A comparative analysis of oral healthcare policy development between a developed country (Australia) and a developing country (South Africa)

Abstract

Introduction: Health policy analysis aims to explain the interaction between institutions, interests and ideas in the policy process in order to ensure the best possible health outcomes. Cross-national policy analysis of oral health policies can be undertaken using a conceptual framework, and the results of this analysis could allow for cross-national lessons to be learnt that could be used to improve policy processes. This could result in improved population oral health service delivery and health outcomes. Aim: To undertake a cross-national policy analysis of a developed country (Australia) and a developing country (South Africa) in order to highlight lessons that could be learnt to improve policy development, implementation, reform and service delivery, that could lead to improved oral healthcare policy-making and provision. Objectives: This study sought to develop, and apply, a conceptual framework to undertake a cross-national comparative policy analysis study of a developed country (Australia) and a developing country (South Africa). This developed conceptual framework would need to allow policy analysts to undertake a comprehensive comparative policy analysis that could lead to an understanding and contextualisation of the complex policy environments found in developed and developing countries. Methods: A cross-national policy analysis of oral health policies for the period 2001-2011 was undertaken. A policy analysis conceptual framework was developed and used to comparatively analyse the various constructs, policy influences and policy actors that were involved in oral health policy-making. Data from a desktop literature search, and key stakeholder interviews were comparatively analysed using thematic content analysis, and a Strengths, Weakness, Opportunities and Threats (SWOT) analysis was used to identify lessons in policy development, implementation and reform that could be applied cross-nationally. Thereafter a Systems Dynamic (SD) computer simulation model was constructed and applied cross-nationally to human resources for health forecasting in order to expound the use of SD modelling in policy development and reform.

Results: The results revealed that both countries have policy development and implementation structures that are historically embedded within the countries unique social contexts, and offer lessons regarding their strengths and weaknesses that could be applied cross-nationally to improve healthcare policy-making and provision. The results of the document analysis, together with the interviews and literature review, were triangulated and comparatively analysed using the themes outlined in the conceptual framework. These results revealed that a general policy development theory could be formulated and modified to suit local conditions. The need for high-quality valid and reliable data was also highlighted. Another result is the need for the appropriate needs-based and equitable reallocation of resources in order to ensure a feasible and practical oral healthcare system. Conclusions: The lessons offered from the cross-national oral health policy analysis could be adjusted and implemented to both developed and developing countries in order to improve their oral health policy development, implementation and reform structures and processes.