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TB in PNG and Western Province is one of AusAID’s highest priorities and we welcome the debate on cross-border TB control. There has been real progress and commitment from PNG. With AusAID support, PNG TB experts such as Dr. Rendi Moke and his team have shown real leadership and drive. They are making a real difference in Western Province. (See http://www.ausaid.gov.au/HotTopics/Pages/Display.aspx?QID=677) AusAID is committed to long term support (10+ years) for TB services in Western Province, including broader support to Western Province’s health system. Our approach is in line with the World Health Organization (WHO) best practice guidelines for TB and addresses many of the issues raised by the authors. These include: the need for long term support to the PNG health system; ensuring access to primary health and appropriate hospital TB services; a strong focus on community engagement in controlling TB; and independent monitoring and evaluation. We have an initial $8.5 million program over four years to support the PNG Government to strengthen control of TB in Western Province and it will continue for as long as necessary. We also support Western Province primary and secondary health care services, essential for TB control, though improving the supply of essential drugs, training health workers and health infrastructure. This includes South Fly communities. We also provide core funding to the Global Fund for AIDs, TB and Malaria (GFATM) for PNG’s national TB program (total program US19 million) and core support to WHO - the global technical lead on TB and other communicable diseases. Our total package of support to PNG health priorities (including HIV) in 2011/12 was $113 million. Other Australian government agencies are responsible for health and TB services within Australia. AusAID’s mandate is to work within PNG borders. We are working to support cross border coordination, oversight and accountability through the Torres Strait Health Issues Committee (HIC). The blog authors note the risks of incomplete TB treatment within Australia, an issue <a href="http://www.abc.net.au/news/2011-11-26/who-warns-of-untreatable-tuberculosis/3696226" rel="nofollow">raised</a> by an independent WHO expert assessment in October 2011. WHO plans to undertake a substantive epidemiological risk assessment in September 2012 which will include a specific focus on drug resistant TB cases. AusAID support to the PNG South Fly TB program is based on <a href="http://www.who.int/tb/strategy/en/" rel="nofollow">established</a> WHO global standards for an effective TB and MDR-TB response. Our support seeks to ensure continuity of care through a strong community based response and appropriate hospital care. This approach, backed by WHO, is proven to work internationally and to have an impact. There is no evidence that “…the net outcome of these programs will be rapid emergence of XDR-TB.” There has been real progress and commitment from PNG. AusAID will continue to work closely with the PNG government, WHO and other Australian partners to monitor progress of our support and adjust accordingly. WHO will be undertaking an independent review of the progress of the strengthening of the TB services in the South Fly in November 2012.

Thanks Geoff, that's a very useful clarification. Economist, Lant Pritchett, has coined a handy phrase 'flailing state' to describe states where administrative capability is lagging. Announcing increases in funding and policy intent is the relatively easy party, implementing it through a labyrinth of legislation and layers of government is another.. These are the kind of issues that the public need to pay close attention to, supported by good policy analysis and monitoring. You may be interested in a research project that Devpolicy is doing with NRI. We are planning to conduct public expenditure tracking surveys in the health and education sectors--similar to those that the World Bank did in 2002. Potentially this research will highlight how much funding actually reaches to services at the end of the track, and what happens to fees and the quality of services. Devpolicy/NRI are just getting started and plan to conduct the surveys later this year. Thanks again for your comment. Perhaps we can tempt you to write a post for the Devpolicy blog..

For clarificaiton, the Government of PNG has not abolished fees for health care. The Public Hospital (Charges) Act 1972 and associated regulations which set charges for public hospitals and clinics is very much in force. As the National Government only has jurisdiction over national health with provincial governments having jurisdiction over rural health services (the bulk of the health system) they are not in a position to abolish fees for rural health even if the had the desire.

Robin, That's an excellent set of comments. And I must concede I have contradicted myself by asking what sort of aid might go to, say, Indonesia after it has graduated. What I should have written is what sort of aid we might give to Indonesia after it has graduated from a conventional aid program. The future of aid is very uncertain. Countries such as Thailand and Malaysia have been pretty much graduated. Will aid fade away all together from Asia if and when countries such as Indonesia graduate? I both hope not and doubt it. But it will be difficult. As you say, at the moment aid is such a useful tool for international action "because the funding pool is there [and], because it can be used for almost anything" Things will be more difficult if we lose that flexible funding pool. Still, my sense is that the need for funding around issues of common interest will remain strong, and that as a result somehow a way will be found through. I think you agree. What about the multilateral dimension? I agree with you that we will still need multilateral approaches. But these might fall short of binding treatries. Rather they might provide frameworks for bilataral and regional deals (as we are seeing in climate change). And for regional public goods we will continue to see purely bilateral and regional approaches.

Bob, Every country has the capacity to do more to reduce poverty. Because others should do more does nothing to reduce our own obligation. It seems odd to me to say "I'm not going to help you because someone else could or should." Isn't that called washing your hands? You might want to move away from questions such as how much aid we should give to Asia, but, as you concede, it is not a question the government can avoid. And there are several who think we should give less aid. It's a valid and important subject to engage in. We spend a lot of time arguing about specific aid themes and projects, but it is useful sometimes to step back and address the bigger questions, however difficult they are and however imperfect our answers.

To be able to help people in need is nothing wrong. Actually, it is part of our human natures However, when it comes to politics, it is a different story. Unlike churches, politics something puts its selfish thoughts above the justified folks need.

Thank you Michelle very informative,like Vanessa I must admit I am bit weary about reading blogs,tweets, facebook posts under pseudonyms, but I find Tavurvur's information through his tweets and blogs are informative. Looking forward to reading more.

Thank you for this illuminating discussion, Stephen. I suggest that we might look at the case for aid in different ways. The arguments to assist the poor are compelling but not sufficient. If poverty reduction is a major impetus for aid then we can ask why we aren't continuing to support the poor in Thailand or Singapore or, for that matter, the poor in the US? One answer is that these nations seem have the capacity to address poverty themselves. The question can also be asked in the case of Indonesia. Here there are large numbers of poor but also a large and growing affluent class of people. In your first blog you noted the success of Australian aid in tax reform that "... resulted in huge increases of revenue to the Indonesian government, much larger than our aid, collected in a relatively clean, non-corrupt way." Given the large population in Indonesia and presumably a very large number of people with incomes comparable to those in Australia, it seems reasonable to ask if this group is paying its share through taxation for poverty reduction and other public goods? Is it possible that this affluent group is numerically larger than the comparable group in Australia? Are they sharing an equitable responsibility for the financing of the development of their own country? The second way in which we need to look at aid is with a sharper focus. I think it is time to move away from big, complex questions such as ‘should we be giving aid to Asia’ towards more manageable and focused questions such as ‘should we be giving aid to Cambodia for education or to PNG for health’? This avoids mixing very different aid needs in the huge and diverse Asian continent. It may be more useful to focus more on the need for aid in identified areas such your excellent example of Indonesian taxation, or education, health, or security, and so on. Policy makers do have to deal with the bigger questions of the overall aid program. What I am suggesting is a bottom-up approach that aggregates more specific need in context, the evidence for supporting these needs and lessons learned about meeting such needs in those contexts. These are not arguments against aid, but arguments for aid where it is demonstrably needed, where it can be most effective, and where responsibilities for funding it are shared fairly.

Stephen, I have found your three posts on the case for aid to Asia admirably clear and comprehensive. It seems to me that this second post, which enters into the increasingly busy debate about the role of development agencies in supplying international public goods, is quite different in character from the other two. I offer the following three comments on it. First, this post is presented as complementing the humanitarian case, or in fact largely superseding that case within two decades. However, I’m inclined to think that it’s not in the same line of business – that it makes a case for something that is not aid as we know it. This point almost makes itself in the post when you say that “sooner or later successful economies are graduated from aid” but then ask “is there a longer-term case for aid, one that survives the prospect of graduation?” The subsequent argument, therefore, might be better described as an argument for continuing international public financial transfers in a post-aid world (leaving aside, for now, the fact that there will always be a residual group of stubbornly unsuccessful economies) rather than an argument for aid. If we do speak of such transfers as aid, we’re using the term in a new sense. Second, the post argues that, even as Asian countries get wealthier and traditional aid is no longer warranted, countries substantially wealthier than they are should still bear a greater share of the burden of supplying international public goods. Why, exactly? If the substantially wealthier countries are, in this scenario, no longer obliged to help Asian countries achieve their domestic policy goals, why would they still obliged to help Asian countries meet their share (however measured) of the costs of supplying global or regional public goods? If the economic differential creates a moral obligation to help in this way, then one might wonder why that obligation would not extend to helping them provide ever better social security systems, safer roads, etc. Presumably the argument is not based on the moral obligation owed by the richer to the poorer, but rather on the principle of fairness in international burden sharing. That principle seems clear enough in general terms, namely that the contribution of each country should be based on the expected benefits to it of the action financed, adjusted to take account of its current capacity to pay (and perhaps also its historical responsibility for whatever international public bad might be at issue). This is where your reference to the requirement of progressivity seems relevant – the richer should be required to contribute more than is required to secure their share of the benefits, and the poorer less, with this surplus/deficit effectively defined as aid. While there’s nothing problematic about the above proposition, it only makes sense if there exist multilaterally or regionally agreed policy goals, financing targets and associated burden-sharing frameworks. However, the post proceeds on the assumption that aid, in this sense just defined, is an alternative to, rather than an ingredient of, multilateral agreement-making. You say, “International binding agreements seem to be a thing of the past. But money talks. Aid talks.” And third, a case for international public financial transfers based on equitable burden sharing in pursuit of international public goods is probably never going to be a strong case for bilateral transfers. Given the need for coordinated action across all countries with a stake in the outcome, it will generally make sense for the bulk of the resources to be concentrated in multilateral funds and institutions, who then finance action where it is most needed in an integrated way. Certainly some bilateral technical assistance will continue to be useful, but this won’t be costly and won’t really be distinguishable from technical cooperation between developed economies. Currently aid is a useful tool for international action because the funding pool is there, because it can be used for almost anything and because its use in support of international public goods is not particularly prominent. However, the presence of the funding pool is dependent on the humanitarian case. In a scenario where that case no longer applies, or only applies to a residual group of countries, the pool will shrink. Contributions toward the cost of supplying international public goods will have to be extracted painfully from consolidated revenue on a case-by-case basis, with lengthy battles about what benefits we can expect from the action financed, what is our relative capacity to pay, and what is the cheapest and most effective way of achieving the relevant goals. I don’t think there’s any escaping the pain of multilateral negotiation – which is not meant to imply any optimism about it! (A converse point here is that one might expect the humanitarian case for aid to be heavily stressed by those wanting to defer the pain for as long as possible, including finance ministries.)

That the new caps on the Seasonal Workers Scheme are so low is an absolute scandal!! If Australia is taking 37,000 or so backpackers a year to work in agriculture (most of whom are already wealthy and/or on a holiday) surely the intake from the Pacific should be higher than 2,600 a year? Underemployment in the region is such a big issue, and 2,600 people a year (for a few months at a time) is barely going to make a dent for that issue...

Signs of Change and Progress Papua New Guinea has changed, for the mere fact that PNG can put three women into the traditionally male dominated Parliament. These three women hails from the predominantly patrilineal societies (Highlands, Momase and Southern), which were the least expected regions to have women representatives in Parliament. Alas the rural electorates and provincial seats. This is CHANGE we can believe in. We've proven ourselves to the international community that Papua New Guinea can change and have changed. The first two National Directive Principles enshrined in our constitution are Integral Development and Equal Participation. That was established since 1975 before the UN created their Millennium Development Goal (MDG) that identified gender equality as a development goal. PNG recognized gender as a development issue decades ago before the international community (UN). Again, Human Capital Development, Gender, Youth and People empowerment is the first strategic development focus areas of our Vision 2050. We know where we are and where we are going. We cannot be forced or lured by some external forces to adapt their standards and values. We have our own standards and values which for centuries have bonded tribes, clans and families together. We know our development needs and goals. However how we accomplish these development goals and needs may not be consistent with the international rules and appeasing to their referees. But we know we will get there one day. We are actually "crossing the river by stepping on the stone," a famous Chinese parable. That means to take one step at a time. Another interesting point to note is that the newly established political party "Triumph Heritage and Empowerment" (THE) Party, impressively has two of its female candidates voted as MP. THE party's political platform amplified the values of equality and empowerment of individuals including gender which are also reflected in our National Directive Principles and Vision 2050. Hence Papua New Guineans may be graduating from tribal politics to party politics. People no longer voted for ethnic pride but for values and principles. This is CHANGE we can believe in.

Whether an MDG or now a SDG, what use are Goals without an agreed means to achieving them; that is, a framework for growth and development? As always Sachs sidesteps the means to development and all the inconvenient arguments over the respective roles of capital, human capital, technology, the environment for investment ... institutions, policies, and good governance. By strong implication Sachs' only means to his Goals is to spend more and more money and that has rarely worked since the Marshall Plan.