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Six examples of large-scale transformation and what we can learn from them See more at:

Our new report, written jointly with The Kings Fund, calls for a dedicated Transformation Fund to
oversee and be accountable for essential changes to NHS services. Making change possible: a
Transformation Fund for the NHS draws on the experience of funding other transformations in the
health sector and beyond.
The report includes six detailed case studies of UK and international examples of transformation,
which provide invaluable learning about the process of transformation and where improvements
can be made. The case studies and learning points are summarised below.

Six examples of large-scale transformation funds

*Costs in brackets show 2015/16 prices

Deinstitutionalisation in UK mental health services: Since the mid-1980s, mental

health services have been radically transformed. A process of large-scale deinstitutionalisation
saw a shift in care and support for people with mental health problems from psychiatric
institutions to community-based settings. In the UK, this resulted in the closure of all institutions,
where approximately 100,000 people had lived.
Total cost: Not available / Cost per head per year: Not available


The National Service Framework for Mental Health in England: In the early 2000s,
community mental health services in England underwent a national programme of development
that was central to a 10-year plan to improve the outcomes and experiences of people with
mental health problems. The programme resulted from public and media pressure to reform
community care provision following a series of high-profile adverse events involving people with
mental illness.
Total cost: 700m (978m) / Cost per head per year: Not available


Canadas Primary Health Care Transition Fund: This CAD800m fund ran from 2000 to
2006, providing transitional costs to support the transformation of Canadas primary health care
system. Primary health care in Canada is publicly funded and mostly free at the point of use.
Transformation in primary care was deemed a priority after public and political concerns over
quality and access.
Total cost: 360m (503m) / Cost per head per year: 1.95 (2.73)


Denmarks hospital transformation Quality Fund: In 2007 the Danish government

introduced a national Quality Fund of DKK42.7bn (5.9bn) to build new hospitals over a 10-year
period. These would form the basis of a new infrastructure for health and care delivery. The
Quality Fund operates as part of a wider set of reforms to health and local government structure
implemented in 2007.
Total cost: 5.3bn (5.9bn) / Cost per head per year: 96 (107)


The London Challenge: The London Challenge was established in 2003 to improve the
quality of education and outcomes in secondary schools in London. It emerged in response to
the limited progress being made in London towards meeting government commitments to
education, despite a number of national initiatives and policies. Central government ran the
Challenge from the Prime Ministers Office and the Department for Education and Skills (DfES).

Total cost: 80m (105m) / Cost per head per year: 22 (28)

Girls Education Challenge (GEC) Fund: This 354m fund was set up by the
Department for International Development (DFID) in 2013 and runs for six years. It aims to help
up to a million of the worlds poorest girls improve their lives through education.
Total cost: 344m (354m) / Cost per head per year: 86 (88)

What do these case studies tell us about how to manage


Ensure clear and coherent objectives for how funds are allocated: Be clear about
the objective of transformation itself in addition to the objective of the funding.


Engage stakeholders in transformation: Engage with the public, patients, and staff,
build a dialogue about the process of change, and actively address concerns as a means of
facilitating transformation.


Effective leadership is vital: Good local leadership is conducive to the bottom-up

development of transformation plans and seeing them through to implementation, while strong
national leadership is important to set and maintain direction.


Base plans on an established evidence base: Evidence should inform, where

possible, decisions about what to implement as well as how to do it. A stepped approach to the
requirement for evidence can be built into funding allocation.


Balance implementation, innovation and risk: Innovation is essential to develop new

solutions to existing problems and deliver cost efficiency, so there must be space for failure and
risk taking. The GEC Fund provides a good example of this.


Set funding in line with the scale of transformation expected: In cases of major
service transformation, it was common for costs to be underestimated. While mechanisms for
releasing funding (including sale of estate, improvements in cost efficiency and reduced service
use) were often core components of the original cost estimates, in practice, they largely failed to


Funding allocation must be sustainable and flexible: Funding should take into
account longer term running costs of new provision (including double-running costs while
establishing new services) and allow different streams of funding for different purposes. The
ability to ring-fence transformation funding is also important.


Plan for the workforce implications of transformation itself: Projects must allow
front-line staff to be released from their day-to-day roles in order to contribute to transformation,
while also actively engaging with people to encourage their support for change.


Investment in learning and evaluation is essential: Several case studies failed to

ensure appropriate evaluation and effectively disseminate learning, leaving new approaches
open to criticism. The London Challenge and the GEC Fund demonstrate how learning and
evaluation can be built into fund infrastructure.


Ensure accountability in management of transformation and funding allocation: A

range of mechanisms have been used to improve accountability, including asking for matched
funding, using milestones, basing accountability on peer-to-peer support and outcomes data, and
setting up independent organisations to manage funding and the transformation process.


Be realistic about timescales: It takes longer than you think to achieve

transformation. All four of our health care case studies exhibited delays beyond their original


Choose wisely between national or local administration: Providing appropriate

expertise and support will ensure that projects are capable of delivering and are sustainable.
National guidance can support progress, especially where transformation impinges on areas
under the remit of national bodies.


There are always unknown and unintended consequences of

transformation: Strong evaluation helps, but extra resources are often needed to respond to
emerging evidence. The value of establishing dedicated leadership and organisational support,
such as was achieved as part of the NSF-MH and London Challenge, should not be

Find out more

The case studies and learning points are described in further detail in chapter 3 of the report. Full
length case studies are published in Appendix 1: Case studies of large-scale transformation.
Download Making change possible: a Transformation Fund for the NHS.
- See more at:

Agriculture Transformational Projects and Programmes

23/10/2013 - The AfDB and Agriculture

Under its Strategy for 2013-2022, At the Center of Africas Transformation, and itsAgriculture Sector Strategy
2010-2014, the African Development Bank has designed a new set of innovative projects aimed at improving food
security in Africa.
Nigeria: Agriculture Transformation Agenda (ATA)
My interest in this programme stems from the fact that it is a departure from the past approaches which were
challenged in one way or the other.
In a major departure from past approaches, agriculture is now being treated as a business, not a development
program in Nigeria. The transformation agenda is focused on major policy reforms to:

improve rural infrastructure;

improve farmers access to financial services and markets;

eliminate corruption in the seed and fertilizer sectors;

improve the functioning of market institutions;

establish staple crop processing zones to attract private sector;

reduce post-harvest losses and increase value-addition.

The Agricultural Transformation Agenda Support Program Phase II will enhance value chains through the
development of 50,000 ha of land for sorghum, maize, and cassava, including the farm-level supply chains and
establishment of staple crop processing zones. It will also:

reduce of post-harvest losses;

improve linkages with industry with respect to backward integration as well as access to financial
services and market; and
improve rural institutions and infrastructure through the rehabilitation of 550 kms of agricultural access


Cte d'Ivoire: Support to Agro-Industrial Development Centers

The Support to agro-industrial development centers in the regions of Lakes and Poro Project, which is under
preparation will enhance large-scale production, processing and marketing of coffee/cocoa (15,000 ha) and rice
(13,000 ha) in agro-industrial clusters. It will establish processing units, including cogeneration of electricity,
develop agricultural infrastructure and marketing facilities. The anticipated annual production of 100,000 tons of
rice and 15,000 tons of coffee/cocoa certified products will supply local, regional and international markets. The
project will create approximately 7,000 direct and indirect jobs and will benefit about 500,000 people.
Horn of Africa and Sahel Drought Resilience Programmes
These programmes are expected to improve, on a sustainable basis, the livelihood of the populations in the Horn
of Africa and the Sahel, which are frequently affected by droughts, through multi-phased, multinational and multisector interventions including:

capacity building for advocacy, formulation and implementation of adequate policies;

development of agricultural production, irrigation and water management, processing and marketing
infrastructure; and

agricultural commodity value chains development with special focus on natural resources (soil, water,
plant) management.
The Phase-I of the Drought Resilience and Sustainable Livelihoods programme in the Horn of Africa was
approved by the Bank in December 2012, for a total amount of USD 125 million. It includes Loans to the
Governments of Ethiopia and Kenya; and Grants to the Government of Djibouti and the IGAD Secretariat. The
second phase is under preparation.
The Sahel program to Strengthen Resilience to recurrent Food and Nutrition Insecurity is currently under



~ By Jan Gordon

An excellent manager taps into talents and resources in order

to support and bring out the best in others. An outstanding
manager evokes possibility in others.

1. Creativity
Creativity is what separates competence from excellence.
Creativity is the spark that propels projects forward and that
captures peoples' attention. Creativity is the ingredient that
pulls the different pieces together into a cohesive whole,
adding zest and appeal in the process.

2. Structure
The context and structure we work within always have a set
of parameters, limitations and guidelines. A stellar manager
knows how to work within the structure and not let the
structure impinge upon the process or the project. Know the
structure intimately, so as to guide others to effectively work
within the given parameters. Do this to expand beyond the

3. Intuition
Intuition is the capacity of knowing without the use of rational
processes; it's the cornerstone of emotional intelligence.
People with keen insight are often able to sense what others
are feeling and thinking; consequently, they're able to
respond perfectly to another through their deeper
understanding. The stronger one's intuition, the stronger
manager one will be.

4. Knowledge

A thorough knowledge base is essential. The knowledge base

must be so ingrained and integrated into their being that
they become transparent, focusing on the employee and
what s/he needs to learn, versus focusing on the knowledge
base. The excellent manager lives from a knowledge base,
without having to draw attention to it.

5. Commitment
A manager is committed to the success of the project and of
all team members. S/he holds the vision for the collective
team and moves the team closer to the end result. It's the
manager's commitment that pulls the team forward during
trying times.

6. Being Human
Employees value leaders who are human and who don't hide
behind their authority. The best leaders are those who aren't
afraid to be themselves. Managers who respect and connect
with others on a human level inspire great loyalty.

7. Versatility
Flexibility and versatility are valuable qualities in a manager.
Beneath the flexibility and versatility is an ability to be both
non-reactive and not attached to how things have to be.
Versatility implies an openness - this openness allows the
leader to quickly change on a dime when necessary.
Flexibility and versatility are the pathways to speedy

8. Lightness

A stellar manager doesn't just produce outstanding results;

s/he has fun in the process! Lightness doesn't impede results
but rather, helps to move the team forward. Lightness
complements the seriousness of the task at hand as well as
the resolve of the team, therefore contributing to strong team
results and retention.

9. Discipline/Focus
Discipline is the ability to choose and live from what one pays
attention to. Discipline as self-mastery can be exhilarating!
Role model the ability to live from your intention consistently
and you'll role model an important leadership quality.

10. Big Picture, Small Actions

Excellent managers see the big picture concurrent with
managing the details. Small actions lead to the big picture;
the excellent manager is skilful at doing both: think big while
also paying attention to the details.

Jan Gordo