The WHO and primary healthcare reform: Mind the implementation gap

Policy makers are well known for producing grand plans. However, they routinely overlook the fact that their big idea for the way forward may account for perhaps only 5% or 10% of the healthcare policy process. The rest sits in the practical undertakings of policy adoption and implementation (1,2). The literature points to various conditions that need to be taken into account if policy is to achieve its goals in implementation (3,4). These include whether pre-existing institutional arrangements (the regulatory, financing and organisational forms as well as the traditions that govern how healthcare is delivered in a country) will be conducive to adopting and promoting new policy directions. Issues such as the scope of change required will influence potential for change, as will support from among those affected (e.g. healthcare providers and interest groups). Routinely, policy makers avoid analysing these conditions and simply hand responsibility for implementation to someone else. This is why the grandest of policies often falter in execution (5).