Understanding Policy Making and Implementation in Pakistan: A Case of Hospital Autonomy Reforms

Abstract

Pakistan a complex country – with great unrealized potential – has its peculiar history, culture, traditions and dynamics. Most important contextual factors are its colonial legacy which involves governance model including civil and military bureaucracies; generalist vs. specialist debate and political instability. Policy making and implementation are vital processes of the governance systems of a society. In Pakistan, these processes are strongly influences by its colonial legacy. There are various different ideal models which explain these processes however most of such models are normative in nature and don’t explain the happenings which occur in Pakistan vis-à-vis these processes. While studying the Hospital autonomy reforms, a behavioral descriptive model appears to emerge which explains a few dynamics of Pakistan governance system. At policy level, it was found that Hospital Autonomy Reforms were international capitalist agenda imposed through donor on different countries including Pakistan. At the implementation level, the findings of the research are that this process is not a straight forward, apolitical process rather very much a political one in which different stakeholders influence it according to their interests.

Key words: Hospital reform, public policy, implementation, colonial legacy