Publications

	Table of Contents
p. 19 of 27 BACK | NEXT Executive summary Introduction Regional health context The Bank’s involvementin the health sector Issues and options The health of the poor, women, and indigenous peoples Setting clear priorities Mobilizing resources for the public health sector Building managerial capacity Testing innovative approaches Introducing effective, new, and affordable technologies Focusing on functions which constitute public goods Increasing collaboration between public and private sectors The Bank’s health policy

Policy for the Health Sector : Issues and options

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Testing innovative approaches

Given the compelling financial and organizational challenges facing health care systems in the region, there is a great need for DMC governments to implement innovative approaches. Unfortunately, innovation is not synonymous with success. Thus, there is a need to rigorously pilot test new approaches to separate the merely novel from the truly effective. In addition to determining effectiveness, pilot testing of policy alternatives also provides a means for discovering operational problems prior to widespread implementation. These problems can then be addressed before large amounts of resources are wasted on what are often costly and complicated interventions. Through pilot testing, ministries of health can become learning organizations that increase their efficiency through continuous quality improvement. The sharing of experiences will help develop an international body of knowledge about successful practices.

Experience with pilot testing has pointed out a number of problems, particularly the pilot test bias. This occurs when an innovation is implemented in a small area with (i) levels of financial inputs per beneficiary that are not replicable on a broader scale; (ii) excessive external technical and management assistance; and (iii) selection of pilot areas based on high levels of political support that may not be representative of other areas. With extensive resources and political support, even poor ideas may be “doomed to success.” When implemented on a larger scale, these supposed successes are not replicated. Another common difficulty with pilot tests is the absence of proper evaluation, particularly the lack of a comparison group. Without a concurrent comparison and rigorous evaluation, the proponents of an innovative approach are usually able to claim success. However, when the innovation is scaled up, the lack of effectiveness becomes apparent. Large-scale pilot tests by their nature reduce, if not eliminate, the pilot-test bias. Testing innovations in areas with populations in the hundreds of thousands or millions makes it more likely that expenditures per beneficiary approximate what would be available on a countrywide basis. External technical and management assistance is also dispersed over a large area thereby lessening the likelihood that excessive managerial inputs exaggerate perceived effectiveness. Large-scale pilot tests also enjoy economies of scale in carrying out evaluation, which increases the probability that it will be done properly.

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