From Promise to Delivery: Organizing the Government of Peru to Improve Public Health Outcomes

Abstract

Knowledge and good intentions in public health often do not translate into concrete impact. While politicians and health system officials struggle to fulfill promises and achieve results, populations bear an increasing burden of avoidable death and suffering. Pioneered in the UK and later disseminated globally, the “delivery approach” is a management system which aims to improve government performance and citizen outcomes. Despite success stories, there is limited documentation about what makes translation of the “delivery approach” to different contexts successful. Given the prominent role often played by government organizations in health systems, translational knowledge about what works in public sector performance management is key to strengthening public health and other essential services. This thesis critically examines the government of Peru’s efforts to deliver on its health targets by 2021. Childhood anemia, chronic childhood malnutrition and waiting times for medical appointments were the three focus areas of the government. Government’s interventions were divided into four work streams: setting up the Delivery Unit, reviewing current system capacity, forming guiding coalitions and planning for delivery. A framework for analysis was developed combining components of the “delivery approach” framework and pillars of public policy. I adopt an adaptive, qualitative approach to data collection and analysis. Primary research included interviews, focus group discussions, participant and non-participant observations, whereas secondary research involved documentation and literature reviews. This project illuminated tactics and behaviors which helped accelerate and optimize government’s organization for delivery in Peru. Aspects potentially associated with success included forming a highly capable implementation team, establishing strong guiding coalitions across government, understanding service frontlines, using data for decision making, and prioritizing targets and interventions. The project also allowed examination of public health interconnections with other areas. Findings underscore the value of systemic thinking and the importance of technical, political and ethical dimensions of delivery work. Understanding which characteristics support and which undermine government delivery efforts may inform political leaders, policymakers, public officials and practitioners on how best to increase the effectiveness and accountability of health systems. Cross-cutting lessons from experience provide practical recommendations for public health professionals to achieve better outcomes and thrive in the process.