Putting Policy Priorities into Practice: The Bureaucratic Challenge

Translating policy goals into programs is perhaps the most challenging part of government. Many a government minister has big ideas, not many of them see those ideas implemented during their often limited time in office. One reason is the gap between the political leadership in most government ministries and the professional civil service. Technically the minister is both political leader and chief operating officer, but in reality, the civil service generally see ministers as sojourners with bright ideas who come and go, while they keep the government running. Bridging the gap between political leadership and ministry officials is one of the objectives of the In-Country Follow-up Component of the Harvard Ministerial Leadership Program.

After selected health and finance ministers participate in the annual Ministerial Leadership Forums at Harvard University, a small number of ministers who demonstrate strong leadership are invited to establish a ‘delivery team’ of senior –level officials in their ministry to work with the minister to implement the minister’s priorities. The delivery team helps inform and shape the minister’s goals in ways which ensure a greater degree of ‘ownership’ among the officials charged with implementing those goals. The Harvard Ministerial Program provided technical support and capacity development for the delivery teams helping ensure implementation of the minister’s goals over 18-24 months.

In February, delivery teams from Burkina Faso, Ethiopia, Liberia and Mozambique gathered in Pretoria, South Africa for a weeklong planning and strategy development program. By the end of the week, the teams are expected to have turned the minister’s objectives into a coherent plan and to develop a detailed strategy for implementing the plan. Ministers usually articulate their goals in terms of desired outcomes, but achieving the intended outcomes most often requires focus on remedying fundamental systemic weaknesses giving rise to underperformance and bolstering the essential delivery platform for the minister’s goals. Root cause analysis is a large part of the initial team planning exercise. The result is a country-specific comprehensive implementation strategy focusing on strategic interventions for strengthening health systems performance and operational efficiency in order to achieve the minister’s envisioned end-goal in a sustainable fashion.
An additional dimension to the Follow-up Program is inclusion of delivery teams from both the health and finance ministries in each of the participating countries with the objective of enabling closer collaboration between health and finance. The product of this closer collaboration is more effective budget allocation and shared responsibility for increased efficiency in budget utilization. Having health and finance ministries collaborate in developing a shared vision, plan and strategy for improving health sector performance has enabled much higher order understanding of the perspectives and official constraints of each giving rise in many cases to unexpected opportunities for more effective use of resources and even additional budget allocations.

Twenty countries have participated in the Follow-up Program since 2012. Although conditions and the relative impact of delivery teams varies across countries, ongoing external Program evaluation finds that overall the delivery teams have played a crucial role in helping driving the internal processes essential to mobilizing and otherwise recalcitrant bureaucratic machine to put the minister’s goals into practice. For more information see the most recent impact evaluations of the Follow-up Program. Beginning in 2018, education officials will also be included in the Follow-up Program.