Jordan case study

Against a brief background description of the Jordanian health setting, this report describes the strategic approach used in the consultancy and the method of its implementation. AUPHA"s overall approach addressed the general areas to be affected; targets for change within these areas; the objectives for change that should be set; the sequence to follow in addressing these areas; and methods for achieving change. Also considered in the approach were cultural and bureaucratic impediments to change, the limitations imposed by Jordanian health professionals, and the constraints specific to AUPHA. The objectives set included seven incremental objectives -- problem awareness; problem specification; ability to design solutions; design of solutions; knowledge of implementation practices; implementation of the design; and evaluation of the new system, which can be modified, depending on the amount of intervention needed. In implementing this approach, the consultants endeavored to keep costs low; used the same three consultants throughout the project, rather than employ specialized experts; kept inputs brief, in the form of 2 to 4 person-weeks of work every 2-3 months; distinguished between the intangible and functional aspects of management, while addressing both; differentiated among management functions based on degree of routinization in a functional area; minimized externalization so as not to weaken management"s role -- a key concern was that no methods encourage the belief that the areas dealt with were more the concern of consultants and donors than MOH officials; and gave priority to MOH"s expectations above all others. Although the MOH staff were generally pleased with the approach, the AUPHA consultants make the following recommendations for similar projects: (1) stress team continuity; (2) avoid arbitrary parcelization of responsibilities; (3) provide incentives to involve local institutions; and (4) test consultancy premises for cultural acceptability. The consultants also stressed the need to employ a method that addresses comprehensively preset policy objectives. Appendices include a resource inventory of MOH field facilities.