Why child health policies in post-apartheid South Africa have not performed as intended: the case of the School Health Policy

Le résumé fourni par la source

The unprecedented scale of health sector reform in the course of radical political transformation in post-apartheid South Africa is well-documented. This thesis examines child health policy reform as a crucial part of this process. The goals of broader health sector reform were to improve the overall health status of citizens, in particular those most vulnerable, and eliminate inequities in health service provision and health status outcomes. Although children were accorded explicit prioritisation during this time, child health indicators remain and some have worsened. Amidst the documented explanations for the progress with child health indicators, the specific role and contribution of child health had not been interrogated. The thesis examines the development, design and implementation of national child health policies, with particular focus on equity. The National School Health Policy serves as a case-study for the analysis. Three complementary policy analysis frameworks guide the enquiry. Findings are based on a documentary analysis of key and 81 qualitative interviews with national policy makers and managers, provincial and district managers, and service providers in three socioeconomically different provinces of South Africa. The common assertion by South African health system analysts, that are good, but implementation is poor, is refuted by this research. The findings show that child health have many deficiencies in their design and development. These poor policies contribute to inadequate child health service provision, which in turn have a bearing on child health outcomes. In particular the failure in clearly defining and conceptualising equity in policy development and design contributed to the absence of equity considerations in the implementation phase. The explanations for these policy failures include: lack of strategic direction for child health services; policy making capacity; a lack of clear policy translation; and the diverse politics, power and passion of policy actors. Broader health system factors, such as an immature and poorly functioning district health system, compound these policy failures. The thesis deepens the understanding of child health policy reform through a retrospective policy analysis and so contributes to the body of knowledge on policy reform in South Africa and in low- and middle-income countries more generally.

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