Development Research Group, World Bank, Washington, DC, USA.
Scand J Public Health. 2018 Jun;46(22_suppl):10-18. doi: 10.1177/1403494818765690.
In rich and poor countries alike, a core challenge is building the state's capability for policy implementation. Delivering high-quality public health and health care-affordably, reliably and at scale, for all-exemplifies this challenge, since doing so requires deftly integrating refined technical skills (surgery), broad logistics management (supply chains, facilities maintenance), adaptive problem solving (curative care), and resolving ideological differences (who pays? who provides?), even as the prevailing health problems themselves only become more diverse, complex, and expensive as countries become more prosperous. However, the current state of state capability in developing countries is demonstrably alarming, with the strains and demands only likely to intensify in the coming decades. Prevailing "best practice" strategies for building implementation capability-copying and scaling putative successes from abroad-are too often part of the problem, while individual training ("capacity building") and technological upgrades (e.g. new management information systems) remain necessary but deeply insufficient. An alternative approach is outlined, one centered on building implementation capability by working iteratively to solve problems nominated and prioritized by local actors.
在富裕国家和贫穷国家，一个核心挑战是建设国家的政策执行能力。以负担得起、可信赖和规模化的方式，为所有人提供高质量的公共卫生和医疗保健，这就体现了这一挑战，因为这需要巧妙地整合精细的技术技能（如手术）、广泛的后勤管理（供应链、设施维护）、适应性问题解决（治疗护理），并解决思想差异（谁来支付？谁来提供？），即使随着国家变得更加繁荣，流行的健康问题本身也会变得更加多样化、复杂化和昂贵。然而，发展中国家当前的国家能力状况显然令人担忧，未来几十年的压力和需求只会加剧。流行的建设执行能力的“最佳实践”策略——从国外复制和扩大所谓的成功——往往是问题的一部分，而个人培训（“能力建设”）和技术升级（例如新的管理信息系统）仍然是必要的，但远远不够。本文概述了一种替代方法，该方法的核心是通过迭代工作来解决当地行为体提名和优先考虑的问题，从而建设执行能力。
