‘Doing’ governance & (self indulgent) thoughts on #governance & #evidence & #health

I joined DFID on 9/11 (11/09/2001) as a Social Development Adviser.
Not drunk on the MDGs, but slightly merry.
I had never heard of governance. 1/25
I started work in 1993 in health research (Tz, malaria; drug prescribing), then disability inclusion (India) & consulting in health, WATSAN.
After 6 yrs in Kolkata I heard that DFID was recruiting regional specialists.
I fancied myself as a DFID South Asia specialist! 2/25
....DFID sent me to Malawi.
I hadn’t heard of ‘Governance’.
But slowly realised that I had worked on it – local govt, politics, rights in health; water tariffs, participation & transparency, health management.
So Governance in sectors, not Governance as a thing. 3/25
In 2005 I passed DFID’s test (& was sworn in as a Governance Adviser "I solemnly declare that it is always about incentives..")(joking).
Since then some governance themes endlessly change, while more or less staying the same, including in health. For example... 4/25
This contrasts governance projects (e.g. tax, accountability, public sector reform) with tackling governance and political constraints within big sectors (health, ed, energy, security, climate, jobs). 5/25
I am firmly ‘Sector First’.
I think we should deploy at least 50% of governance expertise/££ to help partners tackle enduring problems in big, important dev & growth ‘sectors’ e.g. health.
Otherwise governance speaks unto governance & we risk going spiral, not viral. 6/25
Each new governance generation asserts that ‘politics is REALLY important’. Back in 2001 DFID mainstreamed ‘Drivers of Change’.
My Social Development colleague noted "I see that Governance has discovered Political Science... Again." SDA🔥 7/25
When governance people gather they risk getting lost in politics. I think we need balance. Technical stuff really matters – as well as the politics of where/how/when to deploy it. As a taster, below is the trailer of @hamarquette 's forthcoming paper (& merch). 8/25
As a junior jimmy consultant my $trat£gy was ‘never say no’. If asked "do you know anything about…XXX?" I said ‘yes’ (then rapidly learnt enough for the next meeting – & shamelessly asked real experts for key reading & advice).
This was…
…ideal preparation for working as a Governance Flexpert– swot up on a new technical area; then find real experts for detailed work – drug supply; payroll reform; police recruitment; update prison manual; alcohol policy & VAWG; power sector reform. Extreme variety. 10/25
But this diversity of themes/freedom to roam/magpie entrepreneurism is what I like most about being a DFID governance adviser. Thought leadership needs thinking, not encyclopaedic knowledge. A few Flexperts can be a blessing (if they/you know their limits). 11/25
POL v. TECH (#2)
So, thinking (& manoeuvring) politically was essential to spot opportunity. But most longterm effort has been ‘technical’, with governments, CSO, World Bank etc. This meant ‘know enough’, not ‘know it all’. But also know real experts. And evidence. 12/25
My favourite example: GHOST BUSTERS
You need to think POLITICALLY to understand WHY there are ghost workers on a government payroll, & the interests that keep them there. But you need TECHNICAL skills (pay roll management; electronic payments) to EXORCISE the ghosts. 13/25
In the 2000s, sector programmes (health/ed/water/power) had big budgets & sector-wide, transformational ambitions. Many used budget support, including some governance reforms amongst the triggers for disbursing multi-donor aid. 14/25
Political governance barriers were clear– e.g. poorly motivated govt workers expected to take on new tasks; professional & pvt sector groups with interests directly challenged by reform. These were ‘risks & assumptions’, not something we usually addressed... 15/25
...except by ‘Demand Side’ activities - e.g. broad accountability initiatives, Health civil society fora. Conceptually framed (short or long route?), reflecting values/aspirations, but not evidence based, or rigorously tested.
Like much of ‘old skool’ governance. 16/25
Sector wide & system investments are in the air again. Hard lessons (I hope) mean we are more politically realistic – about how much change is possible (not much, slowly) & how much influence external players can have. 17/25
In the 2000s we drew some magnificent health sector diagrams; largely technical, & imagined all moving parts working well after a dose of ££$$ & Technical Assistance. Transformed! We thought too little about ‘is this really politically feasible?’. Or election cycles. 18/25
Today's diagrams zoom in on sub-systems; include political & technical; & are more realistic: Can we tune one part of the machine (not 'makeover' the whole sector) & so tackle specific problems (tweaks, not ‘solutions’).
See bit.ly/2EmMSA7 for more on this. 19/25
My own work has also zoomed in, focused downward. More pessimistic. Or realistic. Less conceptual, less value driven, less aspirational. More problem-specific. And often more evidence based.. as the stock of high quality, relevant research grows. 20/25
In 2014 I joined @DFID_RED_GCSD to commission research. Problem focused. Political-AND-technical. (My heart races when I hear a political scientist say ‘pharma molecule’. {In a good way}).
Q: But doesn’t ‘problem focused’ = think small? 21/25
No! ‘Specific’ problems can have vast negative effects (VAWG; leaky drug procurement). And huge benefits if we can tackle, skirt round or squeeze them. Our Political Economy research is a public good #OpenAccess; for everyone, not secret behind-the-scenes smarts. 22/25
Many c.1993 ‘health gov’ problems endure: drug theft/price fixing, absenteeism. But research now considers pol/tech feasibility of interventions; tests them, measures outcomes & [🙂proud] health's mainstream- @WHO @governance_hs - is using great governance research e.g.. 23/25
@ACE_soas bit.ly/2Hvb3y7 absenteeism,pharma
#ESID bit.ly/2YHwHox Mat Health
#GIACE bit.ly/2HWCRue drugs
@BaselInstitute corrupt H networks
@JPAL_Global H accountability RCTs bit.ly/2EqlX6i

✅so looking Fwd to SDG3+ ActionPlan 24/25
And governance research has changed my mind about a range of things that 15 years ago I (we?) regarded as truths.

So #UniversalHealthCare?
Let’s do this! but #PoliticallyRealistic & #EvidenceBased

*why 'governance Half-life' clickbait?
1993-19=25yrs & I am 50.
Thanks for some great responses to this friday thread. <<thinking>> next gcsd governance thread could be "gov/pol research that really changed my mind*".
But before then we shld do some conflict and inclusion research threads.
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