Reforming operational policies: A pathway to improving reproductive health programs
Many countries around the world have made great progress in improving reproductive health programs that now reflect the principles of the 1994 ICPD Programme of Action. Governments and donors have pursued two main routes to improving reproductive heath. First, they have enacted national policies and laws aimed at expanding services and raising the quality of available services. Second, they have implemented a wide range of service projects and demonstrations to show how services can be enhanced and client education improved. Too often, however, national policies and laws are not translated into systemwide programs and improved reproductive health services, especially for the poor. Because these doctrines are necessarily broad and encompassing, they neglect the structures and systems that serve as a bridge between national policies and local programs. Projects and demonstrations are often not replicable because they are not financially sustainable in the long run. More important, they generally do not systematically address the underlying policy constraints in the structures and systems that affect the service delivery environment. This paper focuses on the vast arena between national policies and the point of service delivery, which is the domain of operational policies.
Operational policies are the rules, regulations, codes, guidelines, and administrative norms that governments use to translate national laws and policies into programs and services. While national policies provide necessary leadership and guidance, operational policies are the means for implementing those policies. In many cases, program deficiencies, such as a lack of trained service providers and other resources, can be traced to operational policies that are inadequate, inappropriate, or outdated. Poor operational policies result in wastage and inefficiency that pervades every clinic, health post, and hospital and adversely affects health personnel and every client. When drafted or modified appropriately, operational policies can help enhance the quality of reproductive health programs by making more efficient use of existing resources.
The paper discusses the nature of operational policies, stresses the important role they play in the continuum from national decrees to local services, and provides a framework for operational policy reform.