Planning and change: a Cambodian public health case study

This paper questions the appropriateness of highly structured strategic pla nning approaches in situations of complexity and change, using the Cambodia n-German Health Project as a case study. Based on participant observation a nd 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 limitat ions of these planning processes in complex situations of high uncertainty, with little reliable information and a rapidly changing environment. Havin g highlighted the limitations of the strategic planning process in these ci rcumstances, the paper recommends changes that shift the focus away from pl anning towards informed strategic management, that monitors the changing en vironment and is given freedom to respond to emerging risks and opportuniti es. The Cambodian-German Health Project was initiated in October 1995 as a bila teral health aid project between the German government and the government o f the Kingdom of Cambodia, but was disrupted by the "events of 5-6 July, 19 97", as the military action is officially described. Project planning had i ncluded an intensive goal oriented planning process (ZOPP) undertaken in co llaboration with counterparts from the Ministry of Health, Provincial Healt h Departments and other bilateral, international and non-government stakeho lders. Following the military action, the project was initially suspended, then substantially re-drafted within a new framework of assistance, and eve ntually 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: Pre ntice-Hall) argument that strategic planning fails because of three concept ual fallacies implicit in the process: (1) The fallacy of predeterminism al lows planners to assume that goals, results, appropriate activities and req uired inputs can confidently be predicted based on past and current experie nce, when the reality is that both the internal and external environments a re subject to change that may not be predictable. (2) The fallacy of detach ment suggests that the functions of planning and implementation are discret e management functions, and that objective, rational decisions in determini ng activities and inputs are sufficient to successfully achieve project goa ls and results. (3) The fallacy of formalisation provides an expectation th at the processes of planning will "capture" the creative insight required f or successful strategic development, and reach a binding consensus despite the complex interactions and relationships that characterise bilateral aid projects. (C) 2000 Elsevier Science Ltd. All rights reserved.