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Table 3 Limitations of learning by stage and by blocks of learning

From: The place of learning in a universal health coverage health policy process: the case of the RAMED policy in Morocco

  Leadership that reinforces learning Environment supportive to learning Purposeful learning processes
Agenda-setting and policy formulation • Continued influence of the hierarchical structure of public administration • Sometimes a top-down approach in decisions • Difficulty in expressing all the points of view • Learning more at the individual level with weak organisational learning • The sharing was not for all aspects (some retention among departments) • Practical processes were not systematised • Most developed knowledge was tacit • The learning agenda was episodic and ephemeral, and not integrated into the routine of organisations • Problems storing the knowledge for further use
Policy implementation • Weak autonomy of hospital directors • Lack of resources to encourage learning at the local level • Continued influence of the hierarchical structure of the public administration • Weak integrated information system • Weak sharing with other departments at regional level • People were not reassured enough to express their opinion regarding the design of guidelines and regulations • Openness to expressing ideas depended on the profile of the manager • There were overlapping roles of entities involved in RAMED (conflicts) • Learning processes were quite ephemeral • Unshared reports (lack of platforms for sharing) • The practical processes of learning were not systematic (lack of systematic knowledge management strategy)
Policy evaluation • The Ministry of Finance did not adopt the recommendations of the evaluation to increase resources for health • Participation in the evaluation was limited to a few persons from the Ministry of Health, not a large participation in the discussion of recommendations • Weak translation of the evaluation’s recommendation to action in the field for the implementation of RAMED