背景:世界范围内,全民健康覆盖(UHC)热情与日俱增。南非政府于2012年开始试行旨在实现UHC的政策。这些全民健康覆盖政策已经并正在十个选定的试点地区推出。我们的研究探索了参与UHC政策实施的71个参与者的政策实施经验,在一个使用上下文交互理论(CIT)镜头的南非试点地区。
方法:我们的研究应用了双演员演绎实现理论,上下文互动理论(CIT)分析了来自南非一个国家健康保险(NHI)试点区的71个关键线人访谈。该理论使用动机,信息,电源,资源和这些资源之间的相互作用来解释实施经验和成果。研究问题集中在CIT原则在解释参与者观察到的实施经验和结果方面的效用,特别是政策-实践差距。
结果:AllCIT中心原则(信息,动机,电源,资源和互动)是行为者在其政策实施经验中提到的,这些原则的缺乏或存在被解释为政策执行的促进者或障碍。人们发现该理论对于解释决策者和促进者的政策实施经验非常有用。
结论:在这种情况下存在但未被CIT完全捕获的核心原则是领导力。领导互动被揭示为政策实施的关键,因此,我们建议将领导力互动纳入当前的CIT中心原则,成为动力,信息,电源,资源,所有这些的领导和互动。
BACKGROUND: World-wide, there is growing universal health coverage (UHC) enthusiasm. The South African government began piloting policies aimed at achieving UHC in 2012. These UHC policies have been and are being rolled out in the ten selected pilot districts. Our study explored policy implementation experiences of 71 actors involved in UHC policy implementation, in one South African pilot district using the Contextual Interaction Theory (CIT) lens.
METHODS: Our study applied a two-actor deductive theory of implementation, Contextual Interaction Theory (CIT) to analyse 71 key informant interviews from one National Health Insurance (NHI) pilot district in South Africa. The theory uses motivation, information, power, resources and the interaction of these to explain implementation experiences and outcomes. The research question centred on the utility of CIT tenets in explaining the observed implementation experiences of actors and outcomes particularly policy- practice gaps.
RESULTS: All CIT central tenets (information, motivation, power, resources and interactions) were alluded to by actors in their policy implementation experiences, a lack or presence of these tenets were explained as either a facilitator or barrier to policy implementation. This theory was found as very useful in explaining policy implementation experiences of both policy makers and facilitators.
CONCLUSIONS: A central tenet that was present in this context but not fully captured by CIT was leadership. Leadership interactions were revealed as critical for policy implementation, hence we propose the inclusion of leadership interactions to the current CIT central tenets, to become motivation, information, power, resources, leadership and interactions of all these.