Andrews, Matthew. "Beyond 'The Answer' to Flexible Solutions in Managing Health in Africa." HKS Faculty Research Working Paper Series RWP08-067, November 2008.

Abstract

The critical issues facing public administration manifest in droves in developing countries. I focus here on problems of administering the health sector in Africa, characterized by dire conditions and woeful results. I contrast two approaches to fostering administrative solutions in Africa’s health sector. The first is reflected in an older regime of development interventions in the 1990s focused on introducing a decentralization blueprint. The second is a newer regime centered on performance-based funding that incites more flexible, context-specific administrative solutions. I label the first approach a misguided example of experts proposing “THE ANSWER” and suggest the second accommodates dynamic solutions “appropriate to circumstance”. I show that the development community may be moving toward the second approach through a comparison of newer Global Fund projects that look different to older World Bank projects. I also show that the newer projects appear to be better implemented, with more tangible results. I don’t suppose to say the evidence is conclusive but do think that it suggests African administrations need space to find themselves rather than prefabricated answers to who they should be. Administrative systems in places like the United States developed in just this kind of space. The same space should be afforded those now trying to develop.