October Reflections

Listen to the September Reflections by Dr. Nkechi Olalere, Executive Director at Strategic Purchasing Africa Resource Center (SPARC).

In my years of work in both public and private sectors, I have held many discussions on the role of politics in health policies or decision making. I have met many a technical experts, purists, who strongly believe that politics has no role in health…or better put, should have no role in health. And that healthcare decisions should be purely based on facts and figures; we should be led by the evidence and nothing else. This would have been the ideal – a world where the evidence is the only determinant of what we do and practice. But, that’s not how it works in the real world.  Politics is an important determinant of population health

This was the focus of our virtual engagement in October. Our theme, taken from one of the key messages from the SHP progress mapping activity of our technical partners was that, ‘technical and political stakeholders both need to be involved in strategic health purchasing reforms’. Two country examples during the in-person convening of our technical partners in February buttressed the importance of having these two voices in the room when planning and implementing SHP reforms – Kenya started its benefit package review with technical experts only and involved the policy makers much later. In a reverse of this situation, Benin started its reforms with policy makers and the technical team was brought in later on. Neither of these situations played out well and critical reforms were delayed until both countries realized that the perspectives of both the technical and policy makers are needed to advance discussions, purposefully.

SPARCchat VII set out to understand how to get these two all-important teams to work together. I really loved the practical tips given by participants and panellists. Two of them stood out for me and form the basis of our October Reflections:

The first – ‘Messaging is important. Technical experts/experts in SHP must keep messaging simple & in sync with what policymakers best relate to. Engagement with politicians should show what their communities stand to gain e.g. how broader health system goals align with political interests’

This is a very practical message. Technical experts oftentimes tend to get stuck in analysis paralysis. And so, in reflecting, I wondered…

Are technical leaders prepared for the tricky discussions they need to have with policy makers? Are they equipped to present briefs and evidence that are more practical than technical, nuanced rather than ‘rough and ready’? Is communication strategy seen as a key part of building consensus and aligning critical decision-makers?

As you ponder on these, I move swiftly to the second tip – the need to align political priorities with objective evidence and add political weight to non-popular evidence. The participant who contributed this point gave a great example from Eswatini. The government, in the National Social Security Policy (NSSP) II, had made a political commitment to construct new primary health facilities across the four regions every year. However, a quantitative tool for prioritizing where these facilities should be constructed showed that this was not a priority given road network and settlement patterns. To ensure that this policy window for change was not lost, consultations led to a mutual agreement to increase the service package offered at the lowest level of care (especially, maternal care), effectively redefining the political priority of increasing access to care from a focus on infrastructure to actual service provision – the people won!

Great example there…but are all technical experts equipped to understand those critical times when there is a policy window that can be leveraged to move reforms forward? Can they take advantage of the right window of opportunity to introduce relevant evidence that galvanizes action?  

This is where our approach at SPARC plays a significant role. Our typical entry point into country engagements is not technical.  It starts from process facilitation – understanding the political economy and aligning all stakeholders, including (but not limited to) technical experts and policy makers. Our experience has shown that it is difficult, nay, almost impossible to get any work done if the political economy is not well understood and utilized to improve the effectiveness of the policy process. Our coaching approach (which can also be used for technical skills), provides that non-technical input, that soft skill needed to start up discussions, understand challenges and begin to chart a way forward as a neutral facilitator.

Are you familiar with our coaching approach? Want to learn about the soft skills needed to navigate a tricky political economy? Or you know someone who can benefit from those skills? I strongly recommend our online coaching module. It has practical tips that can start anyone up on the journey of navigating the political economy for reforms and/or further fortify you for those very nuanced discussions. Take the course and let us know what you think.

What are your reflections from the month of October? Drop a line and let us know.

October Reflections

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