COVID-19 pandemic has brought unprecedented challenges to societies and threatened humanity and global resilience.
All countries (globally) are challenged but in equal measure.
Low-income and developing countries are facing a more challenging situation than others due to their limited health infrastructure, financial and human resources, and capacity to respond to the developing situation.
Further, the interconnected nature of the COVID-19 pandemic crisis demands an integrated approach and coordinated action, which complicates decision making even more.
Identifying the best set of policies and instruments to address COVID-19 challenges and aligning them with broader social goals will be critically important for sustainable recovery from the pandemic.
The key practical challenge facing the Kenyan policy makers is how to prioritize policies to achieve the interconnected goals of managing the health crisis, recovering the economy, and achieving environmental sustainability.
After due research, Kenya can follow this structure for identifying and prioritizing policy actions to address the COVID-19 challenges and ensure sustainable recovery.
The framework outlines principles and criteria and provides insights into developing shared policy goals, identifying smart strategies, assessing policy compatibility, aligning policy instruments, and factoring sustainability into short and long-term policy decisions.
This framework can assist to link short and long-term goals, mapping the interactions of different policy options, and assessing anticipated consequences and cross-sectoral implications.
It will enable policy makers to prioritize policy choices and allocate adequate resources in such a way that they are directed toward actions that generate synergy and co-benefits, have multiplier effects, and achieve interconnected solutions for health, the economy and environment.
The virus
The virus is highly contagious and spreads fast. It does not recognize borders nor spare anyone. It permeates all aspects of our lives and well-being.
The pandemic has affected healthcare, economic and social norms and values, taken many lives, and threatened the livelihoods of billions of people.
It has brought unprecedented challenges to societies and threatened humanity and global resilience.
Kenya faces a more challenging situation like other African countries due to limited health care facilities, low human capital, high poverty, and limited capacity of the government to respond effectively to such a pandemic.
Kenya has less than 2.5 physicians per 10000 people. The situation is even worse in many African countries. And there are similar problems with health facilities and physical and human resources.
With weak health infrastructure and limited financial and human resources, strategic thinking and planning and setting priorities for policies and activities will be critically important for Kenya to manage COVID-19 challenges
Policy priorities
Identification of policy priorities and selection of appropriate policy instruments are more powerful means for policy success.
However, decision making, and prioritization has always been a challenge, and the uncertain and volatile nature of the COVID-19 crisis has further complicated the issue.
Further, the interconnected nature of the crisis demands an integrated approach and coordinated action, which complicates decision making even more.
The key practical challenge facing Kenya is how to prioritize policies to achieve interconnected goals of achieving health and well-being.
A clear framework will be needed to ensure effective policy development and prioritization in planning and management of Kenya’s response.
The starting point in setting priorities should lie in engaging and consulting with key stakeholders in order to create a common vision for health, well-being, economic security, and environmental safety, with buy-in from stakeholders and commitment on broad social goals, which is key for implementation effectiveness.
Suggested steps
The suggested steps are outlined below and the key elements and supporting structures are presented.
The framework is developed by drawing concepts from public administration, public health, economics, and sustainable development and intended to assist policy makers to weigh policy options and prioritize policy choices within health and outside health sectors for governing complex interconnected issues.
There are two major prerequisites for using the framework.
The first is to establish a cross-sectoral coordination body, and the second to establish the criteria for assessing and prioritizing policy actions.
The principles and criteria for setting priorities identified below are the fundamental basis for weighing different policy choices.
These four criteria are at the center of the framework and related to all four steps. The individual elements are described in more detail in the following sections.
Stakeholder Co-Ordination
Leadership is critically important for effectively dealing health crisis like pandemic as well as engaging and coordination diverse actions and stakeholder in achieving broader social goals.
A multi-sectoral coordination body can provide an effective pathway for engaging multiple stakeholders, and the basis for a mechanism for coordinating and steering the decision-making process, and overseeing the implementation and recovery packages to maximize impact.
Many agencies important for health crisis management work within the health system, ranging from health education to prevention, and protection to treatment.
Outside the health system, food and nutrition, water and sanitation, housing, and elements of the physical environment such as air quality and climate are important for maintaining, improving, and protecting health.
A coordination body could establish a mechanism and develop a protocol for coordinating both the administrative (functional) and the policy (strategic) activities of the different organizations.
While the focus of functional coordination could be on building consensus and ensuring smooth cooperation within and between the key organizations involved in the planning process, policy coordination should focus on improving policy coherence and developing consistent policies to improve synergies.
Effective administrative coordination is a precondition for successful policy coordination.
While detailed consultation is not possible during a time of urgency like the COVID-19 pandemic, this body should be able to engage and consult with key organizations and stakeholders in order to facilitate exchange of ideas, dialogue, and discussion, and provide strategic directions and clear guidelines in setting priorities, allocating resources, and implementation.
The key stakeholders could be key government agencies such as health (including public health experts), finance, security, water, food, and trade and commerce, as well as experts and development partners, think tanks, and both government and non-government actors.
Effective stakeholder engagement relies on appropriate institutional frameworks as well as effective use of both formal and informal coordination mechanisms to facilitate mutual communication and collaboration among stakeholders and oversee the priority setting process.
The overall coordination can remain under the cabinet or national planning commission (who have the authority to mobilize sectoral ministries and agencies), or an inter-ministerial committee.
However, this can vary considerably from country to country depending on the cultural context and administrative and operational capacity.
It could be a single structure or unit such as the Ministry of Health or the Office of the Prime Minister or President or Planning Commission.
However, it is critically important to identify a key coordinating agency within the current institutional framework, which has the authority to convene and coordinate multi-sectoral actions and guide integrated planning.
The coordination body should have broad representation and may include both political leaders and experts in the relevant fields, and should have adequate convening and decision-making power and authority, as well as the capability to deal with strategic issues including policy coordination.
This requires a continuous process of analyzing, balancing, and prioritizing the objectives of different policy goals.
It may also require enhancing institutional capacity, including the operational and coordination skills of coordination agencies, and improving processes that facilitate engagement with stakeholders beyond governments, such as private health service providers and other non-state actors.
In striving to establish multi-sectoral coordination, it is also important to distribute responsibility and establish mechanisms for regular interaction among key stakeholders in order to build inter-organizational trust and promote communication and share knowledge and information among key institutional agencies.
Shared Knowledge and Goals
One of the fundamental steps in the planning and prioritization process is breaking sectoral silos and aligning interest of different agencies to develop a shared understanding on policy goals and strategic objectives and short and long-term needs of a country.
This provides the basis for achieving a consensus on multi-pronged strategies to achieve short, medium, and long-term goals.
To avoid conflicts, decision making on strategic policy choices and programs needs to be mindful of the broader social goals and their potential conflicts.
The short-term focus will be on managing the immediate health crisis, ensuring food and nutrition, and short-term job creation to help the economy survive; the medium-term on boosting economic activities to achieve financial and economic recovery; and the long-term on transforming or bouncing the economy forward by promoting long-term sustainable growth, reducing inequalities, building social coherence and resilience, and conserving resources and protecting the planet.
The different goals are closely linked and interdependent as health, economic, social, and environmental systems are interconnected.
The shared policy goals provide a basis for developing practical criteria and guidelines for prioritization.
Establishing Consensus among Agencies
Building consensus among agencies within and outside of the health system is a daunting task.
It involves engagement with the relevant government agencies and other key stakeholders and reaching societal agreement on common priorities that reflect the views of key stakeholders including epidemiologists and economists
This not only provides the fundamental basis for prioritization but also creates buy-in, commitment, and accountability from stakeholders on the broad social goals.
Although different government agencies have different interests and priorities, facilitating discussion and consultation, mediating conflicts, building trust, and providing a platform to clarify expectations can enhance mutual understanding and align interests.
One way to align multiple perspectives and build shared understanding through the process of engagement known as “principled engagement” that fosters reasoned argument (weigh different options and priorities objectively against broad social goals) and deliberation focused on defining problems and finding agreements together.
It supports shared representation and open interactions of different sectoral actions, and to integrate the concerns and goals of different sectors and agencies.
It allows open discussion, surface multiple perspectives, and enables “shared motivation” that build trust, foster mutual recognition of interdependence and shared ownership, and create a sense of internal legitimacy.
The principled engagement and shared motivation support each other and create an enabling environment for integrated planning, jointly identifying and defining objectives as well as a collaborative, raising awareness about the complementarities and externalities, and using a coordinated approach to consultation with open communication and exchange of information, will help align multiple perspectives reduce disagreements, increase understanding, and clarify organizational responsibilities.
Besides the four fundamental criteria presented above, aligning the different interests in support of agreed goals and building consensus through open communication and effective collaboration is critically important for policy prioritization in managing COVID-19 challenges and recovering the economy sustainably.
In striving to build a consensus on policy goals and maintaining shared understanding, the interests, needs, and positions of different stakeholders need to be understood and assessed based on the fundamental criteria outlined above.
Agreeing on the Principles and Criteria for Setting Priorities
Priority setting is a complex process involving making decisions on the allocation of resources to improve policy goals.
The interests, motivations, and preferences of the diverse array of stakeholders will differ, thus prioritization needs to be based on explicitly chosen and agreed criteria.
Dimension of Priorities
Prioritization is a multidimensional concept and can be seen from different perspectives, all of which need to be understood and taken into account.
From a moral and ethical perspective, managing existing, and emerging threats to human lives is a societal obligation and the primary responsibility of Counties.
Thus, the highest priority should be given to policy choices that save human lives by reducing health risks, improving health care, reducing communicable diseases, and ensuring provision of basic health services, together with those aimed at meeting basic human needs such as access to food, water, and shelter.
From a utilitarian perspective, policy choices should be guided by the utility generated and cost-effectiveness, since resources are finite.
The basic principles and criteria should be agreed by the key stakeholders and effectively communicated across all stakeholders.
Using these broad perspectives, four practical criteria can be identified as the fundamental basis for assessing and prioritizing policy choices and thus allocating resources for;
• Saving human lives and livelihoods
• Efficiency and effectiveness
• Equity and fairness
• Sustainability and resilience
These four principles and criteria may vary from country to country and different countries may attach a different weight to the different criteria based on the socio-economic conditions, existing health facilities, financial capacity, and environmental conditions of the country and the specific social, economic, and environmental concerns.
Smart Strategies That Bring Collaborative Effects
Once agreement has been reached on policies and prioritization criteria, the next step is to develop strategies for integrated and coordinated implementation of the different policy measures.
It is important to explore complementarities and identify potential co-benefits for the different policy options that bring synergistic effects by achieving multiple objectives at the same time with benefits for both health and economic recovery.
In addition to the fundamental criteria for assessing priorities, developing countries generally prioritize providing jobs and income for the poor and vulnerable.
Thus, a typical smart strategy could comprise investing in labor-intensive sectors that immediately generate employment while also generating multiplier effects for the economy by increasing growth potential and supporting economic recovery.
For example, investment in public works, infrastructure, small business, and micro and small enterprises can quickly offer jobs and income while stimulating local economies through using local resources and increasing the demand for manufactured goods.
Addressing Policy Coherence
While in certain areas policy cannot be compromised, there are many areas where improving policy coherence and coordination can reduce trade-offs and improve synergies and thus increase the net positive gain to society.
It is therefore critical to assess the magnitude of trade-offs and find ways and means to minimize them and improve the net positive outcome on the broad social goals outlined in the basic principles.
For example, relaxing lockdown may increase the risk of spreading the virus, but properly regulated may save the jobs and livelihoods of large numbers of poor people.
If the livelihood benefits outweigh the calibrated risk, then the net positive benefit may increase.
This approach can be useful in identifying alternative approaches and combinations of measures and weighing the potential benefits and externalities both positives and negatives to maximize net social benefits in achieving the broad social goals.
Controlling Externalities
Another way to improve policy coherence is to manage externalities.
A positive (beneficial) or negative (harmful) externality is the consequence of an industrial or commercial activity which affects other parties without this being reflected in market prices.
For example, when bees kept for honey pollinate surrounding crops there is a positive externality for the owner of the crops.
However, when industrial waste pollutes a water source and affects and pollutes fish stocks, downstream fisher communities experience a negative externality that reduces income and impacts health.
Negative externalities resulting from production processes can include environmental pollution, overexploitation of natural resources, and degradation of ecosystems, all of which can affect the natural environment and planetary health, which in turn are closely related to human health.
Reconciling Private and Social Interests
Another result of private decision makers not being required to consider the broader social consequences of their decisions is that social goods tend to be under produced and private goods over produced.
The divergence of private and social interests often leads to sub-optimal production of social goods such as public health, public transport, clean air, clean water, education, research, and innovation, which generate positive externalities for society.
Private investors cannot directly capture the full benefits generated through social goods and thus investment in social goods lies outside their interests.
However, it is difficult for governments to deliver the required social goods alone, and private sector participation is important for filling the gap between public need and financial capacity.
Appropriate incentive mechanisms can be developed to encourage private investment in social goods, including improvements in the healthcare system.
Assimilating Long-Term Sustainability in Policy Decisions
No matter what challenges ought to be addressed in the short-term, government policies and actions should take into account the need for sustainability in the long-term.
Thus, policy choices should focus both on resolving urgent needs and on ensuring long-term resilience and sustainability while taking to account the fundamental principles and criteria agreed as the fundamental basis.
Factoring Sustainability Into Short-Term Policy Choices
The COVID-19 pandemic provides an opportunity to take a broad look at factoring sustainability—economic, social, and environmental—into policy choices in order to create more resilient societies.
This requires strategic thinking and a systematic assessment of policy options and strategies for long-term investment to ensure that the short-term actions result in long-term benefits.
Some of the short-term support can be linked to long-term economic growth by appropriate conditions that improve the social and environmental conditions for health.
Improving Long-Term Productivity and Resilience
The short-term focus will be on addressing the impacts of the pandemic and, following the direct health-related activities, is likely to focus on employment generation and restoration of jobs.
However, long-term investment decisions should also be considered.
Investing in a balanced portfolio of physical, human, social and natural capital will help improve long-term productivity and resilience, and thus build capacity to deal with future challenges and mitigate the impact of future pandemics and disasters.
For example, investment in health, education, skills development, innovation, technological upgrading, and green infrastructure and natural capital will increase productive capacity and provide sustainable returns for future generations.
Investment in social protection and job creation will be needed to protect the vulnerable in the short term, but policy priorities could gradually shift to reducing the environmental risks affecting human health and vulnerability to climate change.
Protecting and enhancing natural capital such as forests, soils, water resources, ecosystems, biodiversity, air quality, and climate can support human health and productivity and improve long-term resilience.
My parting shot
Identifying the best set of policies and instruments to address COVID-19 challenges and aligning them with broader social goals will be critically important for sustainable recovery from the pandemic and resilient society.
The way in which governments set their priorities, prioritize policies and programs, and coordinate activities will affect the outcome.
Poorly identified policy choices are likely to be ineffective in addressing the health, economic, social, and environmental challenges and harnessing the potential long-term economic and environmental benefits.
This paper presents a framework for identifying and prioritizing policy actions to address the COVID-19 challenges and ensure sustainable recovery.
The framework outlines principles and criteria, and a suggested approach, for assessing and prioritizing policy choices in planning and decision making.
It offers guidelines for developing shared policy goals, identifying smart strategies, aligning policy instruments, and factoring sustainability into short and long-term policy decisions.
In contrast to the common practice of evaluating policy outcomes after implementation, this framework enables policy makers to think ahead and assess the anticipated consequences of different policy options and their positive and negative cross-sectoral implications, which is critically important for developing a coherent and integrated set of policy decisions in the uncertain volatile situation of the COVID-19 pandemic.
The framework can help governments to prioritize policy choices and allocate limited resources in such a way that they are directed toward actions that generate synergy and co-benefits, have multiplier effects, and achieve interconnected solutions for health, the economy, and the environment.
Enhancing cross-sectoral integration and improving policy coherence is a challenging task requiring strong commitment from governments.
A major prerequisite for using the framework is to establish a multi-sectoral coordination body with the capacity to mobilize and build partnership, consensus, and ownership among the multiple government and non-government agencies and thus increase horizontal and vertical policy coherence and strengthen policy coordination for collective action.
Dr. Nyakundi intends to run for Governorship for Nyamira County in the next general election.
