Here top-down and bottom-up approaches are used to discuss the implementation of any policy initiatives. According to the top-down approach, the policy initiatives that have clear and logical objectives and can show how the initiatives can lead to the desired outcome have greater chances of correct implementation. Similar to agenda setting, policy initiatives should have support from both the legislature and interest groups. A structured process and involvement of highly committed and skillful implementing officials are also required. Another important aspect of policy initiative implementation is its neutrality in socioeconomic changes that can hamper political stability. A major prerequisite for policy initiatives to be implemented is adequate time and resources, the direct relationship between cause and effect, minimal dependency relationships, a clear understanding and agreement on objectives, specified tasks, perfect coordination and communication, authority obtaining the perfect compliance (Buse et al., 2012, pp. 131-132).
The bottom-up approach on other hand emphasizes the role played by implementers as active participants because they can change the way policy is implemented. The frontline staff like health workers, local government officials, and teachers can reshape policy for their own ends; mainly due to the conflict of interest between them and the policymakers. Thus, policy initiatives with good understanding and working with the cultures, good relations, networks, persuasion, and communication are only implemented (Buse et al., 2012, pp. 133-135) .
According to the principle agent theory, discretion and complexity of the principal-agent relationship are the core factor to determine the implementation of policy; which in turn are affected by the nature of the problem, the context around the problem, and the organization of machinery to implement the policy. Policy initiatives that are short-term, clearly defined, independent, cost-effective, and have a technical component are easier to implement whereas, the policy initiatives that are complex, politically and culturally sensitive, interdependent, and long-term have a high chance of getting languish. Context like economic growth, technological change, and availability of resources also determines the implementation of policy initiatives (Buse et al., 2012, pp. 136-137). This means that even if a policy that requires a comparatively high operating cost has been finalized, it cannot be implemented if there is a drastic decrease in the economic status of the country.
Improvement in maternal health can be analyzed to see the reasons for policy initiatives to be implemented. The high maternal mortality rate is considered one of the major health issues in Nepal. So, the policy was formulated with various strategies like compulsory ANC and PNC visits, institutional delivery, and family planning were introduced and promoted. This policy initiative was not only implemented but could also reduce the maternal mortality rate from 850 to 170 per 100000 live births from 1991 to 2011. It was because of a number of reasons: political prioritization of maternal and child health, increased financial investment, and support from international communities like the UN and WHO. Also, these initiatives were feasible to achieve as the primary health care institutions were already providing free health care services and the health personnel were easy to train as skilled birth attendants (WHO, Ministry of Health & Population, Nepal 2015) On the contrary if there was the shift in government’s focus while implementing these initiatives like the budget reallocation which could make it hard to finance free health care or SBA training, the implementation would not have been possible.
Policy initiatives implementation in developing countries also depends upon foreign aid as they may be imposed and the country might not have relevant technologies, the pressure to achieve the indicators along with limited and short funding cycles, pressure to achieve, short funding cycles and administrative difficulties may determine the implementation (Buse et al., 2012, p. 130).
Different approach explained the implementation criteria for policy initiatives but it seems that only the initiatives that are most relevant, time appropriate, culturally and politically neutral, efficient, and effective tends to be successful whereas the others get to languish.
References
- Buse, K., Mays, N., & Walt, G. (2012). Making health policy (2nd ed.). Maidenhead: McGraw-Hill.
- World Health Organization & Ministry of Health and Population, Nepal. (2015). Success factors for women’s and children’s health: Nepal (9789241509046). Retrieved from Geneva: https://apps.who.int/iris/handle/10665/254482