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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