one of the problem with Policy making in India is extreme fragmentation in the structure that fragmentation fails to acknowledge the action taken in one area have implications on another and may work at Cross purpose with policies of other sector. Implementation is not automatic that is more structured and scheduled. Implementation works as make or break the deal of Public Policy.

Effective implementation requires a chain of command, and the capacity to coordinate and control; often there are shortfalls in this exercise, more so in a developing country like India. Problem in the implementation of Policy are common in all countries, be they developed or developing. Even with relatively good administrative structure, Public Policy does not have it’s intended impact due to conceptual and political problem. Implementation deficit may be due to insufficiency of the requisite resources – of time, money or manpower.
Let’s discuss the implementation problem under the headings:

1) Conceptualization Issue of Policy Implementation

Conceptual Problem become the most crucial step in Policy Implementation that holds the high capacity to hinder the implementation. Understanding the nature of contextual problems, acknowledgement to those kind of policies and procedures which can address the inside problems. These conceptual problem majorly related to Policy design and anaylsis conflicts.

• Policy Design Conflict

Hogwood and Gunn stressed if at the stage of Policy design, attention is given to potential problems of implementation; successful outcome will increased. In order to avoid major shortcomings in implementation take care of few preposition that prescribed by Hogwood and Gunn and Policy makers must ensure that:

A) Adequate time and sufficient resources are made available to the programme

B) No constraints in terms of overall resources, and even at each stage in the implementation process.

C) Policy must based on valid theory of cause and effect.

D) Single implementation agency that need not depend upon other agencies for success.

E) Good communication among co – ordination, various elements involved in the programme

The problem of Policy design in Poli design include ambiguous and ill – defined objective and inappropriate measure to achieve the stated goals. Lack of adequate political will, sufficient social support are other reason. For example, National Water Policy (NWP) adopted by Water Resource Council in 1987 was a wanted step in the direction of evolving national consensus. But, because of poor design remained unimplemented. NWP lacks the blue print

• Policy Analysis Conflict

Implementation of Public Policy has also been hampered by conceptual weaknesses of Policy anaylsis. For instance, National health Policy (1983) was adopted without considering alternative Policy option. This inability to set priorities and evolve appropriate strategies for reduction in health problems by the state department

• Policy Statement Conflict

Policy statement announced by the government contain ambiguous and contradictory terms, posing problems in implementation. The implementers at the field level often face a variety of issues because the policy statement lack clarity. Consequently, implementers use their own discretion while implementing them or they refer the statement back to the higher paths of Administration for clarification.

2) Political Pressure

Political Pressure in implementation always been evident and complex. This kind of pressure cannot let bureaucracy to work efficiently.

• Centralisation of Policy Process

Tassel between Central and state government relation has affected the policy implementation process adversely. Environment protection is heavily centralized. Although the central government has been enthusiastic in adopting innovative population, health, education and environmental policies and programmes as a result, health or environment quality has hardly improved in terms of availability of safe water, clean air, and provision of healthy living conditions.

• Unionisation of Bureaucracy

Another important of failure of Policy implementation is due to the Unionisation of civil services, at the lower level in particular. This has destroyed not only the work culture and discipline, but it also demoralized considerably the supervisory levels into withdrawal and promoting them to take least resistance. Higher and middle levels of bureaucracy are not so powerful and marginalized to give any relief to citizen in cases of corruption. Further, political interference by the political executive has compounded the marginalisation of higher bureaucracy thereby undermining it’s capacity to implement Public policies effectively.

• Politics of Interest Group

Many times, it is observed that the policies are not implemented because of to satisfy the interest groups. For example, several industries have little concern about environmental consequences of sitting decisions; industrialist influence the environmental Policy implementation process either directly or through business lobbies and representative of the business interests concerned. Pressure by industrial association during consideration of Environmental Protection Act in parliament resulted in a weakening of government and also forced the government to delay enforcement of enacted legislation. They are links with elites of ruling parties. It’s is, common for exertion of political influence in the environmental Policy process.

3) Bureaucratic Incompentency

Christopher Hood uses the term ‘Perfect administration’ in comparison to comparison to ‘Use of Perfect Competition’. He defines ‘ Perfect administration’ as a condition in which external elements of resources availability and political acceptability combine with administration to produce Perfect policy implementation.

• Lack of Adequate Institutional Capacity

The institutional structure and administrative capabilities for implementation of environmental laws and policies, for example, by no means Adequate in terms of political, social, and economic problem. Institutional structure includes the whole system of rules and regulations by which administrative tasks and responsibilities are clearly defined and juxtaposed with the capabilities of the administrators concerned. Let’s understand by example, when 30 industrial units, including few MNCs in West Bengal failed to comply with environment laws, the supreme Court had to play the role of the executive. In 1995 two judge bench of supreme Court expressed ” these multinational concerns have huge resources yet they are not bothered about protecting the environment”.

• Lack of Personnel and Financial Resources

Many policies will diffuse because of insufficient staff and lack of financial resources. Policies in developing nation have not been implemented in full scale owing to lack of trained staff. Well structured policies fail to attain the proper goals without competent Personnel. Implementation implies allocating personnel resources to the appropriate tasks and activities tasks and activities, motivating them to do well rewarding them for action. Regardless of their status, specialized knowledge, experience and qualifications, the programme personnel need to work as a cohesive team for the purpose of achieving policy results.

• Working under heavy pressure of Time

Pressure of time often creates the implementation gap. While fixing the time frame, the policy formulators do not take into consideration the prevailing conditions. The implementation agencies under pressure are unable to fulfill the targets allocated under the said Policy.

• No Administrative Will and Motivation

Without the conscious cooperation of implementers, nothing can be done. It is responsiblity of government to ensure the working conditions for implementers so that they will not lost their interest. Social policies have remained unimplemented largely for lack of administrative will and motivation. In current environment, officials are not likely to feel enthusiastic about implementing policies. Even when officials willing to implement environment laws, government undermined by manoeuvre of industrial bigwigs. Many of them fall to the dominance of economic interests and monetary temptations end up in formal enforcement of the regulation.

• Cooperation and Coordination

Poor coordination and missing links among the administrative agencies have stood in the way of adequate and appropriate Policy actions. For example, at the administrative level, different department are concerned with implementing policies related to poverty alleviation programme. Gap in Policy implementation are found in population and family planning programme.

• Lack of people’s participation

Public involvement in Policy Implementation such as education, population control, health, pollution control and forest conservation etc have tremendous pressure on administrative staff to cultivate results. By demonstration, protest and Public has tried to offset the power base of interest groups and lobbies that influence Policy Implementation in their favour.

The strength and endurance of the people’s movement for implementing and enforcing regulations have not been a link to that vests interest.

Conditions for proper implementation

W. William inakes an attempt to identify ways in which Policy failure can be prevented. He exhorst policy makers to pay more attention to implementation capacity like must underline few questions:

I) How capable are Policy makers in developing meaningful guidelines for and assistance to implementers?

II) How capable are implementers to do their work efficiently?

III) How well implementer articulated the Public Policy?

Mazmanian and Sabatier formulate a sufficient conditions of effective implementation;

I) The enabling legislation mandates Policy objective that are clear and consistent or at least provides substantive criteria for resolving goal conflicts.

II) The leaders of the implementing agency possess substantial managerial and Political skills. They are committed to statutory goals.

III) The programme is actively supported by organized constituency groups and key through out the implementation process, with the courts being neutral and supportive.

IV) The relative priority of statutory objective is not undermined overtime by emergence of conflicts of Public policies or by changes in relevant socio – economic conditions that weaken the statute’ s casual theory or political support.

Conclusion

Policy Implementation requires a wide variety of actions, including issuing Policy directives that are clear and consistent; creating organisational structure and assigning personnel with the information and authority necessary to administer the policies; coordinating personnel, resources and expenditure to ensure benefits for target groups and evaluating actions of personnel regarding implementation. Therefore, serious efforts are required for Policy Implementation at the level of Policy making itself, because it’s starts from beginning right from the policy making stage.

There’s tremendous gap between Public opinion and Public Policy – Noam Chomsky

CREDIT: SHUTTERSTOCK

PRIMARY HEALTH CARE

Primary health care is a broad term that means providing affordable and quality health care facilities to the whole society necessary to maintain good health by prioritizing those in need. It aims to recognize the needs of the people and then provide the health care facilities accordingly.

Primary health care has three pillars. These are primary care and essential public health functions, multisectoral policy and action, and empowered people and communities.

TECHNOLOGY’S IMPACT ON PRIMARY HEALTH CARE

Day by day integration of technology in primary care is increasing. There was a time when technology was in its naive stage, and its penetration into human life was minimum. The complexity, cost, and limitation to use it in improving primary health were also nil. Technologies like mobile phones, tablets, computers, and laptops are very common to us now but were alien concepts long before. However, by 1990, the advent of revolutionary technologies, especially the internet, had impacted the health care sector vastly.

TECHNOLOGY’S IMPACT ON PRIMARY HEALTH CARE

Day by day integration of technology in primary care is increasing. There was a time when technology was in its naive stage, and its penetration into human life was minimum. The complexity, cost, and limitation to use it in improving primary health were also nil. Technologies like mobile phones, tablets, computers, and laptops are very common to us now but were alien concepts long before. However, by 1990, the advent of revolutionary technologies, especially the internet, had impacted the health care sector vastly.

PRIMARY CARE AND ESSENTIAL PUBLIC HEALTH FUNCTIONS

The usage of technology has increased since then, and now we can see its presence in bringing secondary and tertiary health facilities to the home of the people. Now people can check their blood pressure, sugar, etc., at home through telemedicine, remote care, and mobile health. Technology is increasing the protection of patients by monitoring their health in day-to-day life. Electronic sensors can help inform the risk related to the health issue within time by monitoring and measuring required signs and symptoms. It is common to see technology tracking the stock of medicines and drugs, searching for information related to health, facilitating clinical support, monitoring and mapping transmissible diseases, and monitoring care facilities.

MULTISECTORAL POLICY AND ACTIONS

Gathering, analyzing, and managing the information related to the health sector has become digitally equipped. Handling data accurately and timely is possible now. Data collected and shared can improve the monitoring and surveillance of diseases.
The recorded data will increase the chances of better dealing with emergencies. Doctors can also access patients’ medical history through digitally recorded data within a few seconds, making diagnosing and treating easier and more time-efficient.
Partnering with other sectors like the information and communication sectors and the innovation sector can help disseminate the innovations to those in need. Those located in low-resource settings can also benefit from this partnership with the different sectors. Innovations like hand-held ultrasound and pulse oximeters will provide a quick diagnosis to the primary health care centers. Dissemination of the word about these technologies will be easier with the help of the information and communication department.

EMPOWERING PEOPLE AND ENGAGING COMMUNITIES

No matter how far a patient is, he can connect with the doctor online. Not only that, connecting and forming a community of patients and discussing and emotionally connecting with them has become easy. Accessing high-quality health information has become relatively effortless with the help of the internet. Technology aids transparency, and the process of feedback giving of the experience of health care is available one click away from the patients.

CHALLENGES

The Healthcare sector deals with the sensitive and confidential data of patients that need a proper set of security. Handling the data of every patient with utmost security is a necessity. A proper algorithm needs to be there for encryption, transmission, and decryption.
Technology is making its way in the healthcare sector, but understanding technology is also necessary for healthcare professionals and patients. In many studies, researchers discovered that doctors are reluctant to adopt this technology or have no time to learn this technology.
Further, patients also do not find it necessary to learn and adopt these technologies in their lives. Another problem lies in the cost of the technology, which is higher than we expect it to be. Many hospitals are reluctant to purchase these technologies; only because they find them costlier. To utilize technologies, we need stable and secure internet services in our country; that are unavailable in many parts of our country.

CONCLUSION

The inclusion of technology has opened tons of opportunities for improving primary health care facilities. They have changed the way of diagnosing and treating patients. They have created new patterns of communication, empowerment, and engagement. The government’s commitment to improving primary health care and protecting its commitment to inclusive and equitable growth promises a lot of development soon.

REFERENCES

https://healthadministrationdegree.usc.edu/blog/3-challenges-of-technology-implementation-in-healthcare/

https://www.who.int/news-room/fact-sheets/detail/primary-health-care

https://eduindex.org/category/literature/