Capital to clinic: implementing policy during COVID-19

July 29, 2021 by Cassie Kobrin

Policymaking and implementation processes shifted during the pandemic. PATH experts offer insight on leveraging these shifts to achieve current and future health goals.

23650.jpeg A PATH staff member meets with Dr. Madické Diagne, chief of the inspection division of Senegal’s Bureau of Pharmacy and Medications. PATH/Gabe Bienczycki

Aminata Lenormand, a former PATH staff member, shown consulting with Dr. Madické Diagne, chief of the inspection division of Senegal’s Bureau of Pharmacy and Medications, prior to the pandemic. Photo: PATH/Gabe Bienczycki.

Equitable, robust health policies are critical for achieving better health outcomes and improving people’s lives. But too often, policies are developed and adopted in national capitals, and then sit idle on bookshelves, failing to benefit those the policy was designed to help.

During the COVID-19 pandemic, the policy landscape shifted in many of the African countries where PATH works. Policymakers had to act quickly to develop guidelines for pandemic response, while ensuring the continued provision of essential health services like maternal health and immunization.

In the midst of the global crisis, there was no time to waste—governments adopted and implemented policies at unprecedented speeds. They then had to adapt those policies to get them out as efficiently as possible—from national capitals to clinics in every county or province.

“We saw many of our partner governments acting swiftly, decisively, and accountably in unprecedented ways,” says Rosemarie Muganda, PATH’s regional advocacy director for Africa. “This pandemic forced governments to pursue a more inclusive approach to policymaking, bringing together key players from all sectors to collaborate toward a common goal.”

Fast-tracking policies during a crisis

PATH has decades of experience partnering with governments and civil society to develop and disseminate health policies.

“With the onset of COVID-19, we worked with governments to design context-specific policies and support their rapid distribution,” Rosemarie says. “We also helped maintain communication with health care providers on the front lines of COVID-19 response.”

Fast-tracking policy development and implementation during the pandemic illuminated what works—and what doesn't—in the cycle of policy development, implementation, and adaptation.

This trial by fire made 2020 a unique opportunity to learn about and document effective policy implementation methods. PATH is now exploring how these learnings can help strengthen policy design and implementation systems in the future. Key insights include:

  • Develop policies that are fit-for-purpose and fit-for-context: good policies address the root causes of a health challenge, tailored to a specific regional context. Policies are too often developed routinely, with no sense of urgency or no guarantee that they will be implemented. The COVID-19 pandemic meant that every policy put in place necessarily responded to a specific need within a certain context.
  • Design the policies with implementation in mind: policies should include an implementation plan that covers financing, indicators for measuring success, and clearly defined roles and responsibilities.
  • Make policies inclusive: facilitate dialogue with all who stand to benefit, or lose out, from the policy.

In Uganda, inclusive policymaking helped the government tap into new sources of funding for COVID-19 relief.

“Non-state actors, individuals, corporate entities—[they] all came together at the request of the president to contribute to the national COVID relief fund,” says Dr. Aloysius Ssennyonjo, a lecturer at Makerere University School of Public Health in Uganda.

Dr. Aloysius says that policymakers often struggle to secure financing, while overlooking untapped community resources—resources that can become available when new funders see they have a stake in the issue.

Good policy implementation is also adaptable and can be updated even while it’s being implemented. Feedback loops were among the most important features of the Kenya Ministry of Health’s pandemic response policymaking process.

“We had people who were able to tell us, this doesn’t seem to work or that seems to be happening,” says Dr. Agatha Olago, head of the Division of Primary Health Services and Family Medicine at Kenya’s Ministry of Health. “So the feedback coming in from communications teams helped guide the policies as they were being created.”

As the pandemic progressed, the ministry transferred more and more policymaking power to the county level, so context-specific adaptations could be made quickly and effectively.

These new policies and strategic adaptations to existing policies help ensure that countries can balance the demands of COVID-19 response with the need to maintain the delivery of other essential health services. But these policy improvements can add value well beyond the pandemic.

Effective policymaking beyond COVID-19

To fight the ongoing threat of COVID-19, we must ensure adaptations made during the pandemic can improve health systems in the long term.

“We are looking closely at policy lessons from COVID-19 response over the past year, to identify what can continue to inform the policy cycle from development to implementation,” said Rosemarie.

PATH’s new tool Capital to Clinic: A resource for effective advocacy and policy implementation, guides advocates as they work to move the policy process from development to implementation and evaluation.

C2C infographic capture.JPG

Stages in the policy cycle. Note that this is a nonlinear process. The actions listed are not in chronological order and some actions may be ongoing. Image: PATH/Jennifer Fox.

“Advocates play a key role in driving policy implementation,” Rosemarie says. “They hold policymakers accountable for effective policy dissemination and communication, allocation of resources, citizen and community engagement, and evaluation of how the policy is working. It’s not just in the hands of government. We hope this tool supports advocates as they demand good, equitable, health policies in their communities.”