In depth: Flexible, adaptive, politically-led reform in the Occupied Palestinian Territories

A growing body of literature and evidence demonstrates that conventional aid interventions focused on technical issues and capacity building alone are not sufficient to deliver developmental impact. In view of the growing interest in ‘doing development differently’ and ‘thinking and working politically’ to deliver more effective development assistance, there is a need for operational models that illustrate what this can mean in practice. This note describes a problem-driven iterative adaptation (PDIA) approach to donor-supported health efficiency reform in the challenging context of the Occupied Palestinian Territories (OPTs). Focusing on the management of external medical referrals, which emerged as a political problem, the note highlights how a flexible logframe allowed a series of small, gradual interventions to be introduced, in sharp contrast to the traditional pre-planned ‘projectised’ approach that has been the standard in the development industry to date.

This publication was co-authored by Dan Whitaker.