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Please be aware that the content herein has not been peer reviewed.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.
Overview
Prepared by (Name of the experimenter)
Cristhian Parra
On date (Day/Month/Year)
12/26/2023
Current status of experimental activity
Completed
What portfolio does this activity correspond to? If any
Capacities for Social and Public Innovation
What is the frontier challenge does this activity responds to?
Capacities for Social and Public Innovation
What is the learning question(from your action learning plan) is this activity related to?
How to improve social and public innovation capacities in a "learning by doing" manner, focusing on strengthening public sector innovation capacities through the design and implementation of citizen-centered public policies and services?
Please categorize the type that best identifies this experimental activity:
Quasi Experimental (Analytical, observations, etc)
Which sector are you partnering with for this activity? Please select all that apply
United Nations agency, Public Sector, Civil Society/ NGOs
Please list the names of partners mentioned in the previous question:
UNDP Acceleration Lab, Primary Care Directorate of the Ministry of Health, Tesai Reka Paraguay Association, Latin American Association of Social Medicine
Design
What is the specific learning intent of the activity?
This activity addresses the challenge of improving public sector performance by shifting focus from traditional interventions that target poor service quality to examining instances of positive deviations, identifying successful performances by public servants.
We attent to explore, identify and understand the factors that contribute to the effective performance of public servants in the Family Health Units (FHUs) that are part of the Primary Health Care (PHC) system.
What is your hypothesis? IF... THEN....
IF the community is formally organized and also has a strong and positive relationship with the local administrative body, comprised of field officials who have roots and a sense of belonging to the community they serve, THEN the formal community organization has the strength to engage in advocacy, demand
resources, accountability, and block traditional negative bureaucratic incentives that favor the local administrative body, resulting in the effective performance of field officials.
Does the activity use a control group for comparison?
Yes, a different group entirely
How is the intervention assigned to different groups in your experiment?
Random assignment
Describe which actions will you take to test your hypothesis:
We designed and offered a two-day training aimed at family health teams, where we sought to generate connection with users, based on a historical journey about the right to health, and the connection with the principles of primary care, especially the importance of citizen participation. They were participatory dynamics that included photolanguage, theater and team games.
What is the unit of analysis of this experimental activity?
Family Health Units (Unidades de Salud Familiar)
Please describe the data collection technique proposed
We wanted to use administrative records to compare the results of the intervention. Our proposal was to compare the operational plans of the health units, and identify the number of participatory activities that they have promoted, the trained FHUs and those of the control group. However, this was not possible, because the quality of the records was not sufficient to identify changes. The number of activities carried out is reported only numerically, without giving details of the quality of their execution.
What is the timeline of the experimental activity? (Months/Days)
two months
What is the estimated sample size?
50-99
What is the total estimated monetary resources needed for this experiment?
Between 1,000 and 9,999 USD
Quality Check
This activity offers strong collaboration oportunities
Please upload any supporting images or visuals for this experiment.
Please upload any supporting links
What are the estimated non- monetary resources required for this experiment? (time allocation from team, external resources, etc) If any.
Results
Was the original hypothesis (If.. then) proven or disproven?
The hypothesis was proven as field observations and interviews gathered evidence that, in cases of successful management, various actors, by coordinating efforts and resources from their communities, have developed mechanisms to mobilize resources, demand accountability from authorities, and block perverse incentives that could harm their communities
Do you have observations about the methodology chosen for the experiment? What would you change?
To use planning instruments as impact assessments, it was suggested that the APS Directorate establish normative guidelines connecting both the Anual Operative Plan and the Comprehensive health situation analysis. However, the lack of continuity in the evaluation was due to limitations in the AOP content and budget execution timelines. Structured telephone interviews were considered but were not carried out either.
From design to results, how long did this activity take? (Time in months)
1 month
What were the actual monetary resources invested in this activity? (Amount in USD)
2500 USD
Does this activity have a follow up or a next stage? Please explain
Is this experiment planned to scale? How? With whom?
Please add any supporting links that describe the planning, implementation, results of learning of this activity? For example a tweet, a blog, or a report.
Considering the outcomes of this experimental activity, which of the following best describe what happened after? (Please select all that apply)
This experiment did not scale yet
Learning
What do you know now about the action plan learning question that you did not know before? What were your main learnings during this experiment?
Field observation and interviews have gathered evidence that, in cases of successful management,
different actors, by coordinating efforts and resources from their communities, have developed mechanisms that help mobilize resources, demand accountability from authorities, and block perverse incentives that could harm their communities. These partial results have implications for both academic discussions on good performance and positive deviation, as well as for public policies.
In the implementation part of the field experiment, it was observed that there is very little training in aspects related to social participation, human rights, and the health promotion approach. The work of the Family Health Teams (ESF) is predominantly focused on healthcare. Although the Functions Manual of the Family Health Units (USF) establishes participatory community diagnosis and action plans as tools for managing Primary Health Care (APS), in practice, there is insufficient training and support for their implementation. Compliance is not consistently enforced in all regions, and there is no monitoring or follow-up of the implementation of plans by the Family Health Units (USF). Many Family Health Units (USF) perceive participation activities as a formal commitment to fulfill and report each month, without truly harnessing these spaces with the transformative purpose that the Primary Health Care (APS) strategy proposes.
What were the main obstacles and challenges you encountered during this activity?
The main obstacles and challenges in this activity included the inability to review the Annual Operational Plans (POA) of the Family Health Units (USF) due to the low quality of the documents. Additionally, the POA format did not allow for adapting the plan to emerging local priorities. The implementation of training required agreements with the central and regional levels of the MSPBS.
Who at UNDP might benefit from the results of this experimental activity? Why?
Who outside UNDP might benefit from the results of this experiment? and why?
Primary Health Care Workers and the user community
Did this experiment require iterations? If so, how many and what did you change/adjust along the way? and why?
What advice would you give someone wanting to replicate this experimental activity?
For the implementation of the training, it is essential to reach agreements with the central and regional levels of the MSPBS for the implementation of the program, and that they recognize the importance of the topics discussed for the fulfillment of the established goals.
So that the planning and monitoring instruments could be used as impact evaluation instruments, the APS Directorate should establish regulatory guidelines that connect both operational planning instruments, the POA and the ASSI, requesting the USF to effectively present their POA 2022, where their programmatic goals and schedule are established, and that they present their ASSI, in a format that is easy to read and edit, such as a presentation, including the description of the Participatory Diagnosis carried out (attach to the document minutes of the community Aty carried out for the Diagnosis Community) and the agreed Action Plan.
As an alternative, it was considered that structured telephone interviews could be carried out with those responsible for the 54 USFs subject to the experiment. A list of the items to be considered in the suggested evaluation was designed, as detailed in Table 1. Due to limitations in the content of the POA and the budget execution deadlines of the financing funds, it was not possible to continue the evaluation. . However, the following heuristic evaluation rubric was developed for the plans that can be used in the future when new capacity strengthening interventions are carried out for the USF.
Can this experiment be replicated in another thematic area or other SDGs? If yes, what would need to be considered, if no, why not?
The positive deviance model applied to street personnel can be used to understand good practices in public management and propose innovations in several areas affected by the SDGs. In this case we did the experience in health, but similar models can be applied to improve the interaction of the state in the areas of education, housing, employment and other services.
How much the "sense" and "explore" phases of the learning cycle influenced/shaped this experiment? In hindsight, what would you have done differently with your fellow Solution Mapper and Explorer?
What surprised you?
The need to establish training monitoring and evaluation systems was evident, with greater technical and conceptual support from the central level, as well as spaces for participatory management at the local or regional level to increase the commitment of the ESF and a recognition of the needs and difficulties faced by ESF in each region. Review and improve the participatory operational planning instruments used at the territorial level, ensuring that they are standardized, supervised and monitored by the regional and central levels, so that they are correctly incorporated.
3Good health and well-being
16Peace, justice and strong institutions
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