Disclaimer:
Please be aware that the content herein has not been peer reviewed. It consists of personal reflections, insights, and learnings of the contributor(s). It may not be exhaustive, nor does it aim to be authoritative knowledge.
Learnings on your challenge
What are the top 5 key insights you generated about your frontier challenge during this Action Learning Plan?
This action learning plan evolved from a focus on positive deviance in public administration to a focus on public-sector innovation in general: · There is a lot of openness, interest, and need for a positive deviance approach for development public sector reform proposals. Government counterparts, especially at the managerial level, are very interested in data and evidence about what is working well and why. · Community participation is a key factor in places where the community health agents demonstrate exceptional public commitment to their work. Community organizations co-produce health infrastructure and services, lobby for community needs, and block reform proposals that would weaken the capacities of community health agents to do their jobs. · In places where community health agents demonstrate high levels of public commitment, they develop relationships of trust with health systems users through continuous interaction that goes beyond the simple provision of health services. Co-investment in community infrastructure, such as meeting spaces, community radio and whatsap groups creates important tools to facilitate this interaction. · Community health agents and other staff of the territorial Family Health Units have very little historical perspective about the relationship between primary health care policy, human rights frameworks regarding health and citizen participation in policy making. This appears to limit their understanding and appropriation of participatory policy making and management tools that are mandated but underutilized by the ministry of public health. This led us to develop the following hypothesis, which is the focus of our experimental intervention in this learning loop: If we provide Family Health Unit workers training in the history of the Primary Health Care perspective, the role of participation, and the use of participatory planning tools, then they will appropriate these tools and make use of them in identifying their operations and priorities. · As we developed our relationship with the National Strategy for Innovation (ENI) through Wendá, a key learning was to observe in practice how well suited the learning loop methodology is to address evidence-based public innovation processes. Our two learning cycles from Wendá became exemplary of how to drive public innovation through our method and led us to a stronger commitment to invest in social and public innovation, transforming this frontier challenge into a broader one that will tackle public innovation not only through positive deviance, but through full-range of our learning methods and tools.
Please paste the link(s) to the blog(s) that articulate the learnings on your frontier challenge.
Did you experience any barriers or bottlenecks when impacting the system, working on your frontier challenge respectively?
The low institutional status of the Primary Healthcare Program within the Paraguayan Ministry of Health is itself a barrier to for this project. In the context of the pandemic, where all healthcare and public health workers have been overburdened and where institutional priorities change very quickly, it made scheduling interviews, meetings, and advancing somewhat challenging. In the case of our public innovation processes with Wendá, time was an important barrier. In order to implement the two experimental interventions of this portfolio, the nature of our funding (TRAC) made it challenging to deliver and finish our interventions in time without losing the funds.
For this frontier challenge, how much of your time did you dedicate to the stages in the learning cycle? Please make sure that your answers adds up to 100%.
Data and Methods
Relating to your types of data, why did you chose these? What gaps in available data were these addressing?
In general, there is not very systematic and publicly available data on public administration, the coverage, content and quality of public services, or satisfaction of public services users. Administrative data is generally incomplete, not well compiled, and not systematic enough to analyze and reach conclusions. There is even less systematic study of what produces good outcomes in public service delivery. A qualitative case-study approach was the most efficient way to quickly generate rigorous evidence about this topic. In the case of Wendá’s experimental interventions, they both generated new data as they were innovative interventions for which we did not have prior evidence for.
Why was it necessary to apply the above innovation method on your frontier challenge? How did these help you to unpack the system?
We developed a proof of concept of case study methods for analyzing positive deviance and explaining positive performance in public services. It was necessary to generate as much contextual, qualitative, and process as we could so each case study could be fully described by our data. This was important because we ere looking for in-depth analysis of a few cases first, before we could go to a larger scale effort. Moreover, good performance factors may not be noticeable in the administrative data sources, as they relate to phenomena that is not necessarily captured by them: this was the case of our insights into how citizen engagement and strong community grassroot organization affected performance of Family Health Units staff. In Wendá, it was important to reach the stage of experimentation and to build prototypes of interventions that have elements of public policy put into practice, as our goal behind the specific challenges was to promote and strengthen public innovation capacities in our institutions.
Partners
If applicable, what civil society organisations did you actually work with and what did you do with them?
For the case studies, we made contact with civil society organizations active in the territories where we identified positive deviance. They provided interviews and insight about what explains the positive deviance. These included, Centro de Ayuda Mutua “Salud para Todos” (CAMSAT), Coordinadora de Organizaciones del Bañado Tacumbú, local neighborhood committes (comisiones vecinales), Organización de Desarrollo Rural de Mandu´ara (ODRAM), and local health councils (Consejos de Salud). Fort the third stage of the Positive Deviance project, which is connected also with the citizen engagement challenge, we worked with Tesaireka Paraguay, a network of organizations that work specifically on promoting Primary Health Care as a right, working closely with Family Health Units across several regions of Paraguay. In Wendá, we have partenered with a local grassroot producers’ fair in San Juan Nepomuceno, a city in the rural department of Caazapa, and with Foundation AMORMAR, for implementing the experiment on the field. Moreover, in the flexible manufacturing experimental intervention of this project, we engaged also with a local association of textile workshops.
If applicable, what academic partners (and related institutions) did you actually work with and what did you do with them?
In Wendá, we collaborated with the National Council on Science and Technology (CONACYT) to help them implement their social innovation challenge, building upon our previous experience with Moiru.
If applicable, what private sector partners did you actually work with and what did you do with them?
In Wendá, we partnered with a large textile company, Fenix S.A., in the implementation of our experimental intervention.
If applicable, what government partners (and related institutions) did you actually work with and what did you do with them?
Our main institutional partner for the positive deviance project has been the Ministry of Public Health and Social Welfare. They provided interviews, administrative data, and professional opinion to define the case selection criteria and to identify the case studies of positive deviance, as well as institutional access to the research sites. As we progressively broadened this challenge to include our work with ENI in Wendá, we also partnered with the Presidential Delivery Unit (UGPR). Through them, we articulated efforts with the Social Development Ministry (MDS), The Presidential Technical Unit of the Social Cabinet (UTGS), and the Municipality of San Juan Nepomuceno, to implement an experimental intervention that tested the prototype of a new public food security social program, based on food stamps that were interchangeable at a local grassroot producer’s fair. Likewise, we partnered with the National Service for Professional Promotion (SNPP) and the Municipality of Yaguaron, to test the prototype of public training program, contextualized to the needs that we had identified on a cluster of textile workshops. Synergies between this second intervention allowed us to articulate efforts and incorporate elements on it that could address also the challenge of employment formalization though a productivity increase that could lead to a higher capacity to formalize employees.
End
Bonus question: How did the interplay of innovation methods, new forms of data and unusual partners enable you to learn & generate insights, that otherwise you would have not been able to achieve?
The positive deviance project is still ongoing. Translating field observation into clear qualitative findings and then into actionable insights is a very challenging and time-consuming process. Developing the correct methods and procedures, contracting arrangements, and presentation formats is subject to our continuous learning. That said, the method seems like a very powerful tool for brining new and relevant evidence and perspectives to bear in policy making. Moreover, Wendá is transitioning into a new year, with a refocussing of its challenges to fully embrace public innovation as the overall goal and to contribute to the formation of the newly created Network of Public Innovators that will be trained during this in many of the tools and methods we tested in the past 2 years. The interplay of our learning loop tools and methods, applied to a process of addressing a social challenge in close collaboration with public institution naturally evolved into a process of designing, developing and testing public programs, policies or services. In a way, these methods paved the way for our partners in government to both start prioritizing social and public innovation while also integrating the same interplay of methods into the creation of a network of Public Innovators that will be trained throughout this year.
Please upload any further supporting evidence / documents / data you have produced on your frontier challenge that showcase your learnings.
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3Good health and well-being
16Peace, justice and strong institutions
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