2015

AMDD recently signed a manifesto on Doing Development Differently (DDD).  The Manifesto laments the poor quality and outcomes that characterize some development interventions.  The authors put forward principles that they feel distinguish more successful initiatives.  These principles are quoted below (emphasis is ours): 

• They focus on solving local problems that are debated, defined and refined by local people in an ongoing process.

• They are legitimised at all levels (political, managerial and social), building ownership and momentum throughout the process to be ‘locally owned’ in reality (not just on paper).

• They work through local conveners who mobilise all those with a stake in progress (in both formal and informal coalitions and teams) to tackle common problems and introduce relevant change.

• They blend design and implementation through rapid cycles of planning, action, reflection and revision (drawing on local knowledge, feedback and energy) to foster learning from both success and failure.

• They manage risks by making ‘small bets’: pursuing activities with promise and dropping others.

• They foster real results – real solutions to real problems that have real impact: they build trust, empower people and promote sustainability.

This resonates with AMDD learning over the past decade, particularly with the ongoing Emergency Obstetric and Newborn Care (EmONC) Needs Assessments that we conduct in partnership with national ministries of health and UNFPA in low and middle income countries.  These assessments are censuses of all hospitals and clinics, and a sample of health centers conducting up to a certain number of deliveries per day. They provide a comprehensive picture of what services, equipment, and human resources are available where, resulting in valuable data on actual health system functioning at the local and national level.  The EmONC needs assessment tool is adapted by a multi-stakeholder team in each country, ensuring that priorities are defined by local people, and that the data collection process and follow-up is locally owned.  Depending on national priorities, the needs assessments may be enhanced by adding in qualitative enquiries, geographic information system (GIS) analyses, and other research.

Despite the potential utility of the assessment data, rigorous national and sub-national planning, implementation, and learning do not always follow.  This may be due to any number of reasons, including lack of financial and human resources, poor management capacity, insufficient technical capacity, lack of political will, and competing priorities.  Rather than rehearsing these well-worn explanations for implementation failure, AMDD seeks to work with partners and countries to do development differently.  To that end, we are initiating a multi-stakeholder process to design flexible implementation guidance. This guidance will acknowledge and accommodate the challenging and dynamic reality of the contexts where assessments are conducted.  It will aid countries to use EmONC assessment data as a planning tool, facilitating careful engagement with health system realities without being prescriptive or generic.  For example, informal practices and norms that often undercut best laid policies should be named and addressed, rather than ignored. 

This guidance will be one important step, though certainly not the whole puzzle, in supporting countries to make small bets that lead to real results.