Step 3: Strategy Development

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• Step 3 Strategy Development

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Learning Objectives

• Define strategy/strategic approach
• Understand strategy development process
• Engage in informed dialogue about strategic
  choices and impacts

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Strategy Development

• Brainstorm
• Review experiences of
• other countries/locales

• Developing alternative strategies using
  identified factors
• Selecting a strategy for implementation

• Feasibility analysis
• Cost-benefit estimate

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What Is Strategy?

• Strategy/strategic approach a statement that
  describes the overall approach to attaining the
  goal
• A strategy is just a means of moving from the
  current situation towards a stated goal
• All parts of the strategy must be internally
  consistent and unified

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Strategy Development Steps

• Identifying critical factors
• Developing alternative strategies using
  identified factors
• Selecting a strategy for implementation

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Identifying Critical Factors

• List all the identified factors
• Rate each of the factors on a 5-point scale for
• Importance
• Current status
• Level of internal control
• Identify critical factors most important,
  potential, and controllable

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Identifying Critical Factors

• Why is it an issue? - current status
• Who says it is an issue? (be sensitive to
  different perspectives of different stakeholders)
  - importance
• What are the consequences of not doing anything
  about it? - importance
• Can we do anything about it? - changeability/
  level of internal control

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Rating of Factors

• Environmental factors - least changeable
  outside the direct control of the system
• Goal changeability depends on the preference
  and interest of stakeholders
• Inputs changeability depends upon conditions to
  entry
• Information generated by internal and external
  sources
• Process under direct control highly changeable

Strengths Imp 4-5 Status 4-5 Control ? Opportunity Imp 4-5 Status 4-5 Control 3-5
Weakness Imp 2-5 Status 1-3 Control ? Threats Imp 4-5 Status 1-2 Control 1-3
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Rating of Factors Country Example
Issues Importance Current status Level of internal control
Donors interest 5 1
Dependence on national health policy 5 - 3
Share of the private sector 4 2
40 below poverty line 4 - 1
Increasing level of literacy and awareness 4 1
Large-scale disparities 4 - 3
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Rating of Factors Country Example
Issues Importance Current status Level of internal control
Top leadership 5 3
RH infrastructure 4 3
Public expenditure 5 4
System of accountability 5 - 5
Utilization of information 5 - 4
Supply of drugs 5 - 4
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Development of Strategic Alternatives

• Alternative strategies are developed on the basis
  of clustering of related factors
• Most important, highly controllable and potential
  factors are identified for strategy development
• Alternative strategic approaches are developed

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Alternative Strategic Approaches Country Example

• Improving the performance of the health system of
  Rajasthan by setting performance standards for
  managers, and equipping them with necessary
  authority, managerial know-how, and resources to
  enable them to achieve these standards
• Strengthen government capacity by encouraging
  private sector participation in the delivery of
  health care services
• Decentralization of the health system to the
  grassroots, with power vested in the local
  government

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Selecting a Strategy Purpose

• Devise a strategic approach relevant to the
  concrete situation
• Make it flexible enough to be adapted when that
  situation changes
• Realistically take available resources into
  account

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Selecting a Strategy for Implementation

• A comprehensive, cost-effective, and feasible
  option is selected among alternative strategies

A high-impact, low-cost strategy
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Feasibility Assessment

• Requires a consultative process that considers
• Ones critical judgment
• Viewpoint of counterparts
• Resource issues
• Implications in terms of program effort

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Feasibility Assessment
What will it cost to implement the strategy? (a
rough estimate)
Financial
Does the system require technical expertise to
support the strategy?
Technical
Will the strategy match the system policies and
be acceptable socially?
Socio-political
Are policymakers and implementers competent and
committed?
Managerial
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Sociopolitical Feasibility

• Influential politicians and political groups
• Cultural and religious leaders
• Governmental organizations or NGOs
• Community
• Important funding institutions
• Administration
• Powerful business interests

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Selected Strategy Country Example

• Improving the performance of the health system of
  Rajasthan by setting performance standards for
  managers and equipping them with necessary
  authority, managerial know-how, and resources to
  enable them to achieve these standards

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Full Implementation of a Strategy Means . . .

• Achieving a buy-in by all those responsible for
  implementing it
• Identifying the new behavior required of them
• Identifying the nature and level of resistance
  toward the new/needed behavior

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Full Implementation of a Strategy Means . . .

• Developing ways and means for instituting the
  new/needed behaviors
• Training (if new know-how is needed)
• Incentives to develop stakes in the outcomes of
  the new behavior
• Replacement/reassignment of key personnel
• Establishing a sound monitoring and
  accountability system