Health reforms and policy capacity: the Canadian experience

Area of Science:

• Health Services Research
• Public Policy
• Organizational Capacity

Background:

• Health system strengthening necessitates integrated leadership and policy capacity for effective transformation.
• Policy capacity and leadership are interdependent yet challenging to align cohesively.
• The nested model of policy capacity provides a framework for analysis.

Purpose of the Study:

• To empirically investigate how health reformers in seven Canadian provinces conceptualize and address policy capacity.
• To examine the evolution of policy capacity representations within Canadian health reforms from 1990 to 2020.
• To identify core dilemmas encountered by provinces in developing policy capacity through health reforms.

Main Methods:

• Analysis of scientific and grey literature, including legislation, annual reports, and meeting minutes.
• Qualitative data collection through interviews with 54 key informants involved in health reforms.
• Application of the nested model of policy capacity to frame the analysis.

Main Results:

• Identified diverse framings and considerations of policy capacity across seven Canadian provinces.
• Documented emerging representations of policy capacity within the context of health reforms over three decades.
• Uncovered a series of core dilemmas inherent in provincial attempts to build policy capacity.

Conclusions:

• Developing coherent policy capacity is a complex, multi-faceted challenge within health system reform.
• Provincial approaches to health reform highlight significant dilemmas in constructing and utilizing policy capacity.
• Understanding these dilemmas is crucial for future health system strengthening initiatives.