‘I’m paid to change things, not keep the status quo’

Meeting about universal health coverage in Bangkok, 2019

On the eve of his retirement, Paul Rückert looks back at an eventful career

After 28 years leading German-supported health programmes across Asia, Paul Rückert is retiring from GIZ. ‘I’ve always been driven by a desire to bring about sustainable changes in the countries where I work,’ he says. ‘When you have a motivated team, interested partners, and the space to be creative, you can achieve a lot of positive things.’

When Paul Rückert began working for the former Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ) in 1993, he didn’t think he would stay long. German Development Cooperation was simply the latest stop on a professional journey that had already included medical school, a doctoral degree, a two-year assignment with the World Health Organization in Angola, and a masters degree in public health from Johns Hopkins University in the United States. At the time, he considered himself a Latin America specialist, and had a particular affinity for Brazil.

While he never lost his attachment to Brazil – he intends to retire there – he did change his view about staying with GTZ. Twenty-eight years later, Rückert is wrapping up a prolific career in which he’s led more than two dozen bilateral health projects commissioned by the German Federal Ministry for Economic Cooperation and Development (BMZ) in Pakistan (1994-1999, 2004-2009), Indonesia (1999-2004, 2010-2012), Bangladesh (2012-2014), Nepal (2014-2020) and Cambodia (2020-2021).

What stands out from this long tenure and what has he learned? During a wide-ranging conversation last year, Healthy DEvelopments found out.

Not afraid to shake things up

Rückert’s first assignment with German Development Cooperation was in Pakistan, where the team he led helped to establish a masters programme in public health. ‘In hindsight, this was the best project I ever worked on,’ he says. ‘We had so much freedom to develop something from scratch! There was nothing, just the idea that Pakistan needed its own school of public health.’

Paul Rückert with HSA faculty
Paul Rückert with HSA faculty

Working with ‘a wonderful team of super-intelligent Pakistani colleagues’ and ‘a visionary supervisor’ – Dr Ardy Keilmann – Rückert was able to draw directly upon his own recent experience at Johns Hopkins to shape the curriculum and the overall approach of what eventually became the Health Services Academy. ‘Twenty-five years ago it was revolutionary to include subjects like medical anthropology, environmental health and health financing. We had trouble even finding professors who could lecture on these subjects!’ Rückert fondly recalls how the team engaged in a series of ‘little fights’ against conventional wisdom to realise its vision. It took a long time, for example, to convince everyone that the subject of public health wasn’t only for medical doctors, that it was essential to enrol a large number of women, that selection should be merit-based, and that all the students had to learn to use a computer.

Rückert likes to shake things up, and has made a habit of it throughout his career. ‘When I go to a country, I’m not there to maintain the status quo. I’m paid to bring change,’ he says. Sometimes this means ruffling feathers, or talking about topics that no one is paying attention to. He is grateful for the space he’s been given over the years to work creatively and to develop new ideas: ‘I really appreciate the room and time GIZ and BMZ give me as a manager to shape the design of projects so that they achieve broader impact in a country.’

Working politically to bring about structural change

Rückert took two major things away from his first posting in Pakistan: first, that he enjoyed teaching and mentoring young public health professionals; and second, that he wanted to initiate and implement technical and structural reforms, not only to teach about them in the classroom. The opportunity to turn theory into practice came during his next assignment, in Indonesia. 

Thinking outside the box
Thinking outside the box

‘It was shortly after the fall of President Suharto and the country was ready for change,’ Rückert recalls. He’d had the good fortune to meet a number of Indonesian officials and academics at a health financing training programme in Berlin, and began collaborating with them on health insurance. ‘At that time there were four different health insurance schemes in Indonesia, but none of them was working properly. The government was open to reforming the entire social security system, and GIZ became part of the special committee under the Vice President’s office.’ In 2004, five years after he’d arrived in Indonesia, a major social security law including health insurance was adopted, laying the groundwork for the later consolidation of a national social health insurance in the country.

‘In Indonesia I learned that it’s not enough just to be a technical advisor: to get things started you have to advise and collaborate with politicians,’ Rückert explains. ‘It’s the parliament and visionary politicians who change laws and initiate major structural reforms, not the bureaucracy in ministries of health. They are usually invested in the status quo.’ 

He discovered that study tours offer a simple and effective entry point for building relationships with decision-makers. ‘We took nine members of Indonesia’s parliamentary standing committee on health to the Philippines to show them an alternative to the private insurance model they had been considering. While preparing the trip and travelling together, we got to know and trust one another very well. These were the people who ultimately came up with proposals for reform.’

Finding change agents – and catalysing their ideas

In every assignment he has had, Rückert has kept his eyes open for local change agents, like the Indonesian colleagues committed to health insurance reform. ‘I move from place to place,’ he says, ‘but they don’t. They plan to stay and continue working towards the realisation of their vision.’ In his view, German technical cooperation’s strength doesn’t lie in coming up with brand new ideas, but in acting as a facilitator. ‘Who’s here and what are they working on? How can we catalyse the ideas of these change agents? How can we link them up with other decision-makers in the country to initiate a reform process?’  

Sometimes these change agents are found in unexpected places. In Bangladesh, in 2012, Rückert and his team began working with the head of the Management Information Systems (MIS) unit at the Directorate General of Health Services, who had ‘a vision of what a health information system should look like and was standing there with wide open arms’ when a change of partners was required. Over the next two years, the team supported the MIS unit to build a single, interoperable routine health information system out of 32 separate electronic health datasets and supported the introduction of DHIS2 and OpenMRS into public health facilities in Bangladesh.

Bangladesh team, 2014
Bangladesh team, 2014

‘As a technical agency GIZ picks a few topics and goes deep into the “nitty gritty” to make things work,’ observes Rückert. ‘In the case of Bangladesh, it wasn’t just about coming up with the concept of an information system, but looking at the not-yet-connected pieces of the system that were already available and getting the right people involved to connect the loose ends and make it work. This approach isn’t always successful, but in this instance, it was: the system we helped to build is still working and is one of the largest digital health systems in the world.’ 

Seizing opportunities for change after crises

‘The period immediately following a crisis is a time when people are ready to entertain change,’ says Rückert. ‘There’s a very short window of opportunity to do things differently.’ He has seen this firsthand, following major political changes in Indonesia and Pakistan which ushered in an openness to decentralisation reforms, and also in the aftermath of natural disasters, such as the massive earthquake which struck Nepal in April 2015. 

Nepal
Nepal

Rückert had arrived in the country less than a year earlier and, together with his colleagues, saw an opportunity to ‘build back better’ by supporting the Ministry of Health and Population to digitise the country’s paper-based health information systems. The idea took off and, before long, his team was working on multiple fronts: the introduction of DHIS2 and e-reporting, electronic medical records, the digitisation of health insurance using openIMIS, and the development of an interoperable digital health ecosystem.  

The earthquake also led to an unexpected focus on menstrual health. ‘We saw that women in earthquake-affected areas were having serious difficulties managing their periods because they had no privacy in the camps they were living in,’ explains Rückert. ‘And we realised that they didn’t know how to use the sanitary pads in the emergency kits our project was distributing.’ One thing led to another: the project team organised an initial conference on adolescent health at which a small working group on menstrual health was formed. At that time, only five agencies were active in this area. Later, it supported the establishment of a practitioner alliance and convened the first national conference on menstrual health.  By this point, more than 50 agencies were working on the issue. 

 ‘Suddenly there was a huge surge of interest in this topic that had basically been neglected. Working on issues like this increases your acceptability as a development partner, because you’re doing something very tangible,’ Rückert explains. ‘Not everyone understands what health insurance information systems are about, but they do understand it what it means to have access to sanitary pads.’

Giving others the space to talk, learn and grow

Anyone who has worked with Rückert knows that he has a lot to say. But he also believes in giving other people space to talk, to explore and to try out ideas: ‘If you expose your partners to things happening elsewhere, if you give them a platform to engage with their peers, things often start to move,’ he says. ‘I’m a big defender of study tours. I love organising conferences! It’s not that we as a development partner have all the answers. What’s important is to create the space for people who would not normally meet to come together, to talk with each other and to discover how likeminded they are.’

Nepal
Nepal

He takes the same approach with his team members. ‘I made a conscious decision earlier in my career that I would try to pass on to others the things I know,’ he explains. ‘In practice this means giving people room to try things out, to learn, to grow and to become experts in their own right. It’s important to invest and trust in people. This allows them to develop capacities they didn’t have before.’

A valued colleague who will be sorely missed

Over the years, many people have been touched by Paul Rückert’s generosity of spirit. He possesses a remarkable ability to motivate the people around him to do more than they thought they could – and to have fun while doing it. This capacity to find joy – in work, in good food, in beautiful objects, in other people’s company – is one of the things which colleagues will miss most once he returns ‘home’ to Brazil and begins his well-earned retirement. And the feeling is mutual: ‘I’ll miss working with creative, enthusiastic people,’ Rückert says. ‘I will miss the question which always arises: “What can we do next?”’

Karen Birdsall
April 2021

A ‘best of’ collection of articles and publications spanning Paul Rückert’s career

Healthcare waste management

Menstrual health

Digitalisation

Universal health and social protection

Harm reduction

Managing health emergencies

Occupational health

© GIZ
© GIZ
© GIZ
© GIZ
© GIZ
© GIZ

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