Policy implementation challenges and the ritualization of public health emergency plans: An investigation of urban communities in Jiangsu Province, China

INTRODUCTION: The COVID-19 pandemic has been a global public health emergency, and countries worldwide have responded to it through a vast array of pre-planned, adaptively devised and ad-hoc measures. In China, public health emergency plans - the plans expected to drive the response to epidemics or pandemics - demonstrated a concerning tendency towards “ritualization.” “Ritualization” denotes the practice of public health emergency plans to be reliably developed so that a formal requirement is met, while being implemented selectively or not at all in the emergency response. METHODS: This study explored the phenomenon of ritualization by analyzing data from 1485 questionnaires, 60 in-depth interviews and 85 actual public health emergency plans. It used the Smith Policy-Implementation-Processing pattern as its conceptual framework. RESULTS: The study found that the infeasibility of plans, their ineffective implementation by emergency management agencies, the obstructive behaviors of community residents, and the lack of an appropriate policy environment all contributed to the practice of ritualization. DISCUSSION: As China seeks to better respond to COVID-19 and accelerate the recovery of its health system, it is essential to ensure that its public health emergency plans are effectively developed and implemented.