Robust policy is critical to achieving improved health outcomes—but far too often, action stops once a policy is developed and adopted. Policies are only as effective as the extent to which they are implemented, and poor policy implementation holds back efforts to expand equitable access to health services. To translate goals into meaningful outcomes, every policy needs a plan of action, resources, dissemination, and adaptation. That is why PATH, supported by the Bill & Melinda Gates Foundation, launched the Capital to Clinic (C2C) initiative to examine bottlenecks to policy implementation and create tools to help advocates usher policies from development in national capitals to implementation in local clinics.

This white paper, a key output of the C2C initiative, is informed by key takeaways from consultations with policymakers and advocates as well as the literature on policy implementation science. It seeks to better understand policy implementation by outlining existing frameworks from the literature and examining facilitators and barriers to policy implementation in two case studies—the Community-based Health Planning and Services (CHPS) policy in Ghana and the Community Health Extension Program (HEP) in Ethiopia.