This document discusses how to embed quality improvement initiatives in community health systems in Africa and Asia. It advocates for an adaptive and politically informed approach called "doing development differently" that rejects blueprints and embraces local realities and leadership. Quality improvement uses iterative, problem-driven cycles to identify performance gaps, understand causes, test interventions, and implement solutions. While effective, there is limited evidence on how to institutionalize quality improvement within national health systems. The document recommends using political economy analysis to understand the context, incentives, power dynamics and behaviors of stakeholders to design locally-led strategies that facilitate sustainable change.

2. Embedding quality improvement in community
health in Africa and Asia
,What is the political angle?
Olivia Tulloch. Health Research Fellow.
Overseas Development institute
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3. Doing Development Differently: What is adaptive
programming in the health sector?
• Rethinking how development happens
• Rejecting ‘blue prints’ & best practice models
• Being adaptive and entrepreneurial
• Working in politically informed ways
• Supporting changes that reflect local realities
• and are locally led
Resources: http://www.odi.org/doing-development-
differently-0
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4. How can we do this in the health sector? Quality improvement
Quality improvement cycles
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‘A cyclical process of measuring a
performance gap; understanding the
causes of the gap; testing, planning,
and implementing interventions to
close the gap; studying the effects of
the interventions; and planning
additional corrective actions in
response’
• Quality improvement is problem-driven,
iterative and flexible.
• Principles can be used to identify, test and
implement changes in any context or part of a
health system
• Limited experience and evidence of how to
apply it and embed it within national
structures and systems.
• Systems thinking and analysis of the political
economy environment may help embed complex
interventions like quality improvement and
sustain their achievements.

5. How can we get it right?
Political economy analysis is concerned with the interaction of political (people) and
economic (money) processes in a society: the distribution of power and wealth
between different groups and individuals, and the processes that create, sustain
and transform these relationships over time.
Concerned with questions like:
• What underlying political and economic factors shape development outcomes?
• What are the incentives and distribution of power among different groups, and
how might this affect the success of programmes/policies?
• What is the role of formal institutions and informal social, cultural and political
norms?
• What factors may affect these relationships over time?
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6. Approaches: Doing Development Differently
From the WHAT to the HOW:
• Community participation and partnership; Enhancing civic engagement
and ensuring (local) accountability
• Scaling up provision of global public goods for health
• Forming the national and international coalitions needed to deliver
change.
• Leadership for inter-sectoral coherence and coordination on the structural
drivers of health
• Locally-led, politically-smart strategies
Political economy analysis is a tool that can help to identify ‘what to do differently’
and what makes change happen
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7. 1: Problem
identification
2a: Structural Diagnosis: Context and institutions 2b: Agency Diagnosis: Power, incentives and behaviour
What is the specific ‘problem’ to
be addressed?
Identify:
1.Poor development outcomes
2.Pathway of change behind previous
interventions and their effectiveness.
What contextual features are relevant to
the problem?
- Demography, geography, culture and social
structure, historical legacies, etc.
- Formal institutions and informal social
political and cultural norms
What behaviours and incentives influence
the problem?
- Mapping of key actors (individuals and
organisations) and their motivations
(political, personal, financial, ideological
etc.)
- Mapping of relationships and balance of
power
- Use of relevant concepts e.g. collective
action problems, principal-agent
relationships
1.What is a plausible pathway of change?
- What is a realistic pathway for and theory of change?
2. What actions and entry points are most promising to achieve
change effectively?
- How should strategies be timed, tailored, and sequenced?
3: Prescription
What can
be done?
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8. ODI is the UK’s leading independent think tank on international
development and humanitarian issues. We aim to inspire and inform
policy and practice to reduce poverty by locking together high-quality
applied research and practical policy advice.
The views presented here are those of the speaker, and do not
necessarily represent the views of ODI or our partners.
Overseas Development Institute
203 Blackfriars Road, London, SE1 8NJ
T: +44 207 9220 300
www.odi.org.uk
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