The politics of implementation

Tetanus vaccination - cost effective... but still, who's gonna pay for it? (copyright hdptcar on flickr)

Last week I went to an interesting event by the Society of International Development (SID) about innovative approaches in health system financing in developing countries. The speakers told us about new and more market oriented approaches, local experiences and international trends etc. But what I found most interesting happened in the discussion, when one of the audience members got up and said: “In the end, it’s all about the politics of implementation”. The whole room full of international health and finance expert nodded so vigorously that I felt like the ground was shaking. Yes, everyone who has been in the field and tried to reform pretty much anything, knows that it is great to have sexy innovations or reliable tried and tested approaches to offer. And it is important to push the envelope in trying out new things and also continuing to do (and fund) the approaches that have worked in the past. But that is not at all enough to achieve project success and change the world for better. If you get stuck in the politics of implementation, your best concept will just remain that, a concept. Or, a “plan” as a Ghanaian colleague once defined it for me: “It doesn’t have to be realistic, it’s just a plan.”

Now after I left this room where everyone seemed to agree that you won’t get anywhere without taking politics (in the broadest sense) into account, the question I had was: Why then is it always treated as an afterthought, a surprise, something you have to muddle through once you (Surprise! Surprise!) encounter it? Why is: “How we’re gonna deal with the inevitable politics of implementation” rarely a chapter in project proposals? And why are there few better, more formal or teachable methods than  “muddle through” and “use your intuition/experience/inherent status”? I find this especially surprising as this insight is not limited to public health financing: You could say “In the end it’s all about the politics of implementation” in just about any room of development practitioners and people would agree.

It’s say: If that is one of the main things holding you back, look it in the face, anticipate it, make a plan (I’m being German here, as always, I mean a plan with concrete actions, money and deadlines attached to it), learn and teach methods that help you deal with politics and go ahead, deal with them.

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