National Health Strategic Plans map out the strategic goals and objectives to be achieved in the health sector over a 5-year period. The broad strategic intentions are stated within national development plans and the sector’s strategic policies are developed and written to conform to the national assessment of economic and demographic contexts. They make good sense at the national level, and when approved by Cabinet they form the basis for resourcing the ministry through ministries of finance and public service, and for attracting the support of development partners.
Off to a good start, so why do they often have limited success? A recent review of the Solomon Islands National Health Strategic Plan 2016-20, and a survey of middle management students in the Postgraduate Diploma in Health Leadership and Management at the Solomon Islands National University have revealed why some NHSPs remain as well-reasoned, formally stated policy in documents, but have little effect on the health system’s operations. It has become a cliché that documents are written to remain on shelves. Communication of the strategy throughout the system is assumed; that program leaders and heads of services will be sufficiently familiar with the policies to communicate them effectively.
Provincial health directors, middle managers, health program and service leaders may be aware of the document but not of the strategic intentions, and they see strategic policy as important for higher levels of management, but their own work remains within the constraints of operational policy. Few are aware of their potential to change operations in line with strategic direction and policy intent.
Effective leadership operates in the space between strategic and operational policy and ask the question ‘what can we do to improve our operations in line with strategic policy direction’.
Graham Roberts PhD