Developing a policy analysis framework to establish level of access and equity embedded in South African health policies for people with disabilities
Purpose To date no health policy analysis tool has been developed to analyse access and equity for people with disabilities. Further, there is very little information available on health and disability policy implementation. The intention of this research is to develop a health policy framework to analyse access and equity, focussing on people with disabilities, that can be used by policy makers. This research analyses four health policies and focuses on the facilitators and the implementation barriers. The findings of this research will impact on new policies developed in the future. Method The study included both a desk - top review and a descriptive study. The desk - top review entailed the formulation of a disability - focussed framework for health policy. This was then used to analyse health policies in terms of their disability inclusiveness. Qualitative data was gathered from interviews and questionnaires and focussed on policy processes and implementation. This was incorporated into the analysis. An ideal seven - step policy process model was developed. This was used to compare the reported policy process with the four policies followed. The four health policies used in the research are: the Primary Health Care Policy, the National Rehabilitation Policy, the Provision of Assistive Devices Guidelines and the Free Health Care Policy. Four key informants with extensive experience and knowledge were interviewed on policy processes and implementation. Questionnaires were also sent to Provincial Rehabilitation Managers to obtain their viewpoints on barriers and facilitators to policy implementation. Results Analysis of the four health policies showed varying levels of access and equity features. In terms of policy processes: all four policies had different stakeholders who initiated the policy development process. Two of the policies viz. the National Rehabilitation Policy and the Provision of Assistive Devices Guidelines, had people with disabilities as part of the stakeholder group involved in the policy formulation. The National Rehabilitation Policy had a comprehensive monitoring and evaluation section whereas this was absent in the other three policies. From the information gained from interviews and questionnaires, it appeared that the barriers to policy implementation included: attitudes, environmental access, human and financial resources. Facilitators to policy implementation include: policy process and design, availability of human and financial resources, support systems, management support, organisational structures and finally positive attitudes that all impacted favourably on policy implementation. Conclusions The developed health policy analysis framework served its purpose. Most policies did not have monitoring and evaluation guidelines that make implementation difficult to assess. Recommendations are made to improve policy design and content, specifically related to access and equity. Intersectoral collaboration and disability coordination needs to be improved. People with disabilities also need to engage with government departments, to monitor implemented policies and to advocate for change from outside the health system.