Abstract:
Implementing policy change is notoriously difficult, often marred by chronic delays or
outright failure to achieve its originally desired mandate. This challenge drew the
attention of many scholars who, over the years, published many studies attempting to
describe and analyse what the policy change process looks like and most notably,
strategies on how to better manage it. However, most of these studies tacitly
committed themselves to strategic issues of managing change from a policy-maker s
perspective, with very little consideration of what the change process actually looks and
feels like from the perspective of the change recipients. Yet, it goes without saying that
responses of these change recipients directly affect the outcomes of the change
process.
This study sought to address this gap in literature by exploring South Africa s prevailing
National Healthcare Insurance (NHI) policy reform. Using a qualitative design and
theoretical insights from political sciences, social sciences and organisational studies,
the study analysed how the relevant stakeholders in the private healthcare industry
were variously thinking about and responding to the proposed reforms.
The findings of the study emphasised the critical role of temporally sequenced
historical events in shaping an industry and influencing its change orientation. The
study also weighed in on scholarly debates that challenged general characterisation of
any recipients contradictory opinions as resistance to change . In this study, the
stakeholders seemingly antagonistic attitudes and responses to the NHI policy were
not necessarily a contestation against change in itself. Instead, the conflict was over
compatibility with the policy s implicit secondary goals. This contestation evoked
opinions and responses so strong that it overshadowed the stakeholders initial felt
need for change. From this perspective, this research argued for a distinction to be
drawn between diagnostic congruence and goal congruence. It further proposed that
paying diligent attention to formulating an accurate diagnosis of the problems to be
addressed through policy change could attenuate haggling and achieve far better
results than finding the best way to attain an agreed upon goal across all relevant
stakeholders.
