How do we deliver higher-quality health services in low-capacity settings?
This is the question that we have sought to answer through a long-standing impact evaluation (IE) research collaboration with the Nigerian Ministry of Health and the Bill & Melinda Gates Foundation. The results of this collaboration will be presented at the World Bank on February 8 at Beyond the Status Quo: Using Impact Evaluation for Innovation in Health Policy. This one-day event will bring together policymakers, practitioners, and academics to discuss policy implications and ways to further promote and strengthen capacity for evidence-informed policy.
Aid donors are often maligned for bureaucratic procedures, a focus on short-term results at the expense of longer-term, riskier institutional change, and a technical, managerial approach to aid with insufficient focus on context, power and politics. Are these institutional barriers insurmountable? Can aid agencies create an enabling environment to think and work politically?
Tom Wingfield (top) and Pete Vowles (bottom) from DFID’s new ‘Better Delivery Taskforce’ have been trying to do just that. Here’s where they’ve got to.
For the past year DFID has been focussing on these issues and how we can both guard taxpayer’s money and have transformational impact in the countries where we work. The result has been the introduction of a comprehensive set of reforms targeting our process, capability and culture. This is about creating the conditions that allow us to better address the underlying causes of poverty and conflict, and respond effectively to the post-2015 agenda. At the heart of the reform is a revamp of DFID’s operating framework (ie the rules and principles which govern our work). Known as the ‘Smart Rules’, it can be downloaded here.
Like any institutional reform, this is a long term change process. The next 12 months provide a real opportunity to strengthen our partnerships with a wide range of partners and enhance our collective effectiveness.
However, others working in the development sector, like Blair Glencorse of Accountability Lab, argue that money can actually pervert incentives. He states, "all of our projects are very small-scale [...] but the emphasis is on financial resources actually being less valuable than some other resources like intellectual capital, relationships, networks."
Accountability Lab believes that making power-holders accountable leads to more responsible decisions and actions. In turn, resources are used more efficiently and expectations for further reform are generated, ensuring continued demand for accountability. This is not a clear-cut process, and it is often beset by difficulty. Sudden or massive increases in funding for certain sectors can negatively impact the process and do not lead to lasting accountability of power-holders.
Watch the video and let us know if you agree!
At the basis of communication and public policy are assumptions about human beings- their rationality or irrationality, their foibles, wants and preferences. A lot depends on whether these assumptions are correct. In this feature, we bring you fascinating examples of human behavior from across the globe.
A recent article in The New York Times, “Divining Why One Film Spurs Activism, While Others Falter” highlights the work of Participant Media, an entertainment company that produces film, television, publishing and digital content that inspires social change. According to Participant Media’s website, the company “launches campaigns that bring together government entities, foundations, schools, and others to raise awareness and drive people to take action on issues from each film or television show.”
But all of this begs the question: are these films successful in doing what they set out to do? Do people learn from the films and change their ways? What pushes us beyond social media activism to stand up and do something about our outrage?
“Save, you may not see Parliament again”, one two-term Member liked to tell us. In many cases non-performers with deep pockets are preferred than stingy doers. “As much as possible, avoid your constituents in the first three years and show up only towards the last half of your term, with plenty of money!”
In response, a Member of Parliament (MP) from one of the countries where Mwananchi works said, “You need to put premium on leadership”. In other words, we should not expect leaders to deliver the change we want if society encourages them to pursue perverse incentives to attain and remain in office, and to achieve solutions to collective action problems.
Looking at the backgrounds of MPs in many countries in Africa, you find that some MPs have been activists in civil society, respected civil servants or faith leaders, often suggesting that things would be very different if it was them that were in office. This is a clear case of a common African saying ‘one finger forwards, four fingers backwards,’ reminding us how easy it is to criticise without examining ourselves. This is why it should not be surprising that again and again we find that when the ‘self-imagined’ leaders get into public office they are equally caught up in the quagmire of perverse incentives as their predecessors.