Primary Health Care Policy Implementation Performance in Bangladesh: Affecting Factors

Md. Mohoshin Ali


The extent of how health policy implementation performance is taking route at the national level is a very important issue as far as world population levels in relation to the future workforce is concerned. These require properly implementation of health policy by the respective government. This study was tried in unearthing factors related to primary health care policy implementation in Bangladesh. An integrated conceptual framework was developed based on a review of the literature. Primary data were collected from the total population of 424 Upazilla Health and Family Planning Officers (UH&FPO). Hierarchical multiple regression analysis as a tool of the quantitative method was used. The results revealed that four out of seven explanatory variables were statistically significant and had a unique contribution for the relationships with health policy implementation performance ordering as per the strength; Implementer’s Disposition (ID), Clarity of Goals and Objectives (COGAO), Management Dynamics (MD), and Coordination (COORD). The study also envisioned to recommend policy implications as; the policy makers ought to revise the goals and objectives of the health policy that must be specific measurable achievable realistic and timebound (SMART), government should allocate more resources in primary health care, inter-organizational coordination should be strengthened, to prominence on innovation for effective health care delivery using technology, research and development and health and well-being management, to motivate health providers regarding their responsibility, devotion and attitude, to get local  support specially from local government and administration, and to ensure gender equality deploying female doctors as UH&FPO. Finally, the findings expected to benefit the society considering the contribution of new knowledge generated in the field of policy implementation.

Full Text:



Allison, G. T. (1971). Essence of decisions. Explaining the Cuban Missile Crisis. Boston: Little , Brown & Company. Retrieved from

Bardach, E. (1977). The Implementation Game. Upper Saddle River, NJ: Prentice Hall.

Bardach, E. (2011). The Eightfold Path. A Practical Guide For Policy Analysis.

BBS. (2016). Statistical Pocket Book Bangladesh-2016. Bangaldesh Bureau of Statistics, Dhaka.

Berman, P. (1978). The study of macro and micro implementation of social policy. Public

Bhuyan, A., Jorgensen, A., & Sharma, S. (2010). Taking the pulse of policy: the policy implementation assessment tool. Washington, DC: USAID.

Bouckaert, G., Peters, B. G., & Verhoest, K. (2010). Coordination: What Is It and Why Should We Have It? In Public Sector Organizations (pp. 13–14). London: Palgrave Macmillan.

Brinkerhoff, D. W. (1999). State-Civil Society networks for policy implementation in developing countries. Policy Studies Review.

Brinkerhoff, J. M., & Brinkerhoff, D. W. (2002). Government–Nonprofit Relations in Comparative Perspective : Evolution , Themes and New Directions. Public Administration and Development, 22, 3–18.

Bryson, J. M., Crosby, B. C., & Middleton, S. M. (2006). Design and Implementation of Cross-Sector Collaboration: Propositions from the literature. Public Administration Review, (December), 22–55.

CDC National Center for Injury Prevention and Control. (2012). Brief 3 & 4: Evaluating Policy Implementation and Evaluating Policy Content. Policy Evaluation Brief Series. Retrieved from

Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Lawrence Earlbaum Associates.

Copeland, V. C., & Wexler, S. (1995). Policy Implementation in Social-Welfare - a Framework for Analysis. Journal of Sociology and Social Welfare.

DeGroff, A., & Cargo, M. (2009). Policy implementation: Implications for evaluation. New Directions for Evaluation.

DeVellis, R. F. (2003). Scale Development: Theory and Applications 3rd Edition. SAGE Publication Ltd.

DGHS. (2016). Health Buletin 2016. Health buletin 2016. Dhaka, Bangladesh. Retrieved from 2016 _2nd_edition_13_01_17.pdf

Dunn, W. N. (1981). Public policy Analysis: An introduction. Prentice-Hall, Inc., Englewood Cliffs, N.J 07632.

Dussault, G., & Dubois, C. (2003). Human Resources for Health Human resources for health policies : a critical component in health policies. Human Resources for Health.

Dye, T. (2012). Understanding Public Policy Policy Analysis.

Economist Intelligence Unit. (2010). Enabling efficient policy implementation. The Economist, 29.

Edward, T., Jennings, J., & Ewalt, J. A. G. (1998). Interorganizational Coordination , Administrative Consolidation , and Policy Performance Published by : Wiley on behalf of the American Society for Public Administration Stable URL : Linked references are available on JS. Public Administration Review, 58(5), 417–428.

Edwards, G. C. (1980). Implementing public policy. Washington, D.C: Congressional Quarterly Press.

Elmore, R. (1993). The Role of Local School Districts in Instructional Improvement. In Designing Coherent Education Policy: Improving the System (pp. 96–124).

Field, A. (2009). Discovering statistics using SPSS. Discovering statistics using SPSS 2nd ed.

Franke, V., & Guidero, A. (2012). Engaging local stakeholders: A conceptual model for effective donor-community collaboration. Institute for homeland security solutions.

Giacchino, S., & Kakabadse, A. (2003). Successful Policy Implementation: The Route to Building Self-Confident Government. International Review of Administrative Sciences.

Goggin, M. L. (1990). Implementation theory and practice. USA: Herper Collins Publishers.

Grantham, A. (2001). How Networks Explain Unintended Policy Implementation Outcomes: The Case of UK Rail Privatization. Public Administration.

Hair, J. F., Black, W. C., Babin, B. J., & Anderson, R. E. (2010). Multivariate Data Analysis. Pearson Prentice Hall.

Harold, D. L. (1971). A Pre-View of Policy Sciences. USA: Elsevier Publishing.

Health Policy Initiative, U. (2010). Taking the Pulse of Policy, (May 2010), 50.

Hill, M., & Hupe, P. (2002). Implementing Public Policy. Athenaeum Studi Periodici Di Letteratura E Storia Dell Antichita.

Horn, V., & Thiel, V. (2014). Implementation : Putting Policy into Practice. Retrieved September 11, 2017, from

Hupe, P., Hill, M., & Nangia, M. (2014). Studying implementation beyond deficit analysis: The top-down view reconsidered. Public Policy and Administration, 29(2), 145–163.

Kress, D. H., Su, Y., & Wang, H. (2016). Assessment of Primary Health Care System Performance in Nigeria: Using the Primary Health Care Performance Indicator Conceptual Framework. Health Systems & Reform, 2(4), 302–318.

Lassi, Z. S., Musavi, N. B., Maliqi, B., Mansoor, N., de Francisco, A., Toure, K., & Bhutta, Z. A. (2016). Systematic review on human resources for health interventions to improve maternal health outcomes: evidence from low- and middle-income countries. Human Resources for Health, 14(1), 10.

Laurence, J., O’Toole, J., & Montjoy, R. S. (1984). Interorganizational Policy Implementation : A Theoretical Perspective. Public Administration Review, 44(6), 491–503.

Lipsky, M. (1980). The Critical Role of Street-Level Bureaucrats. In Street-Level Bureaucracy:Dilemmas of the Individual Public Services.

Love, A. (2004). Implementation Evaluation. In J. Wholey, H. P. Hatry, & K. E. Newcomer (Eds.), Handbook of Practical Program Evaluation. Jossey-Bass.

Martin, R. (1983). From Policy to Practice. (the University of Michigan, Ed.). M.E. Sharpe.

Matland, R. E. (1995). Synthesizing the Implementation Literature: The Ambiguity-Conflict Model of Policy Implementation. Journal of Public Administration Research and Theory: J-PART, 5(2), 145–174.

McLaughlin, M. (1987). Learning from experience: Lessons from policy implementation. Educational Evaluation and Policy Analysis, 9(2), 171–178.

Meier, K. J., & O’toole, L. J. (2001). Managerial Strategies and Behavior in Networks: A Model with Evidence from U.S. Public Education. Journal of Public Administration Research and Theory.

Meier, K. J., & O’Toole, L. J. (2003). Public Management and Educational Performance: The Impact of Managerial Networking. Public Administration Review, 63(6), 689–699.

Meier, K. J., & O ’Toole, L. J. (2002). Public Management and Organizational Performance: The Effect of Managerial Quality. Source Journal of Policy Analysis and Management.

Meter, D. S. V., Horn, C. E. V., Van Meter, D. S., & Van Horn, C. E. (1975). The Policy Implementation Process:A Conceptual Framework. Administration & Society.

Meyers, L. S., Gamst, G. C., & Guarino, A. J. (2013). Applied Multivariate Research: Design and Interpretation. SAGE Publications. California, United States of America: SAGE Publications.

Meyers et al. (2005). Applied Multivariate Research.

Ministry of Health and Family Welfare. (2012). National Health Policy 2011. Retrieved from〈=en

MOH&FW. (2011). Strategic Plan for Health, Population & Nutrition Sector Development Program (HSNSDP) 2011 - 2016. Manual. Dhaka, Bangladesh. Retrieved from

Najam, A. (1995). Learning from the Literature on Policy Implementation: A Synthesis Perspective. IIASA Working Paper (Vol. WP-95-061).

Nakamura, R. T. S. F. (1980). The Politics of Policy Implementation. Policy Studies Journal.

Nakamura, & Smallwood, F., R. T. (1980). The politics of policy implementation. St. Martin’s Press.

Nassera, T. et al. (2007). Governance, Health Policy Implementation and the Added Value of Regionalization. HEALTHCARE POLICY, 2(3), 97–114.

NIPORT, & Associates, M. (2014). Bangladesh Demographic and Health Survey, 328.

O’Toole, L. J. (2004). The theory-practice issue in policy implementation research. Public Administration, 82(2), 309–329.

O’Toole, L. J. J. (1986). Policy Recommendations for Multi-Actor Implementation: An Assessment of the Field. Journal of Public Policy, 6(2), 181–210. S0143814X00006486

O’Toole, J. L. J. (2000). Research on Policy Implementation: Assessment and Prospects. Journal of Public Administration Research and Theory: J-PART.

Ottoson, J. M., & Green, L. W. (1987). Reconciling concept and context: Theory of implementation.

Pallant, J. (2010). SPSS survival manual (4th ed., Vol. 36). England: Mc Graw Hill, Open University Press. Retrieved from

Palumbo, D., & Harder, M. (1981). Implementing public policy. Lexington, MA: Lexington Books.

Palumbo, D. J., & Calista, D. J. (1990). Implementation and the policy process. New York: Greenwood Press.

Peterlin, M. (2012). Policy coordination , territorial governance – towards better development decisions. In SEE Conference.

Peters, B. G. (1998). Managing horizontal government: the politics of co-ordination. Public Administration.

Peters, D. H., Tran, N. T., & Adam, T. (2013). Implementation Research in Health: A Practical Guide. Who, 69. Retrieved from

Poister, T. H. (2004). Performance Monitoring. In H. . H. & K. E. N. (et el) J.S Wholey (Ed.), Handbook of Practical Program Evaluation. San Francisco, CA: Jossey-Bass.

Pressman, J. L., & Wildavsky, A. (1973). Implementation (3rd ed.). Berkeley: University of California Press.

Pressman, J. L., & Wildavsky, A. B. (1973). Implementation : how great expectations in Washington are dashed in Oakland. The Oakland Project Series.

Pulzl, H., & Treib, O. (2007). Implementing Public Policy. In Frank Ficher et. al. (eds.) (Ed.), Handbook of Public Policy Analysis: Theory, Politics and Methods. Boca Raton, NW: Taylor & Francis Group.

Rainey, H. G., & Steinbauer, P. (1999). Galloping Elephants: Developing Elements of a Theory of Effective Government Organizations. Journal of Public Administration Research & Theory.

Rovinelli, R. J., & Hambleton, R. K. (1977). On the Use of Content Specialists in the Assessment of Criterion-Referenced Test Item Validity. Dutch Journal of Educational Research, 2(49–60), 49–60. 19-23, 1976

Sabatier, P. A. (1988). An advocacy coalition framework of policy change and the role of policy-oriented learning therein. Policy Sciences.

Sabatier, P. A., & Mazmanian, D. (1980). The implementation of public policy: A framework of analysis. Policy Studies Journal.

Sabatier, P., & Mazmanian, D. (1979). The Implementation of Public Policy. Policy Studies Journal.

Sabatier, P., & Mazmanian, D. (1980). THE IMPLEMENTATION OF PUBLIC POLICY: A FRAMEWORK OF ANALYSIS. Policy Studies Journal.

Shafritz, J. M., & Hyde, A. C. (2015). Classics of Public Administration. Politics (Eight). Boston USA: Cengage Learning. Retrieved from

Stewart, J. J. et. al. (2008). Public Policy: An Evolutionary Approach (3rd ed.). Boston: Thomsom Wordsworth.

Tabachnick, B. G., & Fidell, L. S. (2013). Using multivariate statistics. (Craig & Campanella, Eds.) (6th ed.). Pearson Educations, Inc.

Tabachnick, B. G., & Fidell, L. S. (2007). Using multivariate statistics. Using multivariate statistics.

Tadlock, B. L., Tickamyer, A. N. N. R., White, J. A., Debra, A., Pearson, N. B. J., Tadlock, B. L., … Henderson, D. A. (2005). Leadership in an age of devolution: county commissioners role in the implementation of Appalachian Ohio’s welfare reform. Public Administration Quarterly, 29, 32–53.

Thomas, R. D. (1976). Policy Analysis What Governments do, Why they do it, and What difference it makes (Second). Alabama USA: The University of Alabama Press.

UN, & UNDP. (2015). Human Development Report 2015: Work for human development. Undp.

United Nations. (2017). World Population Prospects: The 2017 Revision, Key Findings and Advance Tables, 46.

USAID. (2007). Policy Reform Lessons Learned : a Review of Economic Growth Related Policy Reform Activities Policy Reform Lessons Learned .

Van Meter, D. S., & Van Horn, C. E. (1975). The Policy Implementation Process: A Conceptual Framework. Administration & Society.

Voradej, C. (2005). An Integrated Theory of Public Policy Implementation. Bangkok: TURA.

Weimer, D. L., & Vining, A. R. (2005). Policy Analysis: Concepts and Practice. David L Weimer.

WHO. (2016). Monitoring the health goal: Indicators of overall progress. In Mointoring Health for the SDGs.

Wikipedia. (2017). Global Health Policies.

Wildavsky, A. (1979). The Art and Craft of Policy Analysis (1st ed.). Palgrave Macmillan UK.

Zahariadis, N., & Morgan, L. (2005). Local Government and the Implementation of Alabama’s Economic Development Policy. Public Administration Quarterly.


Copyright (c) 2018 Md. Mohoshin Ali

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Journal of Public Administration and Governance  ISSN 2161-7104


Copyright © Macrothink Institute

To make sure that you can receive messages from us, please add the '' domain to your e-mail 'safe list'. If you do not receive e-mail in your 'inbox', check your 'bulk mail' or 'junk mail' folders.