The implementation gap: what is the problem?

on Monday, 06 December 2010. Posted in Governance Forum

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

    Adetokunbo O. Lucas

    11 June 2013 at 09:39 |
    Dear Professor Omaswa,
    Thank you for your email. I look forward to participating in the newly
    established Forum
    Yours sincerely
    Adetokunbo O. Lucas
  • Jo Ivey Boufford

    Jo Ivey Boufford

    11 June 2013 at 09:41 |
    This is terrific-happy to participate!
  • Lebogang Lebese

    Lebogang Lebese

    11 June 2013 at 09:42 |
    Thank you Prof Omaswa for the invitation. It is great and I will
    definitely participate. Kindly use also my personal email cceed.

  • Dwyer,Joseph


    11 June 2013 at 09:44 |
    Thanks Professor Omaswa,
    Your call to focus on implementation and results is right on the mark.
    Please include me in this cause.

    Joseph Dwyer
  • Rosann Wisman

    Rosann Wisman

    11 June 2013 at 09:56 |
    Dear Francis,

    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 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
  • Bjarne Garden

    Bjarne Garden

    11 June 2013 at 09:57 |
    Dear Francis,
    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

    Bocar Mamadou Daff

    11 June 2013 at 10:01 |
    Thank you Professor;
    I am very happy to join the group
  • kabiraj khanal

    kabiraj khanal

    11 June 2013 at 10:03 |
    Dear Professor Omaswa,
    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
  • Issa bara issa berthe

    Issa bara issa berthe

    11 June 2013 at 10:04 |
    Dear Professor
    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.
  • Nigel Crisp

    Nigel Crisp

    11 June 2013 at 10:05 |
    Dear Francis
    Looks like a good initiative. Count me in. I hope to catch up in Geneva next week.

    Best wishes
  • Tessie Catsambas

    Tessie Catsambas

    11 June 2013 at 10:08 |
    Dear Francis,
    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.
  • E.Oluwabunmi Olapade-Olaopa

    E.Oluwabunmi Olapade-Olaopa

    11 June 2013 at 10:10 |
    Dear Francis,

    This is good.

    I am in.
  • Blessing Chebundo

    Blessing Chebundo

    11 June 2013 at 10:11 |
    Dear Doctor Omaswa.
    Thank you for your email. I look forward to participating in the newly established Forum
    Yours Sincerely
    Blessing Chebundo [MP]
  • Miriam Were

    Miriam Were

    11 June 2013 at 10:15 |
    Dear Francis,

    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,
  • Seble Frehywot

    Seble Frehywot

    11 June 2013 at 10:19 |
    Dear Professor Omaswa--

    Thank you for the email and invitation.Will be happy to.

  • John Donnelly

    John Donnelly

    11 June 2013 at 10:21 |
    Dear Francis,

    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.

    John Donnelly

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