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Despite being endowed with rich culture and beautiful historic monuments, tourism performance in India has been low. The aim of the paper is to focus specifically on the role of key institutions, i.e., the Central (Federal) and State governments that drive tourism policy development and implementation in India. As tourism policy development and implementation in India has not been well documented and understood, this paper provides an analysis of these institutions. These institutes are critical due to their role in policy making, budget allocation and project implementation in the tourism domain. This paper also helps in highlighting the key factors behind low international tourist arrivals in India.

Purpose – The chapter aims to understand what kind of policy approach has been more successful in facilitating the involvement of patients and the public in the design and provision of health-care services at the local level and the explanatory factors justifying the implementation outcome.Methodology – By applying Richard Matland's ambiguity/conflict policy implementation model, the chapter analyses the impact of a number of policies introduced after 1997 in the English National Health Service that targeted final users and the local population in decision-making processes.Findings – The evidence shows that policies emphasising the importance of context-specific contingencies can be more effectively implemented when room for interpretation and discretion in selecting the appropriate means for involvement is given. In this way, the overall aims/purposes of health policies can be locally reshaped by allowing the adoption of flexible strategies within the implementation process.Practical implications – A strong leadership at the top of public sector organisations and, in particular, from the board of directors is needed to steer and facilitate a consensus oriented outcome in organisational decision-making processes that aim to incorporate the views and opinions of patients and the public.Social implications – Local initiatives in increasing participation, for specific purposes, are bound to be more successful than a general initiative, expecting comparatively uniform implementation.