What you did with a top-down, government-run program was focus on the problem of health care access.

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But a clutch of Western development officials I've been talking to all acknowledge that the "Madonna Incident" points towards a more general shift - already in progress - away from the top-down aid of past decades and towards a new focus on policy development, partnership and business.

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This focus must come from the very top and filter down through the whole organization so everyone has the incentive to add value to the customer.

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When firms reorganize around Scrum teams, but still focus on delivering with big plans, heavy processes, top-down command-and-control leadership, the potential gains are constrained.

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