Conclusion
The accumulation of evidence presented in this study should help allay any remaining doubts about whether existing technologies and interventions, proven to be cost-effective in randomized controlled trials, can be successfully deployed to improve the lives and health of people throughout the developing world. The evidence suggests not only that it is possible, but also that it has been achieved in many parts of the world, in many different socioeconomic and political settings.
The study also found important commonalities among programs and projects that appear to have contributed to the successful deployment and rapid scale-up of cost-effective interventions. Strong leadership, effective management, realistic financing, country ownership, and application of new research findings and technical innovation all played a role in implementation and appeared to have made major contributions to the positive achievements of the cases under review.
In some respects, the study also presents a sobering view of the difficulties inherent in moving from a cost-effective intervention to a successful program or project. No single formula is available, and identification of unique characteristics and attributes that will permit the large-scale, effective deployment of many known interventions is difficult.
In addition, evidence from the case studies suggests that the programmatic characteristics and policies associated with successful outcomes vary depending on the type of intervention. Although no single formula exists, the implementation of the programs and projects structured around various types of interventions appears to depend on certain types of organizational, managerial, and financial capacities that can be anticipated and specifically targeted for strengthening before the full-scale launch of a program or project. Thus, the findings of this study may serve as pointers for future research seeking to understand the range of government capacities that are needed to support the successful deployment and scaling up of interventions in various contexts and in different parts of the world.
Notes
1. Unless otherwise indicated, the background information and health impact data presented about the 17 cases reviewed for this study are drawn from Levine and What Works Working Group (2004). All materials are available at www.cgdev.org/publication/millionssaved.
2. According to World Development Report 2004 (World Bank 2004), because the relationship between provider and client differs, each of the three types of service arrangements will experience a different constellation of market, government, and accountability failures. The report proposes that if these failures are properly addressed and client power increases, the quality of service delivery will improve, especially among poorer groups.
