Comments

Thanks Joel. I've been meaning to read the health strategy and your blog means I can cross it off the list. It offers a comprehensive summary. A question. Australia has engaged with some countries over quite long time periods to strengthen their health systems, such as Fiji and the Solomon Islands. Did the strategy reflect on, or incorporate, any learning from past DFAT (AusAID) experience in this area?

We the people of Gulf must mentally change our attitudes of asking MPs for money please..!! Money will never get us out of the way instead. You eat and use money but you will never change and improve in all areas of physical lives, therefore, we must all cry, beg and ask for services and new developments.

It's true Dr. Amanda, I agree with you that mobile phone sms is one cheapest and fastest way of sending and receiving data on time. It truly covers the gap for poor internet services, poor postal services, poor telephone link etc... Practically, mobile phone sms is very helpful regarding timely data. Thank you Tina

Large numbers, but getting substantially smaller. Having said that I concede the point re average income -- as I made clear in my post, but possibly not in my comment, distribution does matter. Have a good weekend.

'This is contra to your claim that a “very large number are being left behind”'. It all hangs on the definition of 'very large numbers'. In India, about which I know a little, the numbers are very large despite a reasonable social security system to preserve a 'floor'. Where we differ is where you say '[for] aid work the foremost issue remains one of raising average levels of income'. For many aid workers and organisations (even centre-left political parties) it is about a poverty focus and 'lifting the floor'. The 'rising tide does not lift all boats', contra to the views of centre right political parties.

Hi Patrick, Thanks for your comment. My understanding of Ravallion's floor measure is different from yours. As I understand it, he derives (rather than observes) an estimate of the level of consumption that the least well off person globally (or someone approximating to that person) is consuming. This is the value that has not shifted a lot; however, actual proportion of the world's population living at very low levels of consumption ($1 a day ; even 50c a day) has fallen markedly in recent decades (to the extent we trust the data, which I think we can to a degree). This is contra to your claim that a "very large number are being left behind". You can see the falling share of the World's population on slides 31 and 32 of <a href="https://crawford.anu.edu.au/sites/default/files/events/attachments/2015-06/martin_ravallion_-_poorest_left_behind_anu.pdf" rel="nofollow">Ravallion's talk</a>. And, philosophically, for a Utilitarian like myself, as opposed to a Rawlsian, this improvement is more important (with a few caveats) than lifting the floor. Methodologically, I'm still unclear as to how Ravallion can detail a reduction in people living off a consumption level (50c/day) under what he calculates the floor to be (between 47c&87c) and not also see a shift in the floor itself, although I think the issue is hinted at on slide 25 -- which illustrates a falling floor even in a world where poverty has decreased. This points, at least to my thinking, to a significant issue in Ravallion's approach (although I may be missing something, I concede). Beyond all that, please recall that I am in favour of reducing poverty, and think unnecessary economic inequality a bad thing. I just don't believe economic inequality is the most important form of inequality aid workers should be worrying about. Thanks again. Terence

I'm glad I stumbled onto this page and found people with common interests. I totally agree with Dr Watson. I represent the Christian Health Services in PNG. Most, if not all, of our health facilities are located in the remotest part of the country, and you can imagine the issues we are facing with Data Flow/Data Collection. For my case, SMS Data Collection is most definitely the way forward for us. The only problems I foresee is the User Training and the size/structure of data that can be allowed via text messaging. Time does not permit me to go into detail, but currently I am implementing DHIS2, a Health Management System, that has a module for SMS data collection. I just came here to say thank you for your article, and that it gave me the morale that I needed. Alistairs Christian Health Services PNG

Terence, the key point that Martin Ravallion made (at the conference and here at the ANU) is that the 'floor' (the % of very poor) has not moved much in 20+ years. Now that should be of concern to all aid practitioners as that is about the very large number being left behind (and yes most are women, so gender is a key issue in this).

Thanks for the summary - very useful. I'm glad to see DFAT heading in this direction. We've seen some great successes in Indonesia with health systems strengthening projects, so this is quite heartening.

An excellent write up and piece of work to keep people informed of the challenges in PNG related to data collection and of course how one can be able to manage these challenges to get the relevant data. The initiatives you have highlighted can become catalyst for relevant data for information analysis to inform better policy setting as you mentioned. A key challenge I believe is the ability of people with the data and the people requiring or demanding the data is for them to know that they can be able to utilize the methods you have discussed to better serve data collection in PNG for obvious purposes. This is probably a critical challenge and one that I personally think needs advocating across all public service sectors. Thus it will be good if we can integrate some of your discussions - especially generating data - into many of the other governance programs funded by development partners such as DFAT. I am sure these development (donor) partner programs will find it to their advantage to integrate some of the initiatives you have mentioned into their programs. You should talk to PLGP - a governance program targeting sub-national levels of government.. Once again - thank you. John A Piel Finance Adviser

Thanks Joel, this is a very useful overview. It's good to see some clarity from DFAT on current/future health aid directions. Some further thoughts: - The health systems strengthening focus is positive. I find the multiple references to what we've learnt from the Ebola crisis to be somewhat ironic (including that much of the crisis could have been avoided with better health systems investment) however given that (as you've written before) Australia's aid to Africa has fallen off a cliff. - It's positive to see chronic disease featuring much more prominently in this document. Nutrition is a good starting point, and it's good to see tobacco control, immunisation and hypertension mentioned. The NCDs focus still feels under-developed, however. For instance there's no mention of the role of sport/physical activity in Australia's aid program, which on top of being a central plank of the obesity response also provides opportunities for much broader health education, women's empowerment and disability inclusion. In the Pacific, Australia's Sport for Development investments are among the most successful and prominent, but there's no mention in this document. There's a vague reference to 'healthy lifestyle promotion' but that's it. Given the multisectorality of NCDs (see for instance the World Bank's Pacific multisectoral responses paper), a much more coherent strategy is still needed if DFAT is serious about addressing the actual burden of disease, and not just infectious diseases. - I see your point about Australia's unfortunate world leading status in over-nutrition, but would still suggest there's a potential role for Australian organisations in chronic disease that is being neglected. Through my work in Tonga I was able to help leverage Australia's domestic expertise in health promotion (VicHealth) and tobacco cessation (Cancer Council/Quit) to assist with building capacity to address NCDs. Incorporating funding for such twinning/capacity building initiatives into future programming/policy would be wise. - Research seems to be more prominent than it has been for a few years. It'll be interesting to see how that plays out. - On a related note, I'd like to see more reference to cross-government arrangements/collaboration. The brief reference to Health Department is a reasonable start, but what about NHMRC's funding of LMIC research/capacity building?

Great post Joel! The part that has most resonance with me is the 25 year window needed for health systems strengthening in the Lancet article. The challenge then remains how to move from short term-ism in our development partnerships with our near neighbours, to a longer term focus on building their health systems in financially feasible, culturally appropriate and politically nuanced ways...