The ink giving life to the constitution in Kenya has since dried and albeit slowly. The arms of the amorphous government are beginning the long road to devolution and learning the ropes of governance. In the health docket, save for situational desktop reports and some boardroom qualitative analyses, not much is informing the move from the archaic decision making that was top down, to health strategic planning and implementation.
There is urgent need to probe how to monitor, change, and re-align our implementation strategies in order to shift from planning to implementation; and how to implement a health system that is dynamic enough to accommodate the changing disease patterns in different population groups.
The roots of strategic planning, which many counties are currently grappling with are in the military field and were adopted from the World War II (1945!) period where decisions were made based on the past experience, lack of data and poor communication.
Predicting the future based on the past suggests that both are static and engraved in years or decades of any meaningful shift in the basic variables. With the current availability of data and information, anything older than a couple of years quickly becomes obsolete and tends to misinform progress. Communication has changed from being unreliable and slow to real time, constant and accurate.
To overcome static strategic planning, one needs to visualize the dynamic strategic implementation cycle which involves isolating the challenge; listing the number of solutions available; evaluating and selecting the best outcomes and cycling back to the next challenge. This is different from strategic planning which moves from presenting the challenge; offering one solution from best practice; implementing the solution, and evaluating the results.
If the strategic plan is not geared to the dynamic nature of diseases in the current population, a strategic plan will always be in a “catch up” mode of addressing mortality as opposed to morbidity and prevention. This may sound obvious, but if no burden of disease monitoring systems are in place either through surveillance/research/health information systems at the points of health care delivery, how are strategic plans currently being informed?
If we want to plan and implement a working system that addresses the health care needs of the public at the county level of governance, we desperately need to inform our policies with current, reliable and informative data. There is simply no substitute for it.
It is my hope that the building blocks will be put in place to address how we can efficiently move the limited and rather little public health funds available to planning.
By Dr. Isaac Choge
Monitoring and Evaluation Manager, Aurum Institute.
NB. The views in this piece remain the author’s.