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Policy LabPolicy to Practice Fellowship · working tool

Concepts library

The full set of concepts the advisor can raise, ordered by how often they kill real policies. Open any row for the full card. Read them before you draft: most failed health policies fail in one of these ways, and none of them is new.

‹ All concepts
public administration

The implementation gap

Policy is remade at the point of delivery. Nurses, clerks and district officers with too little time and too many rules will adapt, ration and reinterpret whatever the circular says. Lipsky called them street-level bureaucrats, and their coping decisions, repeated daily, become the real policy.

Published example: Kenya removed maternity fees by presidential directive in June 2013. A mixed-methods process evaluation (Tama et al., Int J Health Policy Manag 2018) found rapid implementation with confused stakeholders, delayed reimbursements, and a surge in deliveries that facility capacity was never expanded to meet. The front line absorbed the gap, and quality paid for it. Read More.

Before you design, consider

  • Ask what your instrument costs the person who must comply, in time, money and risk, and fund that cost explicitly.
  • Pair every mandate with a support or enforcement mechanism you can actually staff.
  • Pilot the paperwork: if the form takes 20 minutes, the form is the policy.
Raised automatically by the advisor when your draft touches this pattern.