Enhancing public health outcomes in developing countries: from good policies and best practices to better implementation.

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.

Technical assistance: a practical account of the challenges in design and implementation.

Technical assistance is provided to country governments as part of international development programmes to support policymaking or strengthen state capability. This article presents the conceptual evolution of 'technical assistance' linked to capacity development, starting with programmes aiming exclusively to enhance individual capacity in the 1950s to 1970s and progressing to complex systems approaches in the past ten years. It also presents some of the frequent challenges in designing and implementing technical assistance, drawing from the existing literature and the authors' experience in international development. The article summarises the latest thinking about delivering more effective development, including the adaptive management practices and the initiatives to strengthen evidence about what works. Finally, we complement this article with a follow-up open letter reflecting on the current policy options and opportunities for change.

Towards reimagined technical assistance: the current policy options and opportunities for change.

Technical assistance has been at the heart of development assistance provided to country governments by donor agencies over the past several decades. The current debates on reimagining technical assistance focus on the existing challenges of the different types of technical assistance and the (re)construction of an ideal model for delivering this type of support, with little discussion about the dilemmas involved in making day-to-day decisions and trade-offs in implementation. This article presents technical assistance as a policy option for governments and details the existing models of delivering technical assistance, their limitations, and the required enabling conditions. The models presented focus on the type of role for the technical advisers- as doers (performing government functions), partners (working with the government to perform a specific role) and facilitators (enabling and facilitating change programmes to address wicked problems). Finally, the paper provides a practical account of the implications of the programme design and suggests potential opportunities for change particularly in the context of COVID-19 pandemic. It complements an open letter on the practical account of the current challenges in the design and implementation of technical assistance programmes.