After the Review: How to make sure the Australian aid program saves lives

Written by Garth Luke

In launching the Aid Review and the Government’s response the Foreign Minister acknowledged the interdependence of the five new strategic goals of saving lives, opportunities for all, sustainable economic development, effective governance and humanitarian response.  However he highlighted that the first goal – saving lives – was first amongst equals in these objectives.  He said:

There is a developmental continuum in this overall strategic approach to the aid program. Unless the program begins by saving lives, for examples for children under five, then there is little else that can be done. Assuming therefore that lives have been saved, the task therefore is to provide opportunities for all – both in education, in employment, and the opportunities to develop self-reliance.

While the Aid Review provides effective guidance for a number of aspects of aid design and management it is now up to the Government in its new four year plan to ensure that the aid program saves as many lives as possible.

This cannot be simply resolved by saying that sectoral priority setting should be determined by country needs.  Despite the impact at times of sectorally focused new policy proposals, AusAID has always been structured around country  development and driven by country needs.  Despite this, global aid funding and Australian funding for health continues to fall well short of estimated requirements. This is possibly due to a combination of factors: decision making by (largely male) elites in developing countries and Australia that does not give a high priority to the health and survival of poor people; a narrow economic definition of development progress; a drive to try to generate economic development; and a failure to focus on those interventions that have been proven to be the most cost effective.

The result is that 1.3 million children  and 65,000 mothers died in our region in 2009 (3.0 million and 128,000 respectively if we include India). This is despite the fact that  we know how to save lives, and that health aid is amongst the most cost effective of aid interventions.

World Vision, based on extensive work by WHO, estimates that global aid for health is only around half the level required and that Australia’s health aid is currently a bit more than half of our fair share.  Recent budget forward estimates indicated that aid to health was planned to fall further as a share of total Australian aid. Unfortunately, little in the Aid Review (despite positive recommendations to increase funding for the Global Fund and for medical research) and in the Government’s response so far does anything to change this.

Some have criticised the idea of sectoral targets for areas such as health, however the lack of transparency of the Australian aid program has meant that aid campaigners have had to use a broad brush to highlight the path to improvement in Australian aid.  Aid campaigners have never argued that a fixed sectoral distribution of funds should be allocated to each country.  They have only proposed an approximate distribution by sector to help guide the program overall and to ensure that Australia is contributing fairly to the global need and effectively leveraging the support of other donors.

So how should the Australian aid program move forward at this point to ensure that Australia can save as many lives as possible?  One approach would be to formalise the Foreign Minister’s model of the developmental continuum.  In developing each country strategy the first consideration would be providing resources to save lives given the needs in the country, domestic resources and the contributions from other donors.  Only after the resource needs in this area are adequately resolved would the planning then move on to providing opportunities for all, and then on to other strategic goals.  In some countries that would require significant spending, in others little or none on health. The same model could be used in helping to determine Australia’s level of support for each multilateral.  Our fair share of global health aid requirements would suggest that about 20% of Australia’s total aid would need to go to health (or around $1000m this year based on Australia’s 2.5% portion of total OECD DAC income and a global requirement of around $38 bn) and that health funding would therefore not preclude effective coverage of the other strategic goals.

This approach to put health first should not seem unfamiliar to us as it is pretty well what we do in emergency programs and also in government in developed countries like Australia.   Matters of survival rightly come first.

Such an approach would help to maximise value for money, ensure an aid program in which we can feel proud and would be likely to gain greatest support from the public.

Without an effective strategy to ensure adequate resources go to health many more people will die unnecessarily.

Garth Luke is a Senior Researcher for World Vision Australia.

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Garth Luke

Garth Luke is a consultant researcher and writer on aid and development policy. He was previously a Senior Researcher for World Vision Australia.

5 Comments

  • Great discussion.

    From a quick read of the review document and Government reponse, I find it puzzling that environmental sustainability and climate change did not seem worth mentioning. And while the strong endorsement of “predictable, multi-year funding” is extremely welcome, the documents read as if sectoral and general budget support was not part of the international development framework at all.

    If we are serious about country ownership, avoiding fragmentation, and improving the administration and delivery systems for the essential services that save lives, then surely we have to be looking carefully into providing more aid as budget support.

    Regarding the points made in this post, I largely agree that the focus on essential services and saving lives is a good way of framing the first priority of the aid program. However, @Chris, I think the point you make at d) is strong. What counts as spending to save lives is not always obvious, immediate or easy.

    I think that the relatively poor progress on the maternal health MDG highlights both Garth’s point that insufficient funds are being invested *and* Chris’ that the inter-related and negatively-reinforcing systems of poor governance, discrimination, lack of access to services and infrastructure are part of the story of “health” for women.

    @Chris, I’m not sure that I see the force of your objection in c), though. How is arguing for greater emphasis on “health” and “saving lives” necessarily abdicating responsibility for leading a process of education and transformation in Australian understanding of and attitudes towards development issues? Surely it could just serve as an (intellectually and emotionally) accessible doorway to enter into that journey of discovery?

  • Garth, I still think you’ve reduced the problem too much to one of resources — specifically a target for aid to health. It also seems to let AusAID off the hook too easily: achieving a spending target is much easier than actually saving lives, which would require AusAID to present compelling evidence on the impact of aid. (And the Aid Review cites evidence of instances where spending targets have actually undermined aid effectiveness.)

    A good interpretation of Owen Barder’s analysis is that aid works, but that it could work a lot better, which is why he provides a useful ten point plan on how to improve the effectiveness of aid:

    1. Spend more aid through the multilateral system.
    2. Make aid more predictable.
    3. Make aid transparent, accountable and traceable.
    4. Build the accountability of governments to their parliaments and citizens
    5. Focus on results and simplify aid
    6. Invest more in global public goods, especially new technologies
    7. Focus aid on women and girls and chronic poverty
    8. Leverage the private sector
    9. Use innovative finance to increase the productivity of aid
    10. Learn more and fail safely

    This list could also useful for a discussion of how Australian aid can save more lives..

  • In this article the problem is simple: donors aren’t giving enough aid and as a result millions of people are dying. According to the post, the solution is also simple: spend more aid on health and set targets for the amount Australia should contribute (e.g. 20% of Australian aid or $1bn p.a.).

    In another article today in The Age, Hugh White argues that aid isn’t helping, instead it is economic growth that is lifting people out of poverty.

    Helping people in need is a good thing to do, and there are always more people who need help. But spending money in ways that makes no difference doesn’t help anyone, and there is no virtue in aid that makes donors feel good but doesn’t help the needy.

    What are your thoughts on this? Who is right?

    • No Matt, the problem is not simple but the evidence is clear that aid can improve essential services such as health,water and education for people. There is less evidence that aid can predictably improve governance or generate sustainable economic development. Owen Barder provides a recent brief summary at http://www.cgdev.org/content/publications/detail/1425286.

      The experience over the last few years with vaccines, bed nets, AIDS treatment is that aid has been able to improve and save the lives of people in a wide range of physical, social and political environments. Of course not all health projects are perfect, but overall, as these programs have shown, the main obstacle to preventing the deaths of millions of people is now the lack of finance.

      I am not advocating that all aid be spent on essential services such as health, but that Australia’s aid program should ensure in the development of its country plans that the provision of essential services is the first priority. Of course other sectoral areas are also important and contribute to the adequate provision of essential services, but based on the historical experience of Australia’s aid program there needs to be an operational strategy in place to ensure that essential services are not underfunded.

      The other important reason to broadly reach our fair share of total health aid funding is that,just as with climate action, Australia is much more likely to generate action by other donors and developing countries when we are seen to be doing our share.

    • In response to Garth’s article and in the spirit of healthy inter NGO debate I think it is worth noting the following risks in running this type of argument:

      a. it potentially undermines the case that developing countries and their citizens, rather than donors and aid advocates, should be in the driving seat regarding sectoral spend,

      b. the focus on saving as many lives as possible can play into an impatient, non-strategic, unsustainable agenda. If this approach was really driving the aid program why not simply spend all of the of the aid budget on emergencies, now?

      c. the idea that this is the sort of program that will garner the ‘greatest support’ from the Australian public seems to abdicate responsibility to take Australians on a educational journey and to enhance their understanding of effective development, and their (positive or negative) contribution to it, as well as their deeper engagement in promoting positive social change,

      d. it could contribute to a fragmented approach to development. Fixing maternal mortality in PNG is not just a matter of support to the health sector, as important as that it, it is also a matter of gender inequality and associated gender based violence, it is a matter of governance, corruption and weak civil society, it is a matter of poor infrastructure, and a just distribution of mining royalties etc etc. A narrow short term sectoral focus on health is not going to address these social economic and political determinants of the problem.

      Haven’t we moved beyond a stale debate about whether its aid vs trade (Hugh White in today’s Age), or whether its health vs economic development?

      Chris Roche, Oxfam Australia

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