Notions of policy effectiveness and implications for policy design: insights from public-private partnerships in India

Abstract

The objective of policy design is to devise policies for the achievement of predetermined policy goals. Their effectiveness hinges on a determination of what constitutes policy success, and assessments of the suitability of different design configurations in attaining the intended outcomes. Failure to clearly specify policy goals and ascertain policy success (or failure) can thus render them ineffective. Goal ambiguities are particularly problematic in the context of collaborative policy instruments like Public-Private Partnerships (P3s) due to the multiplicity of stakeholder interests. Using the example of P3s in India's healthcare sector, this paper points to inherent contradictions in the policy expectations of different actors, and how policies which neglect an appreciation of the agendas of diverse constituencies are inherently unworkable and produce outcomes which are inequitable and inconsistent with their underlying motivations. By situating these cases against the academic discussion on frame-multiplicity and policy success, the paper highlights why policymakers must consider these different, sometimes conflicting ideas of effectiveness, and how they can be reconciled through proactive design efforts, so that policies are sustainable and effective in meeting their overarching goals.

Policy capacities and effective policy design: a review

“…It is argued, for example, that several variables are critical for effectiveness within collaborative modes of governance, including reconciling with ‘prior history of conflict or cooperation, the incentives for stakeholders to participate, power and resource imbalances, leadership and institutional design’ (Ansell & Gash, 2008 , 543). Similarly, the absence of clear property rights and mechanisms to enforce contracts stymie the effectiveness of hybrid governance arrangements to design suitable public–private partnerships (PPPs) in service delivery (Virani, 2019 ).…”

“…That is, the range of capacities required to accomplish tasks such as contracting, commissioning, and collaboration while all under the umbrella of network governance require a variety of distinct capabilities and skillsets (O’Flynn, 2019 ). Failing to recognize these variations and invest in task-specific capabilities has played a key role in failed social policy reforms in many developing economies (Maurya & Ramesh, 2019 ; Virani, 2019 ). Along the same lines, variations in the capacities of agencies within government to pursue such tasks must be recognized (Bardhan, 2016 ).…”

Governing healthcare in India: a policy capacity perspective

“…There is simply not enough expertise within or outside the government in these crucial functions necessary to manage the modern healthcare system. Since the 1990s, governments have employed public-private partnerships in multiple areas of public service delivery, with only limited success (see, e.g., Virani, 2019). Systemic weaknesses in adjudicative processes (see, e.g., Shourie, 2018) further undermine the government's ability in effective contract management.…”

“…Effective use of policy tools that PM-JAY relies on for implementation -bidding, contracting, partnerships and so onrequires a high level of analytical and operational capacity to ensure compliance and accountability. The generalist civil service in India, operating under rigid rules and used to operating through command and control, is ill suited for employing the modern policy tools based on partnerships with market and societal partners (Maurya and Srivastava, 2019;Virani, 2019).…”

Policy effectiveness and capacity: two sides of the design coin

“…O'Flynn's concerns about narrow operationalization of policy effectiveness at the systemic level is mirrored by Virani (2019) who focuses on the level of policy programs. Using the example of a sub-national public private partnerships (PPPs) in the health sector in India, he explains the inherent differences (and contradictions) in the policy expectations of different actors and shows how PPPs, if poorly designed, tend to produce outcomes that are inequitable and inconsistent with their original motivations.…”