Using IPP to tackle HIV, Substance Abuse, and Gender Violence in South Africa

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Guest blog by Chris van Rooyen, IPP 2021

I had several expectations when I signed up for the Harvard Implementing Public Policy (IPP) course. First, I was privileged to represent Africa at one of the best global universities. Second, the IPP course was the first international study program of my career. I had preconceived ideas about the world-renowned Harvard University. A few days into the course, I realized that the stakes were high to complete the course successfully over the next 22 weeks.  

I had graduated from several South African universities and anticipated a heavy academic system with reading material from journals and research books. My prospects for the course presentation and content were to receive some theoretical frameworks and tools for implementing public policy effectively. However, to my surprise, the course at Harvard University was accessible to learning based on my own lived experiences. I was impressed with the “flip flop” approach of the course design, where students prepare themselves through readings, case studies, blocks, podcasts, and one weekly discussion and presentation. The social hour exceeded all expectations, and the learning was exceptional. Finally, I was privileged to be part of the best group, which and indeed, the group, was my biggest asset during difficult times. 

Some key learnings were both at a personal and professional level. I have learned that planning and prioritizing your life is the key to success at a personal level. I was hospitalized for two weeks due to COVID complications and had to recover for about four weeks. During this strenuous time, my group members supported me through check-in chats and supportive messages, which motivated me to return to the course. Thanks again to my support group members; this pandemic has deepened our race to humanity.

I have rented the Plan and Control method from the course and applied the principles of exploring the unknown as the first step to addressing the problem. My understanding of how the planning and control process worked in government has deepened tremendously. I learned to trust was earned over some time. The course was my first introduction to the PDIA method, and I have learned to apply some parts of the methodology in my daily operations. The PDIA centralized around other peoples’ views and incorporated these different views into an everyday reality or goal. Modules on leadership were exciting, and my takeaway lesson was that leadership was about multi-agent groups and not single-agent autocrats. I have realized that every person was a leader in their own right by leading his work component. Leadership was about the functional skill of identifying the problem, unpacking the problem through consultations, learning about the situation, and sustainably solving the problem. Multi-agent arrangements contributed to exploring complex issues. Leadership was about taking risks on a specific problem to solve the problem. People develop a sense of purpose and value themselves as part of the problem and the solution. Leadership developed a purpose-driven solution where individuals are valued and appreciated for their contribution to solving the problem. I reflected upon an African proverb about leadership “A good chief is like a forest; everyone can go there and get something.” Good leaders unleash the potential in the people to achieve self-actualization. 

The policy implementation units in HIV and AIDS, Substance Abuse, and Gender Abused Violence units did not respond adequately to the integrated service delivery model. The integrated service delivery is derived from the principle of integration to address social ills in communities. The implementation challenge was complex and required several iterations to understand the problem from diverse perspectives.  

In addressing the issue. Non-interaction was identified as one of the barriers to implementing an integrated service delivery model. In a meeting held between the three units, they agreed that the silo working arrangements do not promote public policy implementation integration. I had a problem identification meeting with officials from the three units. During the workshop, I identified officials to be part of the supportive group.  Part of the workshop agenda was presentations from authorizers to explain their ideas around an integrated approach for Policy Implementation. I have consulted with experts in the Department on how best to integrate the three units both from a goal-setting and financial perspective. The problem originated from different views. Supportive groups required a specific task, and officials in the groups were all leaders in their own right. Authorizers’ opinions and ideas were reflected upon in the smaller working groups and aligned to the group outputs. Every week the groups collaborated with new sources of information, and in some cases, groups held virtual meetings. The group was introduced to the iterative process and used the five Why questions?

The smaller group members were orientated on the fishbone Analysis method and requested to apply the technique in the scope of work allocated to the group. These were some outputs from the Fishbone Method. 

  1. Leadership clarity workshop
  2. The development of the scope of work.
  3. Smaller supportive working groups were established and activated in the meeting. 
  4. IT support to automate the working arrangements between the three units. 
  5. Budget and costing processes as required for each group.
  6. The learning agenda was identified and incorporated into the scope of work.

In the final stage, iteration confirmed the working mechanism between the three units and the role clarification of stakeholders. The solution spread across all three teams. A Fishbone diagram was drawn during the consultation process. Groups received constructive feedback from Authorizers. The proposed working mechanism was updated and documented. The team developed a dashboard for feedback that forwards automated input to all.  The communication team published monthly progress updates to the sources of information. The purpose was to confirm the process, analyze data and provide updates. Finally, the problem-solution was accepted and implemented, and the working team agreed on a reviewing period of three years. 

The idea was long overdue, and officials started developing a common goal in response to an integrated mechanism. I have learned that iteration is a time-consuming process. Working groups tested integration and consulted with beneficiaries.  Authorities are holders of the budget, and the solution should resonate with the views of the Authorizers. My role was to advise the authorizers on how the process evolved over the period. Small groups were influential after they applied the fishbone method in their respective scopes of work. Group members handled people with the utmost respect by the smaller teams. Iteration holds the key to a successful solution to the problem.

I am renting some components of the PDIA method as part of the Monitoring and Evaluation of the integrated services delivery model. The check PDIA check-in tool responded to the problem. I am planning to train government officials on the implementation of the check-in tools. In addition, the four P method of Process, Perception, People, and Projection is helpful for the government planning processes.

People-first approaches are crucial in healthcare policy implementation. The process is about other people’s views in response to complex public policy issues. The three units of HIV and AIDS, Substance Abuse, and Gender-Based Violence consist of people. The action of working together requires broader consultations with people. 

The African leadership philosophy is that a good chief is like a forest: everyone can go there and get something. Leaders unleash the potential in people at all levels. Good leaders build a powerful team by sharing power. 

The most powerful tool I’m taking from the PDIA method of the IPP course to my work and life in South Africa is iteration-based reflection!

This is a blog series written by the alumni of the Implementing Public Policy Executive Education Program at the Harvard Kennedy School. Participants successfully completed this 6-month online learning course in 2021. These are their learning journey stories.

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