Comments

Thanks Robin for a thought provoking and well argued piece. The rationale for cuts in Indonesia appears to be pretty similar to the winding down of the aid program in China and India, so there's at least a precedent. The bilateral relationship is deep and broad, so hopefully any major aid cut would be seen as part of a mature evolving relationship. While I'm not privy to the internal deliberations around the cuts, it strikes me that the whole process would be more transparent and credible (not to mention diplomatically paletable) if the analysis was undertaken and communicated to those effected before the actual announcement was made - it's one thing to make big cuts to the aid program (that may or may not be warranted, depending on your ideological perspective and view of economics) - it's quite another to make them on the run, with little pre planning and in a way that hurts the stakeholders involved and, potentially, Australia's national interests.

Thanks Robin, for an interesting and clean post, on an important topic for which I have not yet seen much constructive engagement. Its worth noting that in in 2014 Indonesia's poverty headcount was 28.4 million: well over triple PNG's entire population (poverty in Java alone is over twice PNG's population). Regarding the scale-up (which if mostly disaster aid should probably be wound back when the disaster is over, I agree), many of the important Indonesian programmes have been well-evaluated and I suspect we have a much better idea of what is working better there (here), than we do in just about any of the other programmes. There is a strong case to be made that the aid to Indonesia has been some of the more effective aid delivered (even if we just focus on poverty, and governance broadly speaking, not the other non-development objectives the program no doubt serves), particularly when we contrast it against some of the other countries' in the region. I'd vote Option 2, or an unnamed third one that targets particular themes/types of aid instead of countries, although this would likely make the quantum harder to hit in a simple way.

Thanks Robin for a wonderful piece. As you note, the level of funding to Indonesia is the elephant in the room. Australian cash is insignificant compared to Indonesia's GNI (US$2.3 trillion). And whether it buys us "influence" is very debatable. Australia can engage on policy issues (universal health coverage for example) without needing huge amounts of cash injections. I think grouping all non-Indonesia and non-PNG country programs together is a bit messy as some of the countries including in that - like Indonesia - are wealthy enough to fund their own development programs. Iraq, Fiji and Tonga for example are upper middle income countries (according to World Bank) - so in theory at least should have sufficient funds to drive their own development agenda (perhaps with some small policy support from DFAT). Samoa and Timor-Leste are just on the cusp of upper-middle-income status and Indonesia and Philippines (two large recipients) are not that far behind (see here http://data.worldbank.org/data-catalog/GNI-per-capita-Atlas-and-PPP-table). Perhaps WB classifications are a bit of a blunt instrument and there of course remain (large) pockets of poverty in those countries. But using the WB classifications as a method for reducing aid would make sense to the Australian public and would - in some ways - return the aid program to a poverty reduction emphasis rather than a model where middle-income Asian countries get the most aid. Joel

Great article - thank you. My multilateral, northern European leaning paradigm says we need a WHO-like entity that is neutral, impartial and independent and is empowered and funded to coordinate and facilitate global health. Unfortunately 'everyone wants to coordinate and nobody wants to be coordinated.' Much of the rhetoric for the recent changes in global health comes from a US / private sector leaning paradigm that 'competition is good'. I agree - often it is and I welcome it. But, with competition for financial and advocacy space comes, paradoxically, increased inefficiency. For example each new entity needs its own experts in communications, advocacy, portfolio management, finance, operations, M+E, gender etc. Competition increases fragmentation at all levels, blurred and overlapping roles, territorialism and decreased collaboration. Competition decreases the likelihood that nutrition, vaccine, MNCH, WASH or noncommunicable disease experts will sit together to collaborate and work together under the umbrella of national health plans. This may be beneficial in the private sector when introducing a new product, but ministries of health struggle to deal with, and coordinate, the increasing numbers of players, indicators to measure and reports to complete. WHO is still (in my opinion) the most trusted partner at country level. In contrast to any of the banks, bilaterals, many NGOs, other UN agencies and foundations. Unfortunately WHO has been undermined by lack of funding beyond specific diseases and many agencies bipass WHO's facilitation role. Without WHO at country level, I believe low and middle income countries would be even more driven by entities with large communications and advocacy budgets; often skewing priorities and budgets away from nationally identified priorities based on local disease burden information and away from holistic approaches to beneficiaries that can be addressed with cost effective interventions and a primary healthcare philosophy.

Thank you Bernard. As it has always been, the grassroots appear to be the ones suffering the most from these socio-economic and political turbulences. Regards Bal

Great Sentiments Mr Kama... Sad to say that majority of the rural folk do get to hear/see the political storm that surround them...2015 is definitely a state of emergency!

Thanks Hutak. I had seen Rudd's new role but very little information was available on it. Good to see that WHO reform is in their remit and interested to see what they come up with. Hopefully they will look at first principles as to what kind of global health organisation the world needs rather than just tinkering with internal WHO processes and office set ups. Will be good to follow it and hopefully someone from the Commission can write a blog for this site to update on plans.

WHO is constrained by the way it is required to work with host governments. Often it cannot act quickly and at times political considerations mean that it does not place public health ahead of other considerations. So it needs to move away from activities that require speedy and relatively independent action. Its core funding is often far too small for the functions it now tries to cover, so like many an NGO it becomes driven by individual donor fixations. It needs to move away from this dependency. Yet WHO does play an important role. It sets policies and standards, and issues good practice guidelines that are internationally recognized and adopted. Its staff provide technical support to ministries of health globally, and the impact of this is often underrated. A good degree of the funding from major donors such as GFATM, GAVI, WB etc. would be ineffective without WHO technical inputs, and in a number of countries essential programs such as immunization and malaria surveillance and control would collapse without WHO technical officers being active in program management. That said, a great failing of WHO at country level is its poor record on local capacity building and transfer of skills. This should be a core WHO function, and one that would have a system-wide impact. That, plus its regulatory and standard-setting functions, need to come to the forefront of WHO's work so that implementation can be left to other agencies. While it is true that its role in relation to data collection has weakened considerably, WHO still plays a key role in surveillance systems and getting up to date information to central decision makers. It should therefore not abandon its data collection role completely, but play to its strengths. In some ways WHO's dilemma is very like that of the ministries of health it supports in developing countries: how to move away from a service delivery role to one that is more focused on policy development, standard setting and health system strengthening through capacity development of health workers.

Interesting and relevant published comments here from @MrKRudd: "The head of a new international commission wants Canada's tough-talking foreign affairs minister to help him reform the United Nations World Health Organization because it responded too slowly to the Ebola crisis. [...] Rudd has also joined other critics who have blasted the WHO for being too slow to respond to the West Africa Ebola outbreak. "In the 21st century, with globalization and mass communication, mass movements of people, we must have a fully competent integrated global health system which can say, 'we have a problem,' and send a red flare up straight away," Rudd said in an interview on Friday. The problem, he said, is not with the leadership of WHO director general Margaret Chan, but with structural problems that give regional federations within the organization a veto over its Geneva headquarters. "That's wrong; that has to change," said Rudd, adding Baird is just the person to help him to "structurally alter the rules" of the WHO. See the article <a href="http://www.cp24.com/world/rudd-asks-baird-to-help-fix-un-bodies-who-in-wake-of-ebola-response-1.2215825" rel="nofollow">here</a>.

Sounds like a plan - let's keep talking

Dear Tess many thanks for your response. You are absolutely right that student migration is another sub-set of intra-Melanesian migration. In my blog, I specifically focussed on labour migration. However, I am planning to look at student migration in more detail at some point. Perhaps something we could do together? Regards Carmen

Great article Bob. You are right that it is embarrassing for Australia that trachoma persists in some of our indigenous communities. As the Chairman of Ninti One Limited (and the Chair of the Cooperative Research Centre for Remote Economic Participation (CRC-REP)) Dr Tom Calma AO recently publicised, the health in Aboriginal and Torres Strait Islander communities in Australia is a global shame. Indeed, for the world’s oldest culture, with all of its unique beauty, trachoma is but one of a long list of embarrassing situations. For example, a woman in the NT has an 80 times chance of being hospitalised due to assault compared to a non-indigenous woman (yes, eighty times) and one-in-eight children born in a group of remote communities in Western Australia's Kimberley region has foetal alcohol syndrome. So, you might ask, why does Australia have such a well-resourced and successful aid program yet we haven’t translated this wisdom to benefit indigenous Australia? More energy needs to be injected into learning from experiences in international development (and vice versa). ACFID is active in this area and they prepared a paper entitled: ‘Effective Development Practice with Aboriginal and Torres Strait Islander Communities’, in February 2014. The Practice Note sets out to explain good practice principles for international non-government organisations (INGOs) and other interested parties engaging in development initiatives in Aboriginal and Torres Strait Islander (A&TSI) communities throughout Australia. The ANU Development Policy Centre has generously given me a speaking slot at next week’s Australasian Aid Conference, where I will be delivering a paper on ‘International Development and Indigenous Australia: Learning from each other’. My survey of aid practitioners and people working in indigenous Australia has identified particular areas where we can learn from each other, and I will be describing these at the conference. It’s great that the Queen Elizabeth Diamond Jubilee Trust (the Commonwealth) is supporting the elimination of blinding trachoma in Australia – and thank you for bringing it to our attention. Ninti One is helping to improve eye health in remote Australia as part of the ‘Vision CRC’ within the Brien Holden Vision Institute.