Comments

Very good point. I have written on the Cuban training model in the past <a href="https://devpolicy.org/cuba-in-the-pacific-more-than-rum-and-coke-2-20120224/" rel="nofollow">on this blog</a>. It does represent a strong training model - though one that does require people to travel outside the region. Part of the challenge is now for those who return home - in terms of mechanisms for internship and residency training. For example, the Solomon Islands and Kiribati struggle to offer the next phase of medical education for those who have returned from Cuba. That is an area where Australia - perhaps in collaboration with Cuba and the US - could play a role.

Phil, if accurate, evidence against my assertions emerged at the recent Addis Ababa Financing for Development conference, where the negotiating methodology stacked the odds against the G77. Read it <a href="https://www.globalpolicywatch.org/blog/2015/07/20/ffd-3-outcome-fishing-for-crumbs-of-hope-in-a-sea-of-lost-ambition/" rel="nofollow">here</a>. So maybe I'm too optimistic.

Thanks, Joel. I am looking forward to the next post. I am in total agreement that training is essential. I do think that examining the issue through a wider HSS lens is important, however. There are also other issues to think about in ensuring adequate numbers of health professionals. For example, when I was living in the Solomon Islands (which, I note, only just reaches the minimum 23 skilled professionals recommended), I was perplexed to learn of nurses travelling to other Pacific countries to work because they could not find work in the Solomon Islands. I never found out what was driving this, or if it was more than just a couple of stories that got blown out of proportion. But it did make me think about the barriers beyond training, such as funding for positions. So I think a holistic approach is important, to ensure various barriers to having an adequate health workforce are addressed simultaneously. But these stories of movement of nurses within the region also raised interesting questions about the potential for a regional workforce. I wonder how many nurses, for example, would be willing to travel to other countries in the Pacific to work? It is certainly something I've thought of doing. There is the potential here for inservice training and workplace modelling and sharing of knowledge. I guess the problem is that all countries in the region are experiencing shortages, NZ and Australia included. Anyway, a fascinating topic and one close to my heart, so bring on the next post and I hope the idea gets implemented.

Dear Joel, Great topic and love the teaser...got to wait for the next blog to read about the model. So I will patiently wait 🙂 - Meanwhile, in case this is where you will take the proposal, I would like to share with you something we have also been socializing with several countries and maybe it's also time for this initiative to be implemented. During a meeting of the Leading Group on Innovative Financing for Development with Michelle Bachelet, we discussed an old idea that would look like the concept of Barefoot Doctor. I am currently on the other side of the Pacific where most countries have now graduated to the rank of Middle Income Country (High) but most of them have systems that are unsustainable and where the problem is not so much the qualification of the medical core (when they exist) .... but the cultural approach to the work in terms of innovation. Lots of ideas in the work and look forward to read about your proposal. Saludos cordiales http://www.keento.org

Would be good to see an acknowledgement of the health work force training work done by ELAM (Latin American School of Medicine in Cuba), possibly the most cost-effective model for training health workers for developing countries. Now that the US has normalized relations with Cuba perhaps USAID and others will actually bother to acknowledge Cuba's achievements in health - at a fraction of the cost of donor countries.

Better than a blog would be the review that has been recommended by the parliamentary inquiry, but with scope confined to the Pacific or at least the near-neigbourhood. Question #1 for such a review would be, 'is the IFC already doing this and, if not, is it capable of ever doing it?' I don't pretend to be certain of the answer but I think I can guess. The following is a quote from one of the IFC's own program evaluations (of the <a href="http://www.ifc.org/wps/wcm/connect/9f228e804602c60aadd5bd9916182e35/Midterm+Evaluation+of+the+Pacific+Micro-Finance+Initiative.pdf?MOD=AJPERES" rel="nofollow">Pacific Micro-Finance Initiative</a>): <blockquote><em>Institutional Realities</em>: IFC is a relatively heavy organization with multiple layers of approval necessary before IFC can engage with new partners. Effectively, IFC as an institution is designed to work with relatively mature organizations that can assimilate IFC global best practice advice and that have internal capacity to transform this advice and associated business concepts/ideas into operational reality.</blockquote>

It's not that distortion is automatic: 'need not do that' wasn't meant to imply 'needs not to do that'. I do think, for example, that there's a role for a publicly funded inclusive business broker, for risk reduction financing and for grants to local organisations to help them work with business to develop pro-poor supply chains. However, as noted in Devpolicy's <a href="https://devpolicy.org/the-varieties-of-engagement-devpolicys-submission-to-the-parliamentary-inquiry-into-the-role-of-the-private-sector-in-development-20140616/" rel="nofollow">submission</a> to the inquiry, official aid agencies' default strategy for forming a partership with somebody is to give money to them. The recently aired <a href="https://devpolicy.org/ecf-mark-ii-is-seed-pacific-a-better-enterprise-challenge-fund-20150427/" rel="nofollow">concept</a> for the new SEED Pacific program illustrates this tendency, as does the average enterprise challenge fund. Many of the businesses and investors whose policies and actions are likely to have the greatest impact on development have little need for public money. Maybe as you say they have some need of the development expertise that resides in the public sector, but of course most such expertise resides elsewhere and is made available to both the public sector and private corporations under contract. And putting money into the picture, for example by offering subsidies for business collaboration on codes and standards, can in fact be harmful if it leads to a loss of ownership on the business side of the table. As for social impact bonds, and now development impact bonds, that's a very long story but my view, I think, is that it is a mistake for governments to assume a coordination role in connection with these things, situating themselves, as bond issuers, between the implementers and the financiers. Once they do so, in what might be a case of 'climbing into the picture', they have too much a stake in the success of the initiative. In particular, they must become accountable to the financiers for the selection and performance of the implementers. I suspect the same aims could be served by a simpler and rather less exciting structure in which governments simply let results-on-delivery contracts.

Robin, thanks for the useful overview. Just a query re: support for a bilateral DFI. This was also raised in the Jim Adams piece the other day. Why do you think there is a gap that cannot be filled by the IFC out of the World Bank Group Sydney office? I know they struggle for traction, but it is pretty well resourced and I don't see why there isn't viability in extending their influence if there is truly demand for financing services in the Pacific. How would a bilateral DFI be any different? Is it a risk issue? If so, having just come back from a trip to DFID and having a conversation with the DFI guys there, my experience on this is that these undertakings are not straight forward. I know I would be reticent to impose this kind of complexity on the current Australian aid program, but I would like more on your views. Perhaps it warrants a separate Blog topic?

Robin, thanks for another entertaining, incisive and frank assessment of Australian aid policy. I am interested to read your caution, brief though it is, on the potential role of Government in impact investing. You say that "For example, in its discussion of social impact investment, the committee’s assumption at all times is that the government must figure out how to climb into the picture. But the government need not do that, and risks creating distortions if it does." Impact investing reminds me of my days working on anti-corruption policy for the aid programme - it was going to be the cure that ended all ills. It wasn't, and yet when done well it's a powerful and galvanising agenda. I do see social impact investing as galvanising for many players in the private sector who want to "do good" or "give something back" - terms that they themselves use. Like any effective development approach, it can bring together disparate interests and actors to share both their genius, and the risks involved. There are some good case studies set out for example in a number of reports by Australian-based <a href="http://socialoutcomes.com.au" rel="nofollow">Social Outcomes</a>, which describe the positive roles that government funders (outside the international development sector) have played in the development of social impact bonds and other innovative financing mechanisms. I also see that effective development expertise (if not funds) is exactly what shared value and other social impact conscious approaches from within the private sector are looking for, and at least some of that expertise resides in the public sector. Can you say more about the distortion that you worry about when governments get involved in impact investing? With thanks.

Hi Ben, In theory countries could set their own targets for the MDGs too; although in practice I don't think many did. So the escape hatch may not be as readily used as you would imagine. And egregious use would be something campaigners could police. Terence

It isn't clear to me how much of a political process has been involved in creating the SDGs. Or at least, not much like other political processes. In standard politics, we operate under constraints. There is a fixed budget, and that has to be allocated among competing priorities. There are competing priorities, and we bargain to reach a final agreement. For the SDGs, it is just an ever growing wish list without any consideration to the feasibility of achieving the goals, or to structuring them in a way that usefully guides the allocation of resources.

Phil, are these goals really imposed? The G77 is a powerful negotiating bloc at the UN. Their votes matter. Do you really think it is as straight-forward as OECD donor countries imposing their will on everyone else? Further, if agreed, these goals will be universal, so this is about a collective agenda for everyone. Also, there is leeway in the goals for countries to chose their own priorities and focus on those. Given the comprehensiveness of the goals there is a lot of scope for choice in there. Finally, the process to create the goals has been consultative on an unprecedented, global scale, with voices from across the world involved - not only the perspective of governments (who wield their own power over their citizens) but also citizens. However, I do agree that in the implementation power differentials in the real world play out in ways that can undermine national government ownership. I just don't think it is as black and white as 'us' imposing on 'them'.