Wednesday, 28 May 2008


KATE HAWKINS, Future Health Systems member

Day 2 of the Geneva Health Forum was characterised by discussions about the most appropriate mechanisms to finance functioning health systems and what changes in policy would be necessary to support this. Whilst development assistance overall is increasing the percentage share allocated to health is not rising at a commensurate rate. Most financing for health in developing countries is out of pocket expenditure. How do we protect the poor from the impoverishing effects of ill health? How do we secure greater investment in health? What are optimal mechanisms for channelling the money where it is needed? These are some of the questions that participants grappled with.

Although we need to spend US$50 - 100 per capita, per annum to reach the health Millennium Development Goals 43 low income countries are still spending less than US$30. David Evans of WHO stressed that action is needed in three areas: to raise more money; raise it the right way and to ensure that it efficiently finances equitable services. Speakers were, in general, in favour of more money for healthcare but were divided on the second two points.

Many speakers at the Forum explored the mixture of international financing mechanisms for health and their effects. The fragmented nature of health financing was highlighted - particularly in relation to global health partnerships such as GAVI and the Global Fund to fight AIDS, TB and Malaria. Some speakers felt that they drew energy and investment from government systems and budgets generating transaction costs and diluting national ownership. However, there was no one size fits all solution to this problem.

Some were adamant that financing should flow to government through general and sectoral budget support and that this, along with progressive central taxation, would enable countries to implement universal access to health services as is seen in settings like the UK. Others, such as Gorick Ooms from the Institute of Tropical Medicine in Antwerp, pointed out the limitations of general budget support due to macro economic policy that sets ceilings for health expenditure.

Other speakers addressed the role of the private sector and enabling them to better meet the needs of the poor. The for profit, not for profit and informal sector are the first port of call for many when they fall ill. Whether it is through regulation, training, support or incentives more interventions are needed to ensure the private sector offer quality care and that 'consumers' are empowered to demand appropriate services. Discussions continue today.

Read more

Monday, 26 May 2008


by KATE HAWKINS, STEPS Centre Member

Members of the Future Health Systems Research Programme Consortium are actively engaging in discussions at the Geneva Health Forum. The conference began in dramatic fashion with an assessment of the changing landscape within which health systems are being forged. The opening plenary session featured a range of speakers who aimed to situate health in a dynamic world. Changes in epidemiology, shifts in political and economic organisation, a strong and growing for profit and not for profit sector and a burgeoning role for information technology all featured.

Andy Haines of London School of Hygiene and Tropical Medicine highlighted changes in epidemiology and demographics which are likely to shape future investment and interventions. As the percentage of people over 65 years old grows in developing countries their health needs will take a growing proportion of health financing. Alongside this chronic disease and diseases of affluence will demand a larger slice of the pie.

Richard Samans from the World Economic Forum talked to the economic drivers of health and their political implications – what he called a ‘cocktail of stimulants’. Emerging economies such as India and China will alter global health governance – demanding leveller playing fields for decision making. States will struggle with how they relate to a private sector and civil society actors who are organising across borders on health issues of interest. Increasing deregulation of health care is, in some settings, reducing the role of the state and reducing trade barriers between countries. He also felt that increased access to information technology would shape the role of health care providers and those who access services.

Information technology was an issue taken up by Kendall Ho (University of British Columbia). He presented on ‘eHealth’ – urging health care workers to respond to the ways in which the Internet, cell phones and other digital technologies have changed the way that we do business. In particular he felt that these technologies could help to improve patient/doctor relationships, increase decision co-creation, streamline inter disciplinary collaboration and speed up judgements on evidence based health interventions.

With this in mind we will continue to use the STEPS blog to report on emerging debates at the conference.

Read more

Thursday, 22 May 2008



It is thirty years since the Alma Ata Declaration outlined an international consensus on the need to provide universal access to primary health care (PHC). During the ensuing years some countries established well-organised government health services in which PHC played an important role. Many others were less successful. The lead up to our session at the Geneva Health Forum on future health systems provides a moment to reflect on some of the new challenges for PHC.

National governments and the international community are renewing their efforts to expand access to PHC and they have committed a lot of money for this purpose. But there have been many major changes in these last three decades that pose big challenges for the future of PHC. The drafters of the Alma Ata Declaration drew largely on the experiences of those post-revolutionary and post-colonial regimes, which were rapidly overcoming a lack of health facilities, health workers and drugs.

Whilst some remote areas still lack health services many settings have both trained and untrained people, providing health care and selling drugs. The boundary between public and private sectors is blurred and government health workers frequently ask for informal payments or see patients privately. Many of these activities occur outside an organised, regulated framework of health care provision. Potential users are much more likely to live near a health facility or some kind of provider than 30 years ago, but now they face major challenges in paying for care and finding competent providers and effective and appropriate drugs.

PHC was designed to deal with prevention/health promotion and with infectious diseases associated with poverty, poor sanitation and certain insect vectors. Although these illnesses persist, there is growing pressure on health systems to address other problems. One dramatic change has been the transformation of HIV infection into a chronic and progressive disease for which people can claim entitlement to treatment. People are also affected by other chronic conditions, associated with ageing and “lifestyle” changes. This raises difficult questions about which treatments are appropriate, who should pay for them and how health systems should be organised to help people manage long-term conditions.

Concern is growing about the potential threat of epidemics of new diseases or organisms resistant to the available drugs. Recent examples are SARS, multi-drug resistant tuberculosis and a possible influenza pandemic. Government responses rely heavily on convincing people to report suspicious outbreaks and cooperate with public health measures they may perceive to be against their short-term interest. This requires high levels of trust between the population and their health system.

More actors are involved in health systems than thirty years ago, including a variety of private providers of health-related goods and services, national and international NGOs, citizen advocacy groups and political parties (where competitive electoral politics have been introduced). Governments are seeking new ways to influence health systems with their powers to allocate money, enact and enforce laws and publish information. This sometimes involves new types of partnership for service delivery and regulation.

Finally, there have been dramatic developments of new technologies for diagnosis and treatment of disease, which influence the design of health systems. In addition, the rapid changes in information and communication technologies are having a big impact. Providers and users of health services increasingly have access to the mass media, mobile telephones and the internet. They carry health information produced by governments, professions, citizen advocacy groups and private companies. In contrast to 30 years ago, when health professionals were the major source of expert knowledge, people have a variety of sources from which to find information.

The anniversary of the Alma Ata Declaration provides a good opportunity to reaffirm national and international commitments to expand access to PHC. But, it is important to understand the changed context when formulating strategies for achieving this. Many innovations have emerged that involve quite different roles for governments, markets, civil society and individuals than the drafters of the Alma Ata Declaration envisaged. We need to find ways to involve all actors in an intensive process of innovation and learning if the latest statements of good intentions are to be translated into major improvements for poor people.

Read more

Thursday, 15 May 2008


by ADRIAN ELY, STEPS Centre member

I am in Bonn this week for meetings around the Cartagena Protocol on Biosafety, the United Nations’ agreement to regulate the trans-boundary movement of living (genetically) modified organisms. From sensitive political discussions over liability and redress to questions over how to incorporate socio-economic considerations into decision-making, the working procedures of the protocol are still very much “under construction” 8 years after its text was first agreed.

The fourth Conference of the Parties, serving as the Meeting of the Parties (COP-MOP 4) to the Cartagena Protocol on Biosafety is running until 16th May. On Tuesday 14th I took part in a side event at the Conference at the invitation of Dr Sachin Chaturvedi of RIS (Research and Information Systems for Developing Countries, based in New Delhi) looking specifically at Article 26 of the protocol. Initially introduced following efforts from the Africa group, the first part of this article allows countries to take into account socio-economic considerations in their decisions over allowing imports of living modified organisms. Although there are a growing number of (primarily economic) analyses demonstrating the benefits and costs to farmers of various transgenic crops, several countries are unclear about how best to employ them in decision-making, and there is no official mechanism for the sharing of such information (as mandated in Article 26.2).

Dr Chaturvedi introduced an RIS report that outlined the Indian experience in this regard and highlighted the need for developing countries to take the initiative in proposing systems for research and information exchange. This presentation was put into an international context by my own talk, in which I gave an overview of US, EU and Chinese regulatory frameworks, and a presentation by Moustapha Kamal of ICTSD, who introduced work that his colleagues had conducted on key trade and sustainability issues around biotechnology. International trade issues were also noted by the session chair, John Komen of the Programme for Biosafety Systems at IFPRI, who highlighted the need for countries to take into account other international obligations (e.g. under the WTO) but stressed that, with only one relevant dispute to draw upon in terms of case law, the situation here was still evolving.

Meanwhile, delegates have been involved in discussions around Article 27, attempting to define “rules and procedures in the field of liability and redress for damage resulting from transboundary movements of living modified organisms”. The process, initially scheduled to last for four years, still seems far from resolution. When I left the discussions in the Liszt Room yesterday, parties were split over a proposal for a legally binding instrument that had been put forward by the large negotiating block known as the "like-minded group". This conflict potentially jeopardises one of the most potent components of the protocol, and has become one of those most discussed in the corridors.
Read more

Wednesday, 14 May 2008


By ADRIAN SMITH, STEPS Centre member

Complexity pervaded debate at the Resilience Alliance conference last month. In one way or another, participants tried to get to grips with the sheer complexities of the socio-ecological systems that concerned them, and puzzled over the kinds of adaptive governance that might ensure these systems provided resilient livelihoods to the various human and non-human members dependent upon those systems. At best, these complexities were bewildering, requiring new kinds of resilience thinking. At worst, an appreciation of the complex connections and interdependencies in the world induced paralysis. Where to start; what to do?

It was only at the very end of the conference that I realised that, in actual fact, the last three days had not been about complexity. Rather, we had been grappling with simplification. We were all trying to simplify in ways that were sensitive to the uncertainties and surprises associated with complex realities.

Apart from discussion of ‘stylised models’, this process of simplification was largely implicit. But perhaps we might advance further if we considered resilience to be about temporary simplifications, sensitive to experience, and open to revision when the inadequacy of those simplifications is subsequently revealed? The critical question is how do we simplify wisely? Whose perspectives are considered in those simplifications; which ones bracketed out; and which ones simply forgotten? Which simplifications subsequently work, and for whom, and for how long before complex reality undermines them?

Buzz Holling’s adaptive cycle is one such simplification. It was the emblem for the conference. A lop-sided figure of eight, used to organise complexity into processes of growth, maturity, decay, and rejuvenation (and out of which is generated a new figure of eight development). And it is a persuasive simplification. Many participants applied it to the natural world, to social development, and to combinations of the two. To many participants, it promises a better simplification than the equilibrial approaches that dominated the governance of complex socio-techno-environmental systems in the last century. But it is still a simplification for all that; as were the agent-based models inspired by Buzz’s adaptation of the infinity symbol, and the equally inspired, contextualised case studies. My own presentations were simplifications of complex processes of social and technological change.

Of course, simplification is dangerous territory. Acknowledging the necessity for simplification risks blunting the critical edge that rightly problematises certain forms of simplifying that currently enjoy institutional privileges, such as narrow and static forms of engineering cost benefit analysis. Contexts and perspectives essential to Sustainability may continue to be deleted out of the equation on pragmatic grounds. How do we avoid simplification legitimising unSustainable expediencies?

Hopefully, the advantage with complexity thinking is that it forces some humility and prevents us from being simplistic. Complex realities force reflexivity into the necessary simplifications we undertake in order to consciously and deliberately act in the world. Institutions simplify, as do policy narratives, as do scientific reports. So as we continue to explore pathways to Sustainability through complex systems, the challenge is to be aware of the simplifications we have to make, and to make them wisely. In my view, this is the basis for resilience.
Read more

Friday, 2 May 2008


By JULIA DAY, STEPS Centre member

The conference defined some critical points of leverage, where delegates and their organisations can achieve a sustainable impact on priorities.The essential ingredients of a Green Revolution in Africa, definition of priorities, desirable outcomes and the points at which value-added initiatives can have an impact have taken shape here in Salzburg. Importantly, some of the competing priorities and unresolved issues and knowledge gaps have been identified.

Strategic alliances among many stakeholders and initiatives have been strengthened and the desire to work together, in partnership, to add value to the future of agriculture in Africa, was repeated time and again.

The momentum continues tomorrow (Saturday 3 May) at the follow-on seminar - ‘A Green Revolution in Africa: What Framework for Success?’ where delegates will revise and refine the work set in motion over the past three days. Then a series of sub-regional meetings in Africa will ground the debate firmly on the continent’s soil.

For news updates on the conference, seminar, sub-regional meetings and all the work around this theme going forward see:
Read more


By JULIA DAY, STEPS Centre member

Farmers and their needs must be placed at epicentre of a uniquely African Green Revolution, conference delegates from across the board agreed on the final day in Salzburg.Photo: Louis Michel, European Commissioner for Development and Humanitarian Aid addresses the conference / Julia Day

Much of the discussion today, running across thematic groups, focused on building alliances of farmers and their organisations at national, regional and continental levels. This was seen as absolutely key for insuring that priorities are set and funds are spent in a way that meets the needs of farmers. The direction of initiatives must all move toward that goal.

However there is an urgent requirement for substantial investment in building capacity. Delegates believe the skills that need developing go beyond the technical to ‘soft’ skills. An equitable Green Revolution requires an increased ability to facilitate inclusive approaches, organisational skills, business management skills, policy, advocacy and impact monitoring skills, delegates said. These seem to be lacking at the moment and are a potential focus for follow up efforts.

One particular proposal for directing research innovation and technology development towards farmers needs was the establishment of an African-wide, farmer-owned and farmer-driven fund. Delegates went as far as to propose a name: the African Agriculture Technology and Innovation Fund (AATIF). This would be an endowment fund supported by government, private sector, philanthropists and farmers to ensure demand-driven research with farmers in the driving seat.

Another key suggestion was that any funds or funding mechanisms to support the Green Revolution need to have independent accountability systems, operating with farmers at the centre. These would hold the delivery of key development actors to account, as well as offering a monitoring, evaluation and impact assessment function.
Read more


By JULIA DAY, STEPS Centre member

To ensure an African Green Revolution is equitable there is a pressing need to ensure that wide representation is assured, delegates said.It is paramount that inclusive processes going forward are attendant to gender and ethnicity issues. It should also be ensured, in particular, that smallholders and those farmers who are consumers, and not just producers, of food have a voice in farmer organisations. Photo: Kofi Annan takes part in the press conference / Julia Day

At present, the interests of smallholders, women and other more marginalised groups, including pastoralists and livestock groups are not well represented by farmer groups or service providers – private or public.

In addition to assessing the achievement sof this Green Revolution in quantative terms, delegates recommended that qualitative targets are also set to define targets in relation to empowerment, voice and inclusion, taking into account a rights-based approach.
Read more


By JULIA DAY, STEPS Centre member

The lack of data and information on crop productivity and prices, and the poor quality of the data that does exist, has been a recurrent theme throughout the conference and was stressed as key to the future on this final day.Photo: Mamadou Goita takes part in the press conference / Julia Day

Challenges to improving the quality and reach of data and information through the support of universities, research centres and statistical services was emphasised. The importance of efficient and more cost-effective systems for data-gathering and market intelligence were discussed, including the use of text, cell phone and internet systems in rural areas.

Data on household income, production prices and broader patterns of public expenditure were seen as priorities. Such data-gathering and analysis will allow the tracking of progress, the assessment of impacts as well as the modelling of future options as the Green Revolution in Africa unfolds.
Read more


By JULIA DAY, STEPS Centre member

The emphasis of the Green Revolution in Africa must go beyond a focus on a narrow range of staple crops, even though these crops remain important, was an issue pin-pointed by delegates as crucial to future action.

Livestock needs to be put centre stage and smallstock and poultry production are critical for poorer people, and women in particular, delegates said. And while pastoral areas remain a site of extensive poverty, they also hold extraordinary potential. Diversity in crops and livestock was seen as the key to enhancing a range of benefits in terms of production, nutrition and wider resilience of the agricultural and food system.

Ensuring that diversity is central to the Green Revolution challenge will require shifts in the thinking in mainstream professional training. How may university agriculture courses, for example, address wild crop relatives and pastoral issues, one delegate asked? The new Green Revolution requires curriculum reforms from universities through to community-based training and extension.
Read more


By JULIA DAY, STEPS Centre member

You join us on the final day of the 'Toward a Green Revolution in Africa?' conference here in Salzburg, Austria, where the emphasis will be on moving from some of the 'what?' and 'why?' questions to the 'how?' and 'who?' Photo: Schloss Leopoldskron, Salzburg, Austria

Yesterday the six key themes of the conference were discussed in roundtable groups: Institutions and innovations; Markets, trade and Investment; Environmental Sustainability and biodiversity; Governance and policy processes; Equity, rights and empowerment; Responding to new threats and opportunities.

And today delegates are attempting to highlight the key issues and messages from each of these thematic groups. One lucky soul from each of the groups will step under the spotlight to present recommendations and/or commitments, and identify critical unresolved issues.

This conference is not about trying to come up with a consensus position, but is about identifying and acknowledging those unresolved issues and still being able to move forward. Let's see what emerges as the day goes on.

Read more


By JULIA DAY, STEPS Centre member

There was much talk across the group and plenary sessions about the importance of coordination and alignment of initiatives and institutions. This is happening under the leadership of the AU-NEPAD CAADP initiative, but needs to be strengthened. Photos: Delgates debate in Salzburg / Julia Day

Such coordination and partnership is critical to the African Green Revolution, and needs alliances between the public and private sector, the conference heard. In the African context markets need states and states need markets. There is a need to enhance facilitation and coordination to make markets work effectively for poverty reduction. The basic enabling environment – infrastructure, research and development, irrigation – needs to be put in place; and this requires governments to take a lead.

However, even with all these efforts is Africa still missing opportunities? Marginalised and vulnerable stakeholders, especially female farmers, are still under-represented throughout institutional processes.

Barriers such as the digital divide, low literacy and a perceived absence of articulated demands contribute to the persistent exclusion. But it was argued that this last reason is unjustified, since there are plenty of examples of how informal, grassroots organisations

are setting up innovative systems and processes, such as intra-regional trade systems, which a lot of learning can be taken from. Informal institutions can make a difference in an African Green Revolution, delegates agreed.
Read more


By JULIA DAY, STEPS Centre member

Talking about a Green Revolution on a global level is the easy part, but how will the Green Revolution reach out to those that are hardest to reach? A platform for dialogue in African countries – to talk at a regional and local level – was a recurring theme. The role of the citizen in creating the Green Revolution was not to be underestimated, delegates said. Photo: Gem Ardwings-Kodhek debates with colleagues in Salzburg / Julia Day

Initiatives to build citizen action, accountability and representation are needed, the conference heard. Helping to bring excluded people into the debate and build the capacity of farmer organisations to be effective is key to this process. Representation and accountability need to be built up, using local, national and global networks to demand more effective government and donor responses.

But who will miss out? One key question is how to engage with those whose views do not usually form part of the policy process? What happens to those living in areas far from townswhere road connections are poor and where government and private sector presence is limited, such as the dryland pastoral areas of Africa?
Efforts must be put into including those who are hard to reach and those stuck in the ‘poverty trap’ where the benefits of a Green Revolution will be missed.
Read more


By JULIA DAY, STEPS Centre member

See photos from Salzburg

Why didn’t we know about the current food crisis until the urban poor of Africa took to the streets in protest? This question exposes one of the main topics of today’s discussions: the need for better data, increased use of data and the importance of learning.

The food prices issue took everyone by surprise. But if we were doing our horizon-scanning properly, why didn’t we see it coming? There are things we know that we don’t know – but what about the things we don’t know that we don’t know, asked one delegate? We need to think a lot more about the element of surprise. There are many threats out there that we don’t know about, but we still need to be prepared.

In order to be better prepared, Africa needs to look forward, to scan the horizon to pick up trends: it needs better information. Improving data and learning and developing a learning culture is key. One delegate called for more, and better, statistics captured from world-class African universities and statistics services. At the moment, poorquality data is often poorly analysed or not analysed at all, particularly around agricultural production.

Improvements could come from boosting capacity and creating incentives for the accurate reporting of data. By improving the quality and reliability of data there will be more potential for setting benchmarks and reviewing progress, impact and outcomes, delegates heard.

Boosting learning can also mean finding out about things in a more opportunistic manner, by scouting for innovations and experiences and sharing those widely for scaling up. ‘We are not starting from scratch,’ commented one delegate.
Read more


By JULIA DAY, STEPS Centre member

See photos from Salzburg

The conference may be titled Toward a Green Revolution in Africa, but the colour of the revolution began to change hue on the second day in Salzburg. A strong message was emerging in both roundtable discussions and plenary sessions – that moving in one direction, with one vision and one goal was the key to the future of agriculture in Africa. However this idea comes with a caveat: that there are no one-size-fits-all solutions. Photo: Lindiwe Sibanda, CEO FANRPAN / Julia Day

The approach required to achieve effective change needs to move away from the single silver bullet method of a magic Green Revolution solution that can fit every African context.

What is needed instead, several delegates suggested, was a ‘rainbow revolution’ with a ‘green ethic’. This multi-hued approach needs to go beyond a production focus to issues of environment, biodiversity, equity and rights. And new initiatives need to have effective prior resilience audits of their potential impacts. We don’t have to make the mistakes of the past Asian Green Revolution, one delegate succinctly put it, because we have the benefits of hindsight.

Under the ‘rainbow revolution’, Africa’s biodiversity would be maintained. The risk of narrowing Africa’s genetic options should be kept in mind and building in multiple options to preserve and increase diversity and flexibility was called for. Only if you have diversity, will the continent be able to cope with shocks in the future.

By the way, Scott Edward Anderson is also blogging from Salzburg, check out his blog, the Green Skeptic

Read more

Thursday, 1 May 2008

By JULIA DAY, STEPS Centre member

See photos from Salzburg

Guten Morgan, and welcome once again to Salzburg, where the clouds have descended upon the city, but inside the Schloss Leopoldskron the mood is decidely bouyant. Delegates ended yesterday's session with the first plenary discussion, and did not hesitate to get stuck straight in to debate. Photo: Schloss Leopoldskron / Julia Day

The 80 plus participants here were obviously raring to begin swapping opinion. And an evening's sleep to shake off the jet-lag seems to have boosted that feeling.

We are in for a busy and rich day with roundatable discussions and themed panels covering issues from innovation, trade and environmental sustainabilty to equity, gender, governance and policy processes.
Read more


By JULIA DAY, STEPS Centre member

See photos from Salzburg

A Green Revolution in Africa must be grounded firmly in an African context, taking African biodiversity, climates, cultures and peoples into account. So the continent’s initiatives must be significantly different to those put in place in Latin America and Asia.

An the many different contexts within Africa must also be considered. That no one-size-fits-all solution will work across the continent was discussed.Whereas Asia’s Green Revolution focussed on seeds and fertilisers as the key to growth, some delegates stressed today that it is crucial a wider perspective is taken in Africa.

In fact for some there had already been too much discussion about seeds and fertilisers, and the idea that the African Green Revolution pivots on boosting production was questioned. It was felt this could detract discussions from the bigger picture, taking issues such as better management of water, environmental issues and the political economy of agrarian change into account.
Read more


By JULIA DAY, STEPS Centre member

If there is going to be one issue that everyone agrees on this week it looks set to be that women are the key the success of an African Green Revolution.
Kofi Annan stated unequivocally that policies must give priority to women, who make up the majority of farmers in Africa, and throughout the afternoon this position was supported time and again.

Many delegates stressed that listening to farmers in the political process is crucial to progress towards a more sustainable and equitable future for African agriculture, and listening tofarmers means listening to women.

The gender equity issue must be at the top of the agenda, cutting across every theme. Governments, donors, farmer’s organisations, NGOs, must all properly account for women’s contribution to agriculture and ensure access to income and control over land.

But a consensus that women are the bedrock of Africa’s agriculture future is not enough. How to achieve equity of distribution will be probed in this week’s sessions, in particularly in one of tomorrow’s priority theme sessions, on equity, rights and empowerment.
Read more


By JULIA DAY, STEPS Centre member

Equity is set to be one of the hottest topics of debate this week. How the benefits of an African Green Revolution are distributed to the poor and marginalised was one of the chief concerns expressed today. Ousmane Badiane of IFPRI highlighted the past decade was Africa’s first 10-year periodof sustained economic growth and that the continent’s exports grew at a faster rate than the world average for 5 years (2001-2005).

Africa has many success stories; we heard about initiatives taken to improve livelihoods and alleviate poverty in Ghana, Malawi and Benin. But these success stories needs to be sustained and discussion centred around the need for research into the reasons behind current sustained growth in order to keep up momentum.
Structural change is needed to ensure more equitable distribution of the benefits of economic improvement. And it was stressed that the poor have not necessarily benefited from this recent sustained period of growth.

Africa has to go beyond boosting supply and short-term policies aimed at defusing the current food crisis. It was suggested that CAADP can provide the necessary framework for policy renewal and structural change.
Read more