Health & Fitness

Slow policy execution adds pain to ailing health sector

Surgeons at work
Surgeons at work. Timely policy implementation key to effective health service delivery. FILE PHOTO | NMG 

Columnist Bitange Ndemo’s Daily Nation article last month on slow adoption and implementation of policy into government practice was spot on. However, it is not just limited to State bureaucracy but also cuts through the medical field.

Nowhere else is this more detailed than the tale of the “discovery” of the cure for scurvy. The disease arises as a deficiency of Vitamin C. For those keen on historical anecdotes, the famous Lind experiment aboard Her Majesty’s ship HMS Salisbury, a British Naval vessel has been immortalised among doctors and nutritionists.

To the layperson, lack of Vitamin C or ascorbic acid is characterised by weakness, skin and connective tissue degeneration, nervous system complaints, fatigues as well as teeth and gums disease. Ascorbic acid is responsible for multiple enzymatic reactions in biochemical reactions and is also an antioxidant at the cellular level.

Back to the story itself, with better navigation and shipbuilding sailors spent lengthy periods in the oceans often months on end with little access to fresh fruits and vegetables, the dietary sources of ascorbic acid. They fed on fish and dried foods while at sea. Due to the scurvy, many sailors were often weakened and worsened by the prolonged seafaring.

Lind’s classical experiment conducted and ultimately published as Treatise on the Scurvy in 1753, was hugely attributed to his canonical experimental approach, meticulous record keeping, diary notes detailed with dates and progress of the patient groups.

At a workshop on how to move from policy to implementation in a public context in Amsterdam last month, a commissioner at the National Health System recanted this story. His conclusion, not surprisingly is that despite Lind sharing his observations with the naval superiors, it took about 40 years for the navy to implement a policy of vitamin C rich diets to address the scurvy scourge. Forty years! This also only after his death.

So even in healthcare where prompt policy implementation has a potential to save many lives, improve efficiency, transitioning to practice is hard.

A few critiques were laid at the study’s lack of rigorous science but time has indeed proven the association between scurvy and vitamin c.

For future reference, the problem is how to improve policy adoption and implementation. There are three levels of policy influence: formulators, implementers and adopters.

Achieving a shift needs a contextual recognition of adopters as the crucial group. Their buy-in is necessary for a rapid uptake. Policy can be formulated afterwards.

Interestingly also, is a shift from a policy. In healthcare reversal of previous practice takes a while to erase. Perhaps as a result of human nature to dwell on the familiar when faced with change.

On a good note, Vitamin C is now amongst the third highest consumed supplements globally.