School of Public Health, Rue Lamfadel Cherkaoui, Madinat Al Irfane, BP-6329, Rabat, Morocco.
IRSS - Clos Chapelle-aux-champs 30 bte B1.30.13 à 1200 Woluwe-Saint-Lambert, Université Catholique de Louvain (UCL) Ottignies-Louvain-la-Neuve, Brussels, Belgium.
Health Res Policy Syst. 2019 Feb 21;17(1):21. doi: 10.1186/s12961-019-0421-6.
To progress towards universal health coverage (UHC), each country will have to develop its systemic learning capacity. This study aims at documenting how, across time, learning can feed into a UHC policy process, and how the latter can itself strengthen (or not) the learning capacity of the health system. It specifically focuses on the development of a major health financing policy aligned with the UHC goal in Morocco, the RAMED, a health financing scheme covering hospital costs for the poorest segment of the population.
We conducted a retrospective analysis of the RAMED policy for the period between 1997 and 2018, along with a case study design. For the data collection and analysis, we developed a framework combining Garvin's learning organisation framework and the heuristic health policy analysis framework. We gathered data from key informants and document reviews.
The study confirmed the importance of learning during the different stages of the RAMED policy process. There is evidence of a leadership encouraging learning, the introduction and adoption of knowledge management processes, and the start of a transformation of the administrative culture. Yet, our study also showed some major shortcomings, especially the lack of structure of the learning, and insufficient effort to systemise and sustain a transformation of practices within the health administration. Our study also confirms that the learning changes in nature across the different stages of the policy process.
The policy decisions and the implementation strategy create a learning dynamic, though not structured in all cases. Despite the positive interaction between learning and the RAMED policy, the opportunity to push forward a more structural transformation towards a learning system has not been fully seized. Hierarchical logics still largely prevail in the Moroccan health administration. The impact of future health policies for both the target beneficiaries and the health system will be bigger if their design integrates purposeful and structured actions in favour of organisational learning. This recommendation probably applies beyond Morocco.
为了实现全民健康覆盖（UHC），每个国家都必须发展其系统学习能力。本研究旨在记录学习如何随着时间的推移融入 UHC 政策进程，以及后者如何加强（或不加强）卫生系统的学习能力。它特别关注摩洛哥制定与 UHC 目标一致的主要卫生筹资政策 RAMED 的情况，这是一个为最贫困人群的医院费用提供资金的卫生筹资计划。
我们对 RAMED 政策进行了 1997 年至 2018 年期间的回顾性分析，并进行了案例研究设计。为了收集和分析数据，我们开发了一个结合了加文学习型组织框架和启发式卫生政策分析框架的框架。我们从主要信息来源和文件审查中收集数据。
研究证实了在 RAMED 政策过程的不同阶段学习的重要性。有证据表明领导层鼓励学习，引入和采用知识管理流程，并开始改变行政文化。然而，我们的研究也显示出一些重大缺陷，特别是学习缺乏结构，以及在卫生行政部门系统地和持续地改变做法方面的努力不足。我们的研究还证实，学习在政策过程的不同阶段性质上发生了变化。
政策决策和实施策略创造了一种学习动力，但并非在所有情况下都具有结构性。尽管学习与 RAMED 政策之间存在积极的相互作用，但没有充分抓住机会推动向学习系统的更结构性转变。等级逻辑在摩洛哥卫生行政部门仍然占主导地位。如果未来的卫生政策在设计上纳入有利于组织学习的有目的和有结构的行动，那么对目标受益人和卫生系统的影响将更大。这一建议可能不仅适用于摩洛哥。
