From vision to reality: Implementing health reforms in Lusaka, Zambia

In sub-Saharan Africa, programmes to restructure the nature of the provision of health care frequently include measures for cost-sharing, increased local management and popular participation. However, similar reform programmes may have very different expression in different country contexts and there is a need for detailed studies of implementation processes. At the same time, common analytical categories need to be found to facilitate some comparison across such individual case studies. Two concepts are offered as starting points in this: veto points within an interaction, feedback model of the policy process and a view of power as having three dimensions, overt, covert and latent. These concepts have not been practically applied to case studies of health reform in low income countries and their relevance is demonstrated through a study of Lusaka, Zambia. The study describes how different actors in a health system, from the national Ministry down to the local population, interpret and experience reform directives and activities. © 1997 by John Wiley & Sons, Ltd.