Flexible and adaptive framework yields significant results in the OPTs
A new OPM briefing note shows how a problem-driven iterative adaptation (PDIA) approach can deliver public sector reform and improved services in a challenging context.
External medical referral costs are a massive drain on the public finances of the Occupied Palestinian Territories (OPTs), but a flexible and adaptive approach to development programming has significantly reduced this burden.
The fractured and shifting conditions in the OPTs mean that development programmes with set goals and outcomes – standard procedure until recently – can easily fail. But adaptive programming allowed the Palestinian Governance Facility (PGF) project to be effective and also to broaden its scope beyond just public financial management reform into the public services that generate financial imbalances.
At the outset of the programme, there was only minimal reference to efficiency measurement in health care, one of the key areas of public service delivery and expenditure. But the cost of referring patients externally for tertiary medical care rose up the political agenda, as it became apparent that this amounted to 43% of public health spending, and rising. With this change in relevancy, reform of the external referrals process was added to the project as a new workstream.
Our note outlines how this flexible approach allowed incremental improvements to be made to the external medical referrals process, leading to a steadily fairer and more efficient system, which cost 27% less to run. This was possible only through flexibility and by moving away from a rigidly ‘projectised’ intervention.
Key lessons learned and how these can be used elsewhere are summarised, including how pilots can be effective for increasing legitimacy, and how donor buy-in and ‘institutional entrepreneurs’ are vital to the success of such programmes.
Albert Pijuan, Senior Consultant at Oxford Policy Management and co-author of the note, said:
‘Our experience with the Palestinian Governance Facility shows that a flexible, innovative approach to programming can achieve impressive things, even when tackling multi-faceted problems. The PDIA approach we agreed with DFID allowed us to take a non-linear path to realising better financial management in the OPTs, which meant we could take advantage of tidal shifts in the political sphere – rather than battling against them. With the sector-wide recognition that projectised programmes can often be ineffectual or at least inefficient, this kind of approach will become more common.’
Read the full note here.