Comments

Ashlee I loved your article. Thanks for your candour and humour - I am already thinking about how I can incorporate your insights into some work I am doing in the humanitarian sector (and I thought I was liberated on women and blood). Here's to the breaking down of this old taboo - and the recognition that this is the blood that nurtured us all in utero. And Sean who ever you are, bless the man (as well as the woman) that can talk about menstruation without blanching, particularly when taboos around it can inhibit girls and women's empowerment profoundly.

"Of girls in Malawi, 82% did not know about menstruation before the onset of menarche." Jeebus. This really shocked me. Great read, Betts!

Thanks to Tess, Alan and Garth, for making similar comments to what I would have. To add, in New Zealand, I would argue (and have, often) the reintegration of the aid programme into foreign affairs has not been a success when viewed through a development lens. And isn't that what aid is for - development in developing countries, with a focus on poverty alleviation? Also, New Zealand's Minister McCully said he was keen to give NGOs more funds. But as service providers. This is a model that views NGOs as advancing the government's development goals, not a view that values NGOs as entities in their own right, with specific visions, missions and values. A service-provider approach threatens NGOs' crucial role of 'voice' - acting as advocates for the people who aren't able to access the halls of power, or supporting marginalised individuals to gain access to those who make the decisions. This role is at least a rhetorical component of many NGOs' values and if we are committed to development, it is a role that needs defending and strengthening, particularly as aid's development focus gets blurred with non-aid foreign policy priorities.

RE: being an ODA 'minnow' in Africa, Australia can still contribute through targeted programmes in Sub-Saharan Africa (47 countries), which is the poorest region in the world (not withstanding successive so-called 'development decades') and is 'off-track' to meet MDG goals for eradicating hunger (MDG1), child mortality (MDG 4) and maternal health (MDG 5)...and others. One of the key strategies for development is building capacity from within. AusAID had been running programmes geared towards capacity building through providing scholarships for African students--who then return to their country of origin to put their credentials/skills gained in Australia to work in their home country. These programmes are now at risk, which would be a shameful outcome of AusAID 'restructuring'.

I have been following the blogs on this with interest and it is good to see so many people getting involved in the conversation. Of course some of the key people are noticeable by their absence not just from this conversation but generally - maybe they are practising their active listening skills. I have a concern with a couple of the points raised here. One is "So clearly the decision to locate aid and trade together appears to make more sense than leaving it in the responsibility of aid bureaucrats who have no or little trade or private sector experience." This seems to imply two things, one is that the 'trade bureaucrats' have lots of trade and private sector experience - I don't know if this is or is not the case and the other is that it seems to imply that it's ok to give aid to trade people even if they don't know anything about development...it's easy to think that 'anyone' can do development but it's patently not true and has already been demonstrated in other 'whole of government' initiatives - the one I am most aware of is using AFP to support policing but I am sure there are others. I have done my fair share at sighing over inefficiency, waste and ineffectiveness on the part of AusAID over the last 16 years. But in my opinion there is nothing as wasteful, inefficient and ineffective as the creation and continuation of a situation in which decisions cannot be made, budgetary or otherwise, relationships cannot be progressed and all that is able to flourish is uncertainty and frustration.

Jiesheng, IDA eligibility is based on income per capita and may also include a few other considerations around creditworthiness of a country - it has no linear relationship to the number of those living on under $2 per day in a country. That is how middle income countries can still have vast quantities of people living in poverty, numerically far in excess of smaller yet poorer countries. You may need to look more closely at the statistics and the definitions to understand this - I'd start with the World Bank's Povcal database. There are also numerous reports based on this information that will explain this data to you.

It's a rather heroic assumption to say that trade-related aid is left to bureaucrats with little or no experience in trade or the private sector. Given the traditional flow of staff and skills between DFAT and AusAID, and the fact that (shock, horror) many AusAID staff have considerable non-aid private sector experience, it seems fatuous to suggest a lack of skill or knowledge in this area, as opposed to others - why would an AusAID bureaucrat know more about e.g. health than trade? Or perhaps the assumption is that all AusAID bureaucrats lack expertise outside bureaucracy. The logic here is a little like suggesting that those running charities lack expertise in, say, diplomacy, and should therefore not comment on those matters.

Brian Doolan correctly points out that there can be positive outcomes in the decision to more fully integrate AusAID into DFAT. However the Government needs to implement its plans with considerable finesse if it is to further improve the effectiveness of Australian aid and not damage an already good aid program. The use of evidence must be central to this change. It is easy to say that the aid program should boost economic development in partner countries, but much harder to achieve. The evidence is clear that aid can dramatically reduce the worst aspects of poverty by helping to provide health, nutrition and other essential services and technologies and can indirectly assist economic development by boosting human capital. The huge cuts in child and maternal deaths in most countries since 1990 testifies to this. However there is very limited evidence of aid directly boosting economic development and trade or dramatically improving governance. For a useful summary see <a href="http://www.cgdev.org/files/1425286_file_Barder_Can_Aid_Work_Submission_House_of_Lords.pdf" rel="nofollow">here</a> [pdf]. There is definitely room for the trialling, with thorough evaluation, of new approaches. However large scale changes to the aid program need to be based on evidence of what works.

Thanks again for making the report available (a very interesting read). As you point out, there is little doubt that improvement management and additional funding has resulted in improved service at the hospital. However, just to echo some of Anna's comments: 1. I'm not sure you can measure "efficiency, access and quality" purely at the hospital level. Lesotho is a health system, and as Anna points out concentrating resources at one point may have degraded outcomes at another (although I realise that would require a totally different study) 2. In a related way, "upgrading the quality of district hospitals and outlying facilities" is not something you can consider as a separate issue/option. If the additional cost of the hospital means that money is not available to upgrade facilities at other points - that has to be taken into account. It's not necessarily remarkable that better inputs result in better outputs (although some of the strategies described are immensely useful). However, drawing policy conclusions requires analysis of some of those bigger issues.

Thank you for your comment. The goal of a PPIP is to get more quality and better services for the same price. That is what the government contracted for - a 30% gain in hospital access and improved quality for the same price. It got much more than this. If there is a great deal of pent-up demand from a population for quality health care, and the only place to obtain this health care is the PPIP system, then demand will far exceed the predictions of the best economists and public health experts. Costs will also increase because of new services - such as the first national Neonatal Intensive Care Unit- so that more babies will live rather than die. Costs due to increased demand from patients on the Queen Mamahato hospital, can be relieved by upgrading the quality of district hospitals and outlying facilities so that patients would not choose to seek care at the national referral center for services that could more appropriately be provided at a lower level. It is unreasonable to expect that a single PPIP project can solve all the problems of a nation's health care system. Lesotho's PPIP has improved efficiency, access and quality for the people of the country. Neelam Feacham and Jane Thomason

Thanks for your comment Sean, I'm glad you found the post interesting. It's a shame to hear that MHM still gets brushed aside in conversations about WASH -- even something as simple as having closed bins in girls' toilets or access to an incinerator, or even just running water and soap in a private place for girls to wash reusable sanitary products, could be a big help. A lot of the interventions don't need to be major, they just require people to remember that this is an issue for girls and women when designing WASH projects, to consider how to most appropriately meet this need in the relevant context, and to be willing to actually talk about it within organisations and with the wider community. It's strange that women are just expected to cope with MHM when really people have been 'coping' with open defecation for a long time too. WASH projects work hard to move beyond 'coping' on this and to improve hygienic practices to reduce disease/infection etc, so why not on MHM?

"Its geographic priority will be the Indo-Pacific region, especially the South Pacific and South East Asia." The term Indo-Pacific leaves Africa (and South Asia) still in the mix much the way they are now; but not sure about the Middle East.