Comments

it is a nice lesson

Terence, There is another reason not to like neo-liberalism and that is (it is so 1990s!!!) the world has moved on quite a bit. The push back by the development state against neo-liberal ideas particularly since the Asian economic crisis is palpable. The State is back and if we need a label we could call it neo-corporatism where the state is exercising much more control over all aspects of society including the corporates, civil society and the like. The state in being interpenetrated by business and (dare I say) religion in particular; so the neoliberal free market is now much more constrained.

Hi Ben, Very good points. A new capacity development model needs to be done hand-in-hand with the other elements of the health system strengthening strategy outlined by the government. Which would include suitable financing for the health system and appropriate governance. I realise that more health workers does not fix a system - the Pacific examples where Cuban-trained doctors are returning but there is no salary for them is an example of what can go wrong if the systems are not aligned.

Thanks Robert!

Hi Chris, Thanks for the link to your interesting analysis and blog post. I agree with the substance of your post: that growth that comes with lower inequality will do a better job in reducing poverty. Indeed, I say as much in my post above. However, in countries where aid has the greatest potential leverage, (proxied in my post by aid/GNI), which are almost inevitably very poor countries, the foremost economic issue, initially at least, is growing the size of the pie. You effectively show the same in your chart one (see the minimal difference between the two blue bars for LICs under the different scenarios). Even so, even in these countries, I still think economic inequality is an issue that aid practitioners should pay some concern to. However, as I say in my post (my central argument), there are good reasons to think other forms of inequality are more important for aid work in the typical aid recipient country. Thanks again. Terence

Hello Terence, Check out the blog below. It highlights a reason why aid practitioners should be concerned about economic inequality. http://post2015.org/2015/07/30/how-many-people-were-left-behind-by-unequal-growth-during-the-mdg-period/ Cheers, Chris

Thanks for the thought provoking post. Moving from capacity building of individuals to capacity building of institutions AND individuals indeed has the potential to drastically improve value for money from these aid investments. An education pipeline for health workers is critical for service delivery. Equally important is institutional capacity building to ensure governments have the planning systems and fiscal space to employ an appropriate workforce. The experience of the Australian Aid Program in capacity building has been mixed and the deployment of expertise has not always built sustained capacity. In recent years the program has made significant strides in moving from capacity substitution to genuine capacity building. In doing so, there has been recognition that the challenges facing health systems are to do with politics, financing and capacity in equal measure, a ‘troika’ if you like. Supporting the development of these systems is a long term endeavour; it requires political engagement, financing support and capacity building in equal measure. The model you propose could well have an impact on one component of the latter, but without the other components, value for money will not be achieved. The Aid Program has huge potential to leverage Australian expertise for a prosperous and healthy region; but only by taking an uncompromisingly integrated and country focused approach. Where delivered in this context, linked to strong bilateral cooperation, the approach you propose could indeed have a significant impact.

Excellent post, Terence. Thank you. I like the direction you take and wish that more people who write about aid would be careful with the language they use. Some terms, as you suggest with neoliberalism, become nothing more than empty slogans. I am particularly pleased you list learning and context. So much of aid is surely concerned with learning and yet, as you point out, so little is learned from the extensive monitoring and evaluation that is carried out, primarily in my experience, for accountability purposes only. Donors, particularly, seem to pay insufficient attention to learning from past experience and putting that learning into policies and practice. Finally, your listing of context is important too. Far too much writing about aid is at a level of generalisation that dos not recognise the peculiarities of development challenges in the vastly different contexts of, say, health in PNG or law and justice in Indonesia. Very different worlds!

Robin, Thank you for the comprehensive analysis. Thank you in particular for keeping the Pacific DFI concept at the forefront. I acknowledge the upfront cost from a diminishing aid budget. However, my understanding is that Austria established its own DFI recently with upfront money from their EFIC equivalent. This is not necessarily the best solution but it is an interesting idea. My experience in the Pacific is that no-one else is or would be prepared to do this in the smaller countries of the Pacific. I believe it could be beneficial and it seems to be an idea which would appeal to the current governments in both countries.

Thank you to the ten people who have provided comments on this blog post. This week, I gave a presentation at the invitation of John Piel to advisers in the <a href="http://www.plgp.org" rel="nofollow">Provincial and Local Level Government Program</a> (PLGP). While John and I had met before, it was through him reading this blog post that this opportunity came about. A number of the advisers saw potential applicability for strategic use of mobile phones in their work. I hope to help them to develop these ideas. Alistairs Dirua, I'd be happy to be in contact with you further about your work with health services and the use of SMS in collection of health data. Rod Reeve, I've been meaning to contact you to follow-up on your comment. I hope we can have further contact. Jason Brown, we used FrontlineSMS for the controlled trial of the <a href="http://www.pngepsp.org/our-activities/mobile-4-development/sms-story/sms-story-overview.php" rel="nofollow">SMS Story project</a> in Papua New Guinea. While it has its limitations, FrontlineSMS is easy-to-use and can work well for sending of mobile phone text messages. There is also a new version, FrontlineCloud, which is operated via online management. For SMS surveys, there are a range of software and service provider options available. Thanks again to everyone who has read this post and particularly the ten people who've taken the trouble to post a comment. Amanda. 🙂

Hi Ann, thanks for your comment. I agree entirely that it is very important not to equate 'screening' with 'care', and not to assume that putting screening in place is sufficient to improve health outcomes. And I can't help but think how difficult it would be to try to demonstrate the effect of such a program on NCD outcomes, compared to other community-based programs that focus on, for example, diagnosing and treating malaria, or providing oral rehydration for children. Hence my cautious optimism -- depending on all those factors that you raise (training and support for the health workers, linkages to care, access to broader advice about prevention, among others), this may be a helpful intervention but certainly not a panacea! Camilla

Thanks for the interesting post. I hadn't seen the Lancet paper. I have two related thoughts about it. First, 'community health workers' covers an incredibly broad spectrum of health care providers from people who have had 18-24 months training, a wage and regular supervision to the untrained, unpaid and unsupported. What they share is that they live in the community, reducing the geographic and social distances experienced in accessing care. I am pleased that there is a trend to involving them in NCD health care. My second concern though is that screening is not health care. It is measuring ill health. Knowledge about a person's health status does not produce better health care without skilled, incentivised and equiped health workers to respond to the information. If the only support a health care system can provide is some broad advice about primary and secondary prevention then there is no need for screening. I was involved in a project in rural Australia that showed that doctors who screened did not respond to the evidence until there was a separate initiative that produced a greater consensus and urgency to take specific action. I have seen that same approach of measuring ill health for the sake of measurement in a number of contexts. Information is great only if there is clarity about what to do with the information. Otherwise information only results in fatalism about high and persistent levels of poor health.