The SAZA study: implementing health financing reform in South Africa and Zambia

This paper, published in Health Policy and Planning, explores the policy-making process in the 1990s in South Africa and Zambia, in relation to health care financing reforms, focusing on the role of technical analysts and technical knowledge. It finds that moments of political transition in both countries provided windows of opportunity in which to introduce new policies, but also created environments that limited the equity and sustainability gains achieved. Technical analysts had varying and often limited influence, whereas front-line health workers, middle level managers and the public had important influences over policy implementation and its impacts.

The paper highlights failures in communicating policy changes, in consulting with groups which would influence the way they were implemented, and in gaining adequate support for the policies. Its conclusions focus on the need to develop both technical capacity and strategies that support policy change. It advocates increasing the numbers of analysts working within government; providing in-service training; and strengthening the links between government and non-government analysts. It also suggests that analysts could work with middle managers and health workers to ensure adequate consideration is given to the reality of implementation. Other recommendations include recognising the need to balance political and technical considerations in developing policy changes.