Planning and change: a Cambodian public health case study

Abstract

This paper questions the appropriateness of highly structured strategic planning approaches in situations of complexity and change, using the Cambodian–German Health Project as a case study. Based on participant observation and organisational analysis in the Cambodian public health sector, the paper examines the rhetoric of values, objectives and strategies outlined in the original project documents and their assumptions and implications, and the responses to the changing political situation. It demonstrates the limitations of these planning processes in complex situations of high uncertainty, with little reliable information and a rapidly changing environment. Having highlighted the limitations of the strategic planning process in these circumstances, the paper recommends changes that shift the focus away from planning towards informed strategic management, that monitors the changing environment and is given freedom to respond to emerging risks and opportunities. The Cambodian–German Health Project was initiated in October 1995 as a bilateral health aid project between the German government and the government of the Kingdom of Cambodia, but was disrupted by the “events of 5–6 July, 1997”, as the military action is officially described. Project planning had included an intensive goal oriented planning process (ZOPP) undertaken in collaboration with counterparts from the Ministry of Health, Provincial Health Departments and other bilateral, international and non-government stakeholders. Following the military action, the project was initially suspended, then substantially re-drafted within a new framework of assistance, and eventually re-established after an interval of eight months. The paper will examine these planning processes and responses in the light of Mintzberg’s (1994 The rise and fall of strategic planning. New York: Prentice–Hall) argument that strategic planning fails because of three conceptual fallacies implicit in the process: (1) The fallacy of predeterminism allows planners to assume that goals, results, appropriate activities and required inputs can confidently be predicted based on past and current experience, when the reality is that both the internal and external environments are subject to change that may not be predictable. (2) The fallacy of detachment suggests that the functions of planning and implementation are discrete management functions, and that objective, rational decisions in determining activities and inputs are sufficient to successfully achieve project goals and results. (3) The fallacy of formalisation provides an expectation that the processes of planning will “capture” the creative insight required for successful strategic development, and reach a binding consensus despite the complex interactions and relationships that characterise bilateral aid projects.