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December 13, 2010 (All day)

The Implementation Gap: What is the Problem?

Dr. Francis Omaswa


Last month I participated at the 52nd Health Ministers Conference for East, Central and Southern Africa (ECSA) in Harare, Zimbabwe. At this meeting, the Health Ministers adopted eleven resolutions, the last two of which were to thank the host country and the partners. The other nine called for a lot of work on the part of the countries and the ECSA Secretariat to implement to scale. These meetings take place throughout the year and so many resolutions are adopted. Not only that, there are also laws, policies, and plans at country level that are adopted all the time. This week in my country Uganda, a new National Health Policy and a Health Sector Strategic and Investment Plan have been launched. There are so many resolutions, so many recommendations, and so many plans. Yet most remain in files and on shelves and are not implemented to scale. There are so many proven technologies, so much knowledge of what works and what does not work. Yet coverage rates remain so low. What is the problem?

I want to argue that the problem is largely with the technocrats and professionals. Why? Most of these resolutions are crafted by techno-professionals and implementation strategies are designed by them. It is the techno-professionals who understand how the technologies work and monitor implementation success or failures round the world. They attend many meetings all over the world on these issues but most go back home to business as usual. They have the statistics on mortality and morbidity rates and can interpret the significance of these in terms of suffering, deprivation, and premature death, including the economic and social ramifications. Yet the sense of urgency and the outrage the situation calls for is nowhere to be seen or heard. The silence and complacency of the techno-professionals is deafening. By the way I am one of them and from now I will refer to ‘we and us’ and not ‘they and them’.

To read Dr. Omaswa's take on implementing health reforms in full, see the Africa Health article in which it originally appeared.

Dr. Omaswa has also written the previous articles,  "Country Ownership and Accountability" and "Reclaiming the 'Can do' Attitude in the Delivery of Health Services in Africa."

Photo credit Dominic Chavez.