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The increases in access and quality are much greater as a percentage, than the cost increase. There are many ways to look at the costs- for example, including capital expenditures, which would have occurred in any case because the hospital needed to be replaced, or looking only at increases in operating expenditures. The full report from Boston University is available on http://www.linkedin.com under Neelam Sekhri Feachem. Endline Report Lesotho final report. If you can not get it from there, please let me know and I will find another way to provide access to the report since it has not been posted yet on BU's or World Bank sites.

Thanks Jane. Very interested to read the report - but the link just goes to a general project page. Do you know the direct link?

Has AusAID fulfilled its objective since establishment? For an Australian who has never been to a recipient country, the answer is certainly yes. For the recipient country? No, or maybe it did. Here is the reason. All AusAID projects are managed by Australian companies and their partners, hence a good portion of the funding goes to remuneration and profits. The best metaphor is a boomerang. The recipient country is left with an asset that it cannot maintain and the asset falls apart, whether it be a tool or infrastructure. Lots of the projects/programs are driven by politics, onshore and offshore, and in many cases AusAID uses the model that has worked in Australia and applies it to the developing nation. Some do not have the essential components or budget to maintain or continue the initiative by AusAID. Tony Abbott knows something and he has the prerogative to review the function of AusAID. Rename the agency for a good start and so make AusAID history, and restructure it under the umbrella of DFAT. Solution: identify the problem and design a sustainable project/program with the locals (not in Australia) and let them be the owners and drive it. It may take years. Start with education.

Hi Rob, the link to the evaluation report is <a href="http://www.bu.edu/cghd/our-work/projects/evaluation-of-the-queen-mamohato-memorial-hospital-public-private-partnership-ppp-in-lesotho/" rel="nofollow">available here</a>, so you can access the information on costs and the full report.

Hi Nik, Thanks for your comment. I agree that reframing masculinities in a way that doesn't come off as 'man bashing' is very important... and an extremely difficult thing to achieve. The report gave some examples of how this could be done -- for example, through the promotion of ideas of positive fatherhood, men in caring roles, the use of positive male role models. One of the things that struck me from this report was the early age that men and boys started to perpetrate rape. So perhaps there is potential in trying to promote different notions of masculinity in early childhood education and primary school and to start to change some gender stereotypes through that (once again though, difficult to do in developing countries with education systems that are often struggling to teach the basics--and this kind of approach would also need community buy-in). Improved sexual and reproductive health education could also be one way to deliver more accurate information about sex and respectful relationships, and to address socially ingrained ideas of male sexual entitlement. You are right that there is likely a strong historical element to this, and the 'tough guy' ideal is very much perpetuated in a lot of pop culture and through media (new, social and old)--as are sexualised images of girls and women. So it's hard to counter these loud, flashy messages. Educating those who create media and bringing them on board as partners (or even introducing standards or codes) could be another option. I think it's a difficult and slow process that requires innovation and a variety of approaches--and it needs to be done hand in hand with other interventions, such as ending cultures of impunity around violence against women and providing women and men with appropriate health services and information. And it's something that definitely needs to be done with men as partners in the process.

Eve teasing to physical torture are all about a sense of ability to overpower the weaker who are taken for granted. Overpowering can be in many forms and can have varied reasons some of which even may not be directly linked to the victim. Reasons are going to stay for a long time and can be smoothed only with decades of corrective efforts. The biggest challenge is how to combat overpowering so that one dare not bring the intention in mind? Already many countries have taken steps through implementation of toll free rescue numbers, stringent punishments if one proved guilty but these steps may not stop one from immediate reaction to overpower the weaker. By the time actions initiate, the weaker might already been overpowered. Definitely then something weaker has to only do. Weaker has to devise new ways to secure, quick ways to inform so that threats can be controlled if not omitted. With this, weaker may not then any more be considered as weaker and taken for granted stamp will slowly disappear. As a society then we have to cull out innovative practices to support the currently weaker section of mankind and help them devising ways of their own to face the every day challenges. It has to be more of pulling exercise that need to be brought in rather than pushing of laws, policing and other stuff.

Robin, The logic of what has happened makes little sense. If we start with the preface that FA and aid are integrated (it is a fact and in that regard I agree with you - not an ideal world but that is the reality and we need to deal with it). Then as you say Aid is an essential part of the diplomatic tool kit. In the modern world AusAID is competing with new and relatively well funded development partners in the sphere for global influence. Therefore, announcing a massive cut and re-organisation is EXACTLY the wrong thing to do. It sends the message to partners that Australia has no long terms plans, it has little money and therefore you are better off looking elsewhere. Before folk argue otherwise - I know the cut is actually to growth but the way this has been communicated with the "freezing" of programs across the region is a bit of PR disaster. It would have been better to call it a focused re-prioritization whereby key areas (I guess in the Pacific and Asia) would be given greater emphasis over others. Diplomatically that would have been better. Alas the first move by FA has shown exactly why many feared the move would be a retrograde step - it has actually been a diplomatic and communication faux pas no matter which side of the debate one stands. I expect the next announcements to be somewhat more positive in tone - but let's see !

I would not use the word "dependency". If there was no aid it could be argued that there would be a corresponding decrease in the balance of trade. It is usually the hordes of foreign advisers who cause a large part of the trade imbalance. Nevertheless, your key point is correct. With the advent of "new development partners" especially from the asian sub continent there is more aid on offer now than ever before. So this means that the new challenge is not about the size of aid per se but how strategically it is used. That may be why FA wants to be closer to AusAID.

Ashlee, Amazing! Well done to highlight this - but - it would be good to hear your thoughts on how to address the need to re frame masculinity so that men don’t feel that violence equates to manliness. I think that is the key otherwise this comes across as men bashing - which it is not. Like you say there is an urgent need to work out why this happens. My own (totally non professional observation) was that the ability to be successfully violent was directly attributable to success / wealth and therefore manliness. Breaking that cycle will not be easy.

Biman & Nilesh, I could not agree more. Several years ago several of us (including Prof Prassad here) argued that Fiji's economy was not as fragile as some in the international community had hoped for / wished. The belief that the Fiji economy would imminently collapse (thereby taking the regime with it) was a bizarre hope / brief that it was almost impossible to argue against in the capitals of Canberra and Wellington even if you had facts on your side. Similarly, the Fijian economy is not as secure as some would believe now either. Your paper and blog correctly highlight several vulnerabilities. In addition is the lack of foreign capital. The challenge with asian investment seems to be that the cash somehow never ends up in your country - a phenomenon seen in many Pacific Islands. So as a result the NFA and therefore exchange rates can be vulnerable. It is true that many are simply waiting the election and foreign largess that may come with re-integrating into the international community - but it must always be borne in mind that Fiji is a very open economy. If Asia and Australasia slow down at the same time the structural faults highlighted by the authors could cause significant financial and economic problems. You chaps are right - there is a need to keep a close eye on poverty (and I would suggest inflation) as they may give a better picture of what is happening on the ground.

Dear Professor, This is well articulated and covers every aspect of SDP and has brought a lot of insights to me personally as a PNGean! My understanding of the country is that there is a huge mismatch of economic indicators and this issue just adds more icing to the cake!! Oh I was an IDEC student at Crawford. Thanks for the opportunity to study there. Cheers Helen

You have been very generous with statistics on increased utilisation but less so about the costs that have "increased". Please could you tell us by how much they have increased 10%? 100%, 1000% Is it true that costs have rocketed to the extent that the GoL even had to default on its payments last year?