The Health Systems Trust and the integrated nutrition programme : a case study of policy implementation.
The South African government has a constitutional obligation to provide health care services to all South Africans. The Department of Health (DOH) has been tasked with delivering health care services to a country which is still recovering from the inequities of the past where unemployment, lack of education, and poverty rates are high. Poverty contributes to food insecurity in many households. Household food insecurity contributes to malnutrition, morbidity, and mortality, particularly in children. Policies are made to tackle a particular identified social problem. In 1995, the DOH introduced the Integrated Nutrition Program (INP) to deal with malnutrition in this country. The Health Systems Trust (HST) is an independent NGO which was established in 1992 to support the transformation of the South African healthcare system. The HST implements the community component of the INP with the aim to contribute to household food security and health status of children under the age of 5 years (INP Progress Report 2002/3: 3). The purpose of the study is to identify policy implementation issues as identified by the literature, particularly the literature on policy networks, while analyzing the implementation of the INP. The key focus of this study is policy implementation. It particularly looks at policy networks as forums for policy making and implementation. It looks at interactions between government and non-governmental organisations, more particularly the DOH and HST and their networking with other organisations. A qualitative methodology was used because, as Marlow (1993:67) argues, a qualitative approach may be more effective because the answers can provide a detailed description of the program. Primary and secondary data was collected from the DOH as well as the HST. Purposive sampling was applied where participants were selected on the basis of their relevance to the study. Interviews were held with key informants. A structured questionnaire was designed for the key participants at the HST as well as the key participants of the DOH. The implementation of the INP by the DOH and HST is an illustration of a policy network in action. The study on the HST's implementation of the INP emphasizes that government cannot afford to ignore the contribution NGOs have made and continue to make in service delivery 'because of their cost effectiveness and ability to engage people at the grassroots level, especially in remote areas' (Taylor, cited in Camay and Gordon, 2002:37). Factors which contribute to network failure, according to Kickert et al (1997:9) include: a lack of incentives to cooperate and the existence of blockades to collective action; proposed goals may be vague; important actors may be absent, while the presence of other actors may discourage the participation of necessary actors; crucial information about goals, means and actors may be lacking; discretionary power may be absent; and the absence of commitment of actors to the common purpose. All the above were evident in the implementation of the INP. The implementation of the INP is for the most part successful. The issue is about whether it is a relationship which will be able to endure and overcome its existing weaknesses thereby sustaining the delivery of an integrated nutrition program.