CEU Electronic Theses and Dissertations, 2025
| Author | Gonzalez Posada, Maria |
|---|---|
| Title | Understanding the Implementation Gap in Colombia's Neonatal Screening Policy for Rare Diseases through the Lens of Street-Level Bureaucracy |
| Summary | Policy implementation has been recognized as pivotal to bridge the gap between policy goals and desirable outcomes. However, literature has recognized policy implementation as a complex phase in the policy cycle, particularly in low- and middle-income countries (LMICs). Yet, the barriers to implementing policies, especially health policies, remain under-investigated. For this reason, this thesis aims to contribute to the ongoing debate on the implementation of healthcare policies in LMIC by using Colombia's lack of implementation of Law 1980 of 2019, which was intended to expand neonatal screening for rare diseases. This dissertation is based on a bottom-up approach, particularly Michael Lipsky's Street-Level Bureaucracy theory; hence, semi-structured interviews were conducted, which helped identify fourteen key barriers to implementation. Among the most prominent are insufficient funding, ambiguous political will, lack of coordination, infrastructure deficiencies, and the absence of specific regulatory guidance. This research concludes that having a policy in the national legislation doesn't imply the success of a policy. The successful implementation of Law 1980 of 2019 was hampered primarily by a lack of funding, which constrained street-level bureaucrats or implementers to achieve the intended policy outcomes. |
| Supervisor | Cartwright Andrew |
| Department | Public Policy MA |
| Full text | https://www.etd.ceu.edu/2025/gonzalez_maria.pdf |
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