The factors affecting health policy implementation performance in primary health care: An empirical study of the sub-district level health facilities in Bangladesh

Abstract

The magnitude of how health policy implementation performance is taking route at the national level is a very important issue as far as world population levels in relation to future workforces are concerned. These require properly implementation of health policy by the respective governments. However, it is noteworthy that not all countries have the same factors affecting health policy implementation. This study concerns the examination of the situation of primary health care at the sub-district level in Bangladesh. Hence, the specific purpose of the study was to assess the factors affecting health policy implementation performance in primary health care in Bangladesh. An integrated conceptual framework and models were developed based on a review of the literature. The primary data were collected from the total population of 421 Upazilla Health Complexes (UHC) using a survey questionnaire mainly through postal and email survey and the respondents were the Upazila Health and Family Planning Officers (UH&FPOs). Hierarchical multiple regression analysis as a tool of the quantitative methods was used. The results revealed that four out of seven explanatory variables were statistically significant and had a unique contribution for the relationships with health policy implementation performance ordering as per the strength: implementer’s disposition (ID); clarity of goals and objectives (COGAO); management dynamics (MD) and coordination (COORD). The three other explanatory variables resources (equipment, human resources, infrastructure, REHI), adequate budget and financial autonomy (ABFA) and micro level support from local stakeholders (MLSLS) were found positive but not statistically significant. Hence, the study revealed that implementer’s disposition (ID), clarity of goals and objectives (COGAO), management dynamics (MD), and coordination (COORD) were the most determining factors in terms of influencing health policy implementation performance in primary health care in Bangladesh. The study also envisioned to recommend policy implications such as (a) the policy makers ought to revise the goals and objectives of the health policy that must be specific measurable achievable realistic and timebound (SMART), and should disseminate the policy goals and objectives among the service providers; (b) the government should allocate more financial resources, employ more health human resources and use modern technology and infrastructure for successful implementation of primary health care policies; (c) the government should emphasis on strengthening the interorganizational coordination specially between health and family planning departments; (d) the policy makers should prominence on innovation for effective health care delivery using technology, research and development and health and well-being management; (e) the policy makers would emphasis to motivate health providers regarding their responsibility, devotion and attitude to the services and recipients as the most significant determinant of health policy implementation performance in Bangladesh; (f) it is recommended the policymakers take steps to obtain adequate local levels of support from the stakeholders especially from the local government, administration or community leaders for successful implementation of health policy and (g) the policy makers think about the gender equality in order to deploy female doctors as UH&FPOs at the sub-district level health facilities. Finally, the findings expected to benefit the society considering the contribution of knowledge generated in the field of policy implementation.