Governments and donors often want to address major health and education issues with one large policy adjustment. But it is the small, daily, improvements that lead to change.
The development sector and governments often like big ideas. Whether it is solving hunger, getting everyone vaccinated, or giving children a quality education, leaders frequently aspire to achieve large goals. However, trying to reach substantial policy objectives with a single step forward rarely works.
How incremental changes lead to major improvements over time
Incremental improvements add up to significant change over time. If vaccine capabilities are fixed first, then the focus can move to cold chains and other areas. Over time, a snowball effect fosters a culture of continuous progression that sustains itself.
Shahmir Hamid, Acasus’s Project Manager for Balochistan, Pakistan, supports this approach: “If you can win every day for 365 days, you’ll have 365 small wins by the end of the year.” This is a better alternative than “one attempt at a big win that may or may not work.”
The government’s work in Punjab, Pakistan, illustrates this concept. The province upgraded hundreds of health facilities to provide 24/7 care for expectant mothers. While the concept seems simple, implementing the improvement solved many small problems, including:
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Overcoming bureaucratic hurdles to gain approval.
- Hiring and training new health workers.
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Frequent rehiring for high turnover in the initial phase.
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Allowing alternative staff to be hired in areas with shortages.
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Lifting court orders that halted hiring.
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Addressing political interference.
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Removing bottlenecks to ensure equipment and medicine were procured on time.
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Highlighting issues with UPS/batteries procurement, and pushing for resolutions.
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Pushing distribution of procured items from provinces to districts.
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Ensuring clusters were functional, and redesigning where necessary.
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Establishing referral linkages with hospitals for referring complications.
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Setting routines for data collection and compilation at district and provincial levels.
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Instituting data validation processes to ensure data integrity.
Deliver an upfront, quick and valuable win for partners
In order to convince partners that small wins can come quickly, amounting to significant progress, it is useful to deliver a speedy upfront victory. Making progress quickly helps build trust and confidence, even where wins are small. If results come quickly, and in succession, they can be cumulatively impactful.
Recently, in a country where we work, a small number of health facilities were converted to 24/7 operations. Due to the focus being on speed, the initial results were not perfect. However, officials became convinced that action could be taken on a larger scale, and deliver the necessary momentum to bring further improvements.
Stakeholders should see what is happening on the front line
KLM airline’s President and CEO, Marjan Rintel, has been known to spend time working as a flight attendant aboard flights. A clever way of seeing what is happening on the front line, these actions bring invaluable insights to stakeholders operating at the top of organisations.
If clear evidence is not provided, stakeholders may disregard feedback as exaggerated or an excuse for poor work standards. However, governments frequently make dozens of changes once they have seen upfront evidence of, for example, crumbling health facilities, or photos showing stock rooms empty of essential medicine stocks.
The importance of incremental improvements
The evidence suggests that incremental improvements work well in the health and education sectors. Telling an impactful story and delivering a quick, yet valuable, upfront win is an effective method for convincing governments and partners that change is possible.
