Guest blog by Benjamin Musungu, IPP ’24
My IPP implementation challenge was far from typical! When I first landed in Sahrawi Republic on April 2023, I was not sure of what to expect. I was half-excited and half-anxious to lead a high-stakes health diplomacy visit in a distant country fraught with geopolitical uncertainties and unknowns. The objective of the visit was to secure political buy-in and goodwill needed for the implementation of a COVID-19 vaccination project that was co-led by my organization (Africa Centers for Disease Control). This was a make-or-break engagement for the project, so I had to spend tons of time flipping through the health diplomacy tradecrafts that I could use to make the visit a success.
While in Sahrawi, I was deeply moved by the weak health systems in Sahrawi’s refugee camps. Their fragile health system is further exacerbated by the rising spread of infectious diseases in Northern Africa. Sahrawi Republic is a state-in-exile located in Algeria’s Tindouf region. The refugee camps that make up Sahrawi Republic are fully reliant on humanitarian aid. Contrastingly, most Northern African countries have fully established health systems. This notwithstanding, they are still afflicted by the increasing regional spread of the infectious diseases as people migrate across borders. The challenges led me to investigate how health diplomacy can foster North Africa’s collaboration to address the widespread disease burden. My anecdotal experiences in Sahrawi influenced the choice of my IPP implementation challenge: Addressing rising spread of chronic and infectious diseases in Northern Africa. The geographic coverage of my policy challenge included Libya, Mauritania, Algeria, Sahrawi, Egypt, Morocco and Tunisia.
Fast forward to June 2024, I was fortunate enough to get a full scholarship to attend Harvard’s Implementing Public Policy Program (IPP) through the Kistefos African Public Service Fellowship. My admission to the IPP program was timely as it came at a time when I was struggling with designing interventions that could improve health outcomes in Northern Africa. To say that my IPP was good is to understate the case. The program has been incredibly rewarding. In fact, it has been life-altering! The IPP course has all the hallmarks of Harvard’s signature pedagogy-Interactive in-person classes at the Harvard Kennedy School, facilitated case studies, group works, graded assignments, monthly check-ins with the lecturers and hands-on course support by the Technical Assistants.
Most policy professionals grapple with accurately defining their policy challenge. It is not uncommon to find problem statements that masquerade as absence of solutions. My initial problem statement was a classical ‘lack of a solution” hitherto to my encounter with the Problem Driven Iterative Adaptation model (PDIA). The PDIA is a tool taught as part of the IPP program. The tool can be adapted to formulate policy challenges and work backwards to design the best-fit solution. The PDIA has overarching prompts that scaffold details of a policy-making process. There are so many things that one can write about PDIA. The key component parts that stood out for me were the Fishbone diagram, Change-Space Analysis, Stepwise process of building authorization, and the teaming process.
- The Fishbone diagram: This has been useful in constructing and deconstructing my core policy challenge and visually mapping its causal strands. I was able to iterate and shift from my initial problem statement (lack of a regional health governance structure in North Africa) to a problem statement with a sharper focus (Rising burden of chronic and infectious diseases in North Africa). Using available data, I demonstrated the gravity of (in)action and the sense of urgency for the health policy practitioners in the region.
- Change-Space Analysis: When confronted with complex policy challenges, it is easy to find oneself behind the brick wall. The Change-Space analysis tool helped me to get past the brick wall of unpacking my complex challenge. Using the 3As framework, I was able to assess the feasibility of my complex policy challenges based on three criteria: Ability (Organizationally implementable), Acceptance (Politically supportive) and Authorization (Permissibility).
- Stepwise process of building authorization: The IPP introduced me to a nuanced understanding of authorization as a function of legitimacy (building trust from authorizers) and functionality (demonstrated results). These two variables can be adapted in any context to build the authorization from ground-up. In my case, I integrated my policy challenge as part of my Performance Appraisal with clearly articulated results and check-in meetings with my supervisor. This helped to cultivate buy-in and a sense of mutual accountability with my authorizers.
- Pushing boundaries from ‘ Teams’ to ‘Teaming’: Recognizing the need to shift from insular organizational teams to a fluid teaming process that values dynamism and shared interests was utterly invaluable. I was able to examine the concept of teams-where a group of individuals have structured membership and shared goals, to the concept of teaming-which is a dynamic activity that involves getting things done without the benefit of a structured team. I was also able to articulate the primacy of psychological safety and rethink the role of hierarchy and leadership in the context of teaming.
Arguably, the magic alchemy of PDIA is its experimental iteration. I constructed and deconstructed my policy challenges 5 times (See below my 1st and 5th fishbone iterations). The 4Ps of strategic leadership (Perception, Process, People & Projection) nudged me to rethink how I can construct a shared understanding of the policy challenge in a way that motivates action. I started practicing mindfulness and understanding other views of my policy challenge (Perception). Fostering inclusivity and participation in my group engagements also enhanced the team outputs in profound ways (Process). I also took conscious efforts to acknowledge other’s emotions (People) and emphasize the importance of story-telling as a way of influencing public narrative (Projection).
Fishbone Diagram (1st Iteration)
Fishbone Diagram (5th Iteration)
In the course of my study, I achieved the following milestones:
- I facilitated the inaugural Regional Technical Advisory Committee (RETAC) meeting held on 8-12 August 2024 in Cairo, Egypt. The meeting witnessed overwhelming participation from all the 7 Northern Africa Countries (Libya, Mauritania, Morocco, Tunisia, Sahrawi, Egypt and Algeria) as well as partners (WHO, UNICEF, US CDC, EMPHENET and the Arab League of States) .The high-level delegations from Member States included the Director Generals of the National Public Health Institutes. Establishment of North Africa’s Regional Technical Advisory Committee was one of my policy solutions in my fishbone diagram. The aim of RETAC is to provide a mechanism for Northern Africa Member States to prioritize joint action to address rising burden of diseases in the region.
- The key hallmarks of the meeting included the review of the Constitution/ Framework of RETAC and the election of RETAC leadership. Tunisia’s representative was elected as the first RETAC chairperson while Libya’s representative was elected the vice-chairperson.
Intercontinental Hotel, Egypt on 8-12 August 2024.
- I participated in a High-level advocacy visit to Sahrawi Republic held on 7-8 September 2024. The meeting involved high-level bilateral engagements between Africa CDC and the Prime Minister of Sahrawi Republic. The meeting identified areas of health policy interventions to be implemented under RETAC’s joint framework.
Group photo with Sahrawi’s Minister of Health
Photo during one of the visits to the refugee camps in Sahrawi Republic
- I participated in a High-level advocacy visit to the Islamic Republic of Mauritania held on 1-5 October 2024. The meeting involved high-level bilateral engagements between Africa CDC and Ministry of Health officials from Mauritania. The meeting identified in-country health policy interventions to be implemented under RETAC’s joint framework.
Africa CDC delegation group photo with Mauritania’s Ministry of Health officials
Field visit to Mauritania National Health Laboratory
The IPP left an indelible mark in my problem-solving approach. I will be more intentional in practicing experimental iterations when constructing and deconstructing problem statements. The teaming approach has equipped me with a nuanced understanding of how to build a collegiate and trust-based task teams that values psychological safety and felt accountability. I intend to make conscious efforts to look for outlier strengths such as personality fitness in my future teaming processes. Reinterpretation of the theory of authorization has been equally illuminating. In my future undertakings, I intend to always document small wins (functionality) and regularly share them with my authorizers (legitimacy). The 4Ps framework of strategic leadership was a game-changer. My mental dashboard of leadership has evolved from a power-based hierarchal model to a value-based model that centralizes the 4Ps of leadership: People, Perception, Projection and Process.
To the PDIA practitioners around the world, let us make PDIA count by celebrating the small wins. In the policy realm, most authorizers value big and immediate results which can lead to a feeling of failure. It helps to slow down and recognize the small incremental gains. Remember, PDIA is all about turning moments into momentum!
This is a blog series written by the alumni of the Implementing Public Policy Executive Education Program at the Harvard Kennedy School. 42 Participants successfully completed this 6-month hybrid program in November 2024. These are their learning journey stories.