The implementation gap: what is the problem?
Francis Omaswa berates the 'silence and complacency of the techno-professionals' in actual delivery of services or policies. He then proffers an apology...Last month I participated at the 52nd Health Ministers Conference for East, Central and Southern Africa (ECSA) in Harare, Zimbabwe. At this meeting, the Health Ministers adopted eleven resolutions, the last two of which were to thank the host country and the partners.
The other nine called for a lot of work on the part of the countries and the ECSA Secretariat to implement to scale.
These meetings take place throughout the year and so many resolutions are adopted. Not only that, there are also laws, policies,
and plans at country level that are adopted all the time.
This week in my country Uganda, a new National Health Policy and a Health Sector Strategic and Investment Plan have been launched.
There are so many resolutions, so many recommendations, and so many plans. Yet most remain in files and on shelves and are not
implemented to scale. There are so many proven technologies, so much knowledge of what works and what does not work.
Yet coverage rates remain so low. What is the problem?
I want to argue that the problem is largely with the technocrats and professionals.
Why? Most of these resolutions are crafted by techno-professionals and implementation strategies are designed by them.
It is the techno-professionals who understand how the technologies work and monitor implementation success or failures round the world.
They attend many meetings all over the world on these issues but most go back home to business as usual. They have the statistics on
mortality and morbidity rates and can interpret the significance of these in terms of suffering, deprivation, and premature death, including
the economic and social ramifications. Yet the sense of urgency and the outrage the situation calls for is nowhere to be seen or heard.
The silence and complacency of the techno-professionals is deafening. By the way I am one of them and from now I will refer to
'we and us' and not 'they and them'.
We have up to now played the 'lack of political will' card but I believe our politicians have done their part.
They have adopted the resolutions that we draft for them – most of them without comment. African political leaders have
given us the green light to cause action on the resolutions. Causing action means translating the resolutions, policies, and
recommendations into actionable and fundable propositions. This is our job which, in my view, we as techno-professionals are
not doing well. In our group we have experts on advocacy, community mobilization, budgeting, writing memos for cabinet and
parliament. We techno-professionals have potential and capacity that can cause things to happen in order to close the
implementation gap in our countries. We can cite political interference, lack of money, and other resources, but let's strive
to do the best with the resources that we have, and if we are seen to be doing this and demonstrating that we have
exhausted all possible efficiency gains, our chances of getting additional resources are so much better. If we do not get
needed additional resources, at least our conscience will remain at peace.
I know of actual examples of countries where strong and driven techno-professionals have made a huge difference in child and
maternal mortality, immunization coverage, access to ARVs, etc. Political leaders, other technical people whom we lead, including
populations, respond well and support health professionals who are practical, selfless, and result oriented. Where are these types
of professionals and technocrats in Africa? How can we grow more of them? Let's discuss this in the next issue of Africa Health ."
Comments (16)
Adetokunbo O. Lucas
Thank you for your email. I look forward to participating in the newly
established Forum
Yours sincerely
Adetokunbo O. Lucas
Jo Ivey Boufford
Lebogang Lebese
definitely participate. Kindly use also my personal email cceed.
Regards
Lebo
Dwyer,Joseph
Your call to focus on implementation and results is right on the mark.
Please include me in this cause.
Joseph Dwyer
Rosann Wisman
So pleased to see this up and running. It will be an excellent tool for sharing and learning among us all. Great to see you last week.
Best wishes,
Rosann
Rosann Wisman
Director, Ministerial Leadership Initiative for Global Health (MLI)
Aspen Global Health & Development
The Aspen Institute
One Dupont Circle N.W. Suite 700
Washington, D.C. 20036
+1.202.736.3852
Bjarne Garden
Most grateful for this opportunity to join a network of your kind. Looking forward to sharing ideas!
Best wishes,
Bjarne Garden
Acting Director
Global Health and AIDS Department
Bocar Mamadou Daff
I am very happy to join the group
kabiraj khanal
Thank you very much for your initiative. Although I dont belong to Africa, the points you have raised are much pertinent to our countries as well. I look forward to participating in your Forum.
Yours sincerely
Kabiraj Khanal
Nepal
Issa bara issa berthe
Thank you for this very useful initiative and thank you to associate the French-speaking part of Africa.
Respectful greetings.
Cher Professeur
Merci pour cette initiative tr?s utile et merci d'associer la partie francophone de l'Afrique.
Salutations respectueuses.
Issa
Nigel Crisp
Looks like a good initiative. Count me in. I hope to catch up in Geneva next week.
Best wishes
Nigel
Tessie Catsambas
Thank you for your continued leadership in this important path. I would be delighted to participate in the dialogue and the actions that may arise from it.
Sincerely,
Tessie
E.Oluwabunmi Olapade-Olaopa
This is good.
I am in.
Olubunmi
Blessing Chebundo
Thank you for your email. I look forward to participating in the newly established Forum
Yours Sincerely
Blessing Chebundo [MP]
Miriam Were
I want to support your analysis that it is we, the techno-professionals, who
are the bottle neck! I fully associate myself with the paragraph towards the
end of your article that there are professionals in our countries who,
through their personal commitment have made things to happen. I am happy to
be part of this initiative.
With kind regards,
Miriam.
Seble Frehywot
Thank you for the email and invitation.Will be happy to.
Best
Seble
John Donnelly
Thanks so much for starting this and including me. And thanks to Miriam for kicking off the discussion on your piece.
I'd also like to respond to your assertion that techno-professionals need to take more responsibility for implementing the resolutions made in these multiple conferences with two thoughts.
One is from a conversation that I had with a highly skilled techno-professional on the sidelines of the MLI Learning Collaborative Forum in Addis last week. He said that he often felt stymied in trying to get traction on his priorities due to lack of support from his bosses. We had just listened to Minister Tedros of Ethiopia give a speech on the four steps toward country ownership of programs. (You can found an account of that speech here .)
"There are three or four people in my Ministry, and maybe any Ministry, who can make things happen and act on things like Minister Tedros is doing," he said.
That raises an interesting question: What can techno-professionals do when they are trying to move a plan that isn't supported by the Minister or other powerful people in the Ministry?
The second point goes to that issue. I've found from my experience through
MLI's five countries (Ethiopia, Mali, Senegal, Sierra Leone, and Nepal) and from interviewing people in Ministries over the last many years that political support is important but vision and priority are also necessary.
And not only that: Can you communicate that vision? Can you inspire others?
It's a complicated process, but those who are great communicators and motivators have a much better chance at getting something done.
Cheers,
John Donnelly