This exercise also emphasized weaknesses in terms of knowledge lows,
either top-down or bottom-up, in the policy-making process. In a devolved
health system, the numerous interfaces in the line of control of the DOH and at
the local government level create risks of errors and laws in the transmission,
interpretation and operationalization of policies issued at the level of local
government units. The policy cycle was most commonly broken when a local
government unit implemented the policies developed by the DOH.
In addition, procedures and methods to make tacit knowledge explicit were
weak: no expertise database or mechanisms to preserve the knowledge of
staff or experts leaving the DOH have yet been institutionalized.