1. Step 3: Strategy Development

2. Learning Objectives Define strategy/strategic approach Understand strategy development process Engage in informed dialogue about strategic choices and impacts

3. Strategy Development Developing alternative strategies using identified factors Selecting a strategy for implementation Brainstorm Review experiences of other countries/locales Feasibility analysis Cost-benefit estimate

4. 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

5. Strategy Development Steps Identifying critical factors Developing alternative strategies using identified factors Selecting a strategy for implementation

6. 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 Identifying Critical Factors

7. 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

8. Rating of Factors 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 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

9. Rating of Factors: Country Example IssuesImportanceCurrent status Level of internal control Donors interest5+1 Dependence on national health policy 5-3 Share of the private sector4+2 40% below poverty line4-1 Increasing level of literacy and awareness 4+1 Large-scale disparities 4-3

10. Rating of Factors: Country Example IssuesImportanceCurrent status Level of internal control Top leadership5+3 RH infrastructure4+3 Public expenditure5+4 System of accountability5-5 Utilization of information5-4 Supply of drugs5-4

11. 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

12. 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

13. 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

14. Selecting a Strategy for Implementation A comprehensive, cost-effective, and feasible option is selected among alternative strategies A high-impact, low-cost strategy

15. Feasibility Assessment Requires a consultative process that considers Ones critical judgment Viewpoint of counterparts Resource issues Implications in terms of program effort

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

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

18. 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

19. 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

20. 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