Comments

From where I stand, the MDGs catalysed a vast increase in the amount invested in HIV/AIDS and malaria treatment and prevention. That's a huge good. (Even if a health system is more than two diseases, the increase there did have large spillover effects into health systems and delivery, and govt prioritisation of health outcomes.) It's difficult to see the same kind of outcome from these vague and non-specific goals. "Ensure healthy lives and promote well-being" means absolutely everything and thus absolutely nothing. Hopefully the impetus to health has been sufficiently engrained to make this process superfluous.

Thanks for an interesting post Terence. I agree with much of what you say, although I do think this should be read as a call for careful and intelligent application of terminology rather than the using words less. This is particularly true with 'context'. In any aid related documents I read, context is written everywhere. It is overused, but under-analysed. So perhaps we could usefully think critically about context rather than encourage further repetition! For example, we could usefully ask these questions: Whose context are we describing? Whose views have we taken into account in doing so? What are the differences between those views? Whose have we prioritised in our analysis? Why? How have perceptions of history shaped how context is understood by different actors today? What world views do we bring to the table with our analysis? How are we part of the context? I could go on...context is often viewed in a static and one-dimensional ('our') way. It's too often a get out clause (our programme/analysis is 'context-specific'). My view is that is what needs to be challenged...

Hi Judy I tend not to look on the internet so have only just seen this. I heard often of your excellent work when you came to PNG. Would love to me you in the future. Carol Kidu

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.