CHEVENING FORUM 2010
Healthcare & Other Public Services How to Innovate to Keep Up With Demands Barcamp Leader: Sulisia Erza (Lishia), Nottingham At the start of the barcamp, the group was given a short introduction on the context and focus of discussion (1 minute). Bold words in this report mark keywords during the discussion. Contacts for further discussion is listed at the end of this document.
Context & Focus 1.Innovation in public service has the following goals: a.to improve quality b.to rebuild trust in government Therefore innovation in public sector is not just about coming up with bright ideas or new policies, but innovation is also needed in putting ideas into practice. 2.Looking at the demands, innovation can have large scale or incremental focus, each will have different challenges. 3.With this context in mind, the barcamp focuses its discussion on: a.Who is responsible for developing and implementing new practice b.How to catalyse and sustain innovation c.Good practice sharing mechanism for replication in other areas (geographic & issue)
Barcamp Discussion We identified several actors involved/responsible for public service innovation in general:
The government is responsible to secure public welfare and develop the society. However, the government has limited period of office, filled with people who are constantly changing their roles, and therefore innovation has lesser sustainability unless a government is in rule for more than 2 periods. The main role of the government in innovation is to inspire and set long term goals, as the government is usually the one with comprehensive data on current state of public service and what the demands are. The government is limited in its capacity to implement, therefore state government is in need of partnership with other actors.
CHEVENING FORUM 2010
IO has higher sustainability with its programs and approach. More often, IO has bigger capacity to influence/catalyze innovation because IO governance lasts longer (lower turnover compared to state government). MDGs for example has a 15 year target, which is more achievable when driven by IO than by state government as no state government lasts for 15 years. The role of IO is to facilitate sustainability.
Society (private enterprises, local groups, specific organisations, academia)
Examples were taken from Russia and UK on the role of society (in a broad sense) as catalysts of innovation. These actors often have bigger financial and technical capacities, therefore they can take on the role to foster: 1.targeted research and development 2.implementation For example, private companies through CSR programs often establish educational institutions, NHS (UK) began an awareness program by involving students and social media.
Although there is a consensus that these actors have to collaborate and form partnerships and that the level of actorsâ€™ influence differ in different countries, differences of opinion occur on the flow of innovation between top down and bottom up approaches. The barcampers finally agree that governments are better at large-scale innovation focus while private/society groups are better at incremental innovation focus. This is due to differences in drive (needs, expectations, aspiration, policy) and obstacles to innovation. An example for drive is taken from healthcare reforms in the USA - that even though the existing US healthcare system was profitable and delivers good quality, it did not keep up with societal changes. With implementation of the current reform, the US have taken a position that a welfare state is the way forward. In this case, social change is a catalyst for innovation. However, it has to be taken into consideration that bottom-up approach affects financing. Scandinavian countries impose high taxes (50-60%) to fund welfare schemes. Uganda (on IMFâ€™s recommendation) cancels user fee, resulting in the inability of the government to provide basic health services. The lesson learned from the above: 1.Innovation (when supported by international organizations) has to take into consideration institutional differences between countries, specifically on what is valued more in specific locations. 2.State government must take on regulatory role in innovation of public services, especially in financing and cost-sharing with other actors. This will ensure effective selection/targeting of schemes to finance. Financing innovation is a crucial point as some industries are dependent on government budgets. For higher effectiveness, innovation in public service to meet demands will depend on informed decision making and capacity building efforts. Think tanks play significant role here. Case in point: Cuba has 100% population coverage but as an effect, they do not have resources to do further research and development. 2
CHEVENING FORUM 2010
Specifically for healthcare, innovation is required not only in service delivery but also in pharmaceutical advancements. Often the challenge is having to choose between cheap but ineffective drugs or effective high-priced ones.
Thinking Forward 1.Innovation requires multi-disciplinary thinking not only to keep up with demands but also
to advance societies. Finance and Budget aspects of innovation is one of the biggest challenge, not only in raising funds but also in prioritizing allocation. Case in point: Mexico. 2.Innovation is not one-size-fit-all. Although there are similarities, every sector (i.e.
education, health, social protection, welfare) will have distinct dynamics (i.e. actors, needs, obstacles). 3.State government is a controlling actor throughout all aspects, but the key to innovation
is to give sufficient freedom/space for other actors to innovate. 4.Innovation is supported through: development of innovative capabilities (testing,
challenging and exploring) as well as managing changes in society (leadership, innovation process, cultures, evaluation of output/outcome.
CHEVENING FORUM 2010
Contacts for further discussion: Sulisia Erza
MA Social & Global Justice (Nottingham)
MSc International Strategy & Economics (St. Andrews)
Health System & Public Policy (Edinburgh)
MA in Comparative and Social Policy (York)
MSc Economic Development and Policy Analysis (Nottingham)
MPhil Perspective on Inclusion and Special Education (Cambridge)
Luis Yahir Acosta
(Queen Mary, London)
MA Conflict, Security and Development (Bradford)