Abstract
Background Despite the growing burden of non-communicable diseases (NCDs) in South Africa, translating
policy commitments into effective action remains a major challenge. Understanding this implementation gap
requires methodological approaches capable of integrating policy content and process, and implementation realities
to generate actionable insights for policy improvement.
Methods This article presents a worked example of a convergent parallel mixed-methods design for health policy
analysis, combining qualitative document analysis of three purposively selected health policies and a quantitative
provincial-level survey of health officials (n = 57) from seven provinces in South Africa. Analyses were
conducted independently and integrated at the interpretation stage to develop and validate policy-improvement
strategies through a Delphi process. The design was theoretically anchored in Stages Heuristics and the WHO
Analytical Framework for Social Determinants of Health (SDH).
Results The integration of qualitative and quantitative findings identified three overarching policy issues: weaknesses
in multistakeholder collaboration across the policy cycle, inadequate attention to SDH, and resource
constraints affecting implementation. Convergence was observed in the recognised importance of stakeholder
engagement, health system strengthening, and monitoring systems for effective NCD control. Complementarity
emerged as policy documents articulated multisectoral, governance, and health system interventions, while officials
highlighted practical implementation challenges, including inadequate human resources, financing, infrastructure,
and technology. Dissonance was evident between policy commitments to multisectoral action and
resource mobilisation and the limited collaboration and resource availability reported during implementation.
Conclusions Convergent parallel mixed-methods design enabled the integration of policy content, stakeholder
perspectives, and implementation realities to identify policy gaps and inform validated improvement strategies.
The approach offers a practical framework for health policy evaluation and strengthening in complex multisectoral
settings.