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