Co-Production in Developing Countries: Insights from the community health workers experience

Abstract

Co-production nowadays ranks high in global development strategies of international and philanthropic organizations. Although long-standing experiences in developing countries can provide a relevant contribution to the co-production theory, it is necessary to verify what contextual and conceptual conditions might alter the existing theoretical models. This article makes a theoretical contribution by modelling propositions that can withstand logical and empirical scrutiny. The literature is reviewed to identify key co-production concepts, their interrelationships, and the underlying assumptions. A longitudinal case study is analyzed to expand the existing theoretical propositions. Policy implications for scaling-up programmes are drawn.

Key words:

• Co-production
• propositional theory
• community health worker
• developing countries
• global health

Notes

¹ The analysis of the case study draws on the theoretical frameworks provided by the literature but it remains open to other elements, coherently with the theory-building aim of this research.

² Cf. also the survey by Bovaird et al. (2012) in different European countries including those characterized by pluralistic administrative traditions or by traditions with more autonomous citizens.

³ Although Ostrom (1999); Alford (2009) and other colleagues use the word volunteering in defining co-production, several authors agree that these are different concepts. ‘What is different as opposed to classical volunteering is that co-production takes place within a context of professionalized service delivery and that it concerns services the people are involved themselves use’ (Verschuere et al. 2012: 1084). Cf. also Alford (2009).

⁴ These are often called intrinsic following the argument that some public outcomes can only be delivered through co-production (e.g. all education is co-produced). Intrinsic forms of co-production are also the least transformative, relying on some productive input from the service user without changing the service delivery system and without a re-location of power and control. Cf. OECD (2011: 31–32, 38).

⁵ Adopting such a comprehensive look of co-production means including traditional forms of deliberative decision-making in the co-production concept. Cf. Fledderus (2012).

⁶ Recent exceptions include evaluations in the fields of safety (Meijer 2012b), education (Vamstad 2012), and health care. For instance, evaluation of telecare experiences introduced in various states in the United States have identified substantial productivity increases (from nurses supporting 7 patients per day to 17–20 patients per day) and reductions in costs between US$3.000 and US$5.000 per patient (OECD 2011: 60).

⁷ Important exceptions include the identification of the main contingencies by the neo-institutional theory (Ostrom 1990; Salamon and Anheier 1998).

⁸ Cf. the Wall Street Journal and Médecins Sans Frontières cited in Spar and Delacey (2008: 8).

⁹ To put it with Edwards’ (2013: 26) words: ‘80% of [..] philanthropic foundations try to solve poverty tomorrow and be celebrated today’. Co-production projects and their integration into the planning and management of public organizations could help avoid the shift from efforts to achieve the wider impacts of co-production to short-term and unsustainable benefits in service quality and quantity.