This case delves into national health planning in Mozambique. It presents a scenario where the newly elected president has set out to address the “dual” burden of persistent malnutrition and rising obesity country-wide. Students must take on the role of a national health planner who must decide between different programmatic strategies, each of which present unique tradeoffs and the buy-in of different stakeholders. The case requires students to think about how advocacy coalitions can agree on broader planning goals but break down during program implementation decisions, and different perceptions of what “evidence” should count when charting an evidence-based policy solution.

Planning Topics

health planning, program planning, evidence-based policy, best practices, program evaluation, humanitarian assistance, organizational capacity, policy implementation, planning ethics, poverty reduction, governance

Learning Objectives

  1. Recognize that breakdowns in communication can undermine and delay the ability of planning communities to work together, and can fracture already small advocacy coalitions when they have a window of opportunity to finally make major reforms.
  2. Understand that intentional and inclusive decision-making procedures are necessary at all phases of the planning process, from agreeing on the goals through implementation.
  3. Explore the complexities involved when national governments start to reassert their authority and coordinate fragmented, often NGO-led efforts that have long dominated many sectors since the era of structural adjustment policies.
  4. Explain the different sources of “evidence” that can influence decision-making, depending on different values (e.g., scientific, operational, experiential, indigenous, etc.).
  5. Acknowledge that the most “effective” intervention not only must consider the scientific evidence, but also must be durable, feasible, appropriate, and politically acceptable.
  6. Recognize that a lack of evidence does not have the same meaning as negative evidence.

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Suggested Readings

  1. Popkin, B, Adair, L, and S Ng. (2012). Now and Then: The Global nutrition transition and the pandemic of obesity in developing countries. Nutrition Review, 70(1): 3-21. Read the abstract
  2. Dominique, B, Tawiah, C, Rosato, M, Some, T, and J Morrison. (2009). Evidence-based policy-making: The implications of globally-applicable research for context-specific problem-solving in developing countries. Social Science and Medicine, 69: 1539-1546. Download the full paper
  3. Pfeiffer, J. (2003). International NGOs and primary health care in Mozambique: The need for a new model of collaboration. Social Science and Medicine, 56: 725-738.  Download the full paper
  4. Rydin, Y, Bleahu, A, Davies, M, Dávila, J, Friel, S, Grandis, G, Groce, N, Hallal, P, Hamilton, I, Howden-Chapman, P, Lai, K, Lim, C, Martins, J, Osrin, D, Ridley, I, Scott, I, Taylor, M, Wilkinson, P and J Wilson. (2012). Shaping cities for health: Complexity and the planning of urban environments in the 21st century. Lancet, 379(9831): 2079–2108. Download the full paper