Citation

Woolcock M. Scand. J. Public Health 2018; 46(22 Suppl): 10-18.

Affiliation

Development Research Group, World Bank, Washington, DC, USA.

Copyright

(Copyright © 2018, Associations of Public Health in the Nordic Countries Regions, Publisher SAGE Publishing)

DOI

10.1177/1403494818765690

PMID

29862909

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 and 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. However, the current state of state capability in developing countries 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.

Language: en

Keywords

Policy implementation; public health; state capability; subnational variation