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1. Enhancing Public Health Outcomes in Developing Countries: From Good Policies and Best Practices to Better Implementation

Author:
Michael Woolcock
Publication Date:
02-2018
Content Type:
Working Paper
Institution:
The John F. Kennedy School of Government at Harvard University
Abstract:
In rich and poor countries alike, a core challenge is building the state’s capability for policy implementation. Delivering high-quality public health and health care – affordably, reliably, at scale, for all – exemplifies this challenge, since doing so requires deftly integrating refined technical skills (surgery), broad logistics management (supply chains, facilities maintenance), adaptive problem solving (curative care) and resolving ideological differences (who pays? who provides?), even as the prevailing health problems themselves only become more diverse, complex and expensive as countries become more prosperous. The current state of state capability in developing countries, however, is demonstrably alarming, with the strains and demands only likely to intensify in the coming decades. Prevailing ‘best practice’ strategies for building implementation capability – copying and scaling putative successes from abroad – are too often part of the problem, while individual training (‘capacity building’) and technological upgrades (e.g., new management information systems) remain necessary but deeply insufficient. An alternative approach is outlined, one centered on building implementation capability by working iteratively to solve problems nominated and prioritized by local actors.
Topic:
Health, Developing World, State, Public Policy, and Policy Implementation
Political Geography:
Global Focus

2. The Big Stuck in State Capability for Policy Implementation

Author:
Matt Andrews, Lant Pritchett, and Michael Woolcock
Publication Date:
01-2016
Content Type:
Working Paper
Institution:
The John F. Kennedy School of Government at Harvard University
Abstract:
We divide the 102 historically developing countries (HDCs) into those with ‘very weak’, ‘weak’, ‘middle’, and ‘strong’ state capability. Analyzing the levels and recent growth rates of the HDCs’ capability for policy implementation reveals how pervasively “stuck” most of them are. Only eight HDCs have attained strong capability, and since most of these are small (e.g., Singapore, UAE), less than 100 million (or 1.7%) of the roughly 5.8 billion people in HDCs currently live in high capability states. Almost half (49) of these countries have very weak or weak capability, and thus their long-run pace of acquiring capability is also very slow. Alarmingly, three quarters of these countries (36 of 49) have experienced negative growth in state capability in recent decades, while more than a third of all countries (36 of 102) have low and (in the medium run at least) deteriorating state capability. At current rates, the ‘time to high capability’ of the 49 currently weak capability states and the 36 with negative growth is obviously “forever”. But even for the 13 with positive growth, only three would reach strong capability by the end of the 21st century at their current medium run growth.
Topic:
Developing World, International Development, State, and Public Policy
Political Geography:
Global Focus and United States of America

3. Doing Iterative and Adaptive Work

Author:
Matt Andrews, Lant Pritchett, and Michael Woolcock
Publication Date:
01-2016
Content Type:
Working Paper
Institution:
The John F. Kennedy School of Government at Harvard University
Abstract:
Many of the challenges in international development are complex in nature. They involve many actors in uncertain contexts and with unclear solutions. Our work has proposed an approach to addressing such challenges, called Problem Driven Iterative Adaptation (PDIA). This paper is the most recent in a series intended to show how one can do PDIA, building on the first paper, "Doing Problem Driven Work." The current paper addresses a key part of the approach one moves to once a problem has been identified, performing real-time experimental iterations. This is intended as a practical paper that builds on experience and embeds exercises for readers who are actually involved in this kind of work.
Topic:
International Development, State, and Experimental Iterations
Political Geography:
Global Focus and United States of America

4. Managing Your Authorizing Environment in a PDIA Process

Author:
Matt Andrews, Lant Pritchett, and Michael Woolcock
Publication Date:
01-2016
Content Type:
Working Paper
Institution:
The John F. Kennedy School of Government at Harvard University
Abstract:
Development and state building processes are about change. Change is, however, elusive in many contexts. In prior work, we have offered problem driven iterative adaptation (PDIA) as an approach to tackle wicked hard change challenges. This is our fourth practical working paper on ‘how’ to do PDIA. The working paper addresses questions about authority, given that authority is needed to make change happen—especially in hierarchical government settings. This authority is often difficult to attain, however. It is seldom located in one office of person, and is often harder to lock-in with complex challenges, given that they commonly involve significant risk and uncertainty and require engagement by many agents responding to different kinds of authority. Every effort must be taken to address such challenges, and efforts should include an explicit strategy to establish an appropriate authorizing environment. This working paper suggests ideas to adopt in this strategy, with practical exercises and examples to help the reader apply such ideas in her or his own work.
Topic:
Development, Government, International Development, and State
Political Geography:
Global Focus and United States of America

5. Engaging with Fragile and Conflict-Affected States

Author:
Michael Woolcock
Publication Date:
07-2014
Content Type:
Working Paper
Institution:
The John F. Kennedy School of Government at Harvard University
Abstract:
The coherence and effectiveness of engagement with the world's 'fragile and conflict-affected states'—beyond ethical imperatives and geo-strategic considerations—turns on answers to two vexing questions. First, on what defensible basis is any given country, at any given historical moment, deemed to be (or not to be) 'fragile'? Second, if a defining characteristic of state fragility is low levels of capability to implement core responsibilities, how can international agencies best support domestic public organizations to acquire capability? The first issue may appear to be a methodological one (wherein more and better data would provide a firmer empirical foundation on which to base key decisions) but any determination, especially of marginal cases, must also be grounded in a correspondingly comprehensive theory of change. Similarly, the optimal response to the second issue may appear to be importing technical and rigorously verified ('best practice') solutions, but in fact it is more likely to require a qualitatively different strategy, one able to experiment with alternative design specifications and adapt in real time to changing contextual realities (thereby iterating towards customized 'best fit' solutions). To this end, an alternative approach to the theory, measurement and practice of engaging with fragile states is outlined, in the spirit of rising concerns across the development community that prevailing strategies have demonstrably reached the limits of their effectiveness.
Topic:
Security, Development, Conflict, State, and Institutions
Political Geography:
Global Focus and United States of America