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Have confidence in NRI taking the lead as our premier think with better grants from governments.

Have faith in NRI being our premier think tank with enough funding from the government.

I find the entire debate on development aid revolving and fascinating having worked in the sector for over 20 years. The following are general views targeting most donor agencies and INGOs and my intention is to provoke a practical discussion: 1. While aid is a good tool to facilitate development in many different ways, I often get the impression that at times donor agencies are taking away the role of the government and it could be that national budgets for certain sectors such as health, clean running water and health seem to be shrinking. I do think donors should ask the governments, or implementers to co-fund significantly as a way of demonstrating commitment and sustainability (this can be reviewed by countries instead of one foot fits all) There seems to be limited discussion on sustainability or transition plans in some of the projects/programs. Are donors doing less or more harm? Other countries have a lot of resources but they still continue to receive funding. Will they not then abuse their own revenue as they rely on spending donor funds? Please mobilize support to bring the discussion on sustainability back on the national and international agendas. 2. Let’s all pause and ask ourselves how we can increase impact by reducing duplication and enhancing transparent coordination and collaboration, the two fundamental concepts that can potentially result in significant savings. Implementers, donors and INGOs have to start talking to each other more often and honestly (to avoid recycling funds) and a proper mapping exercise needs to be presented systematical and not for the sake of meeting a proposal condition before funding is approved. My suggestion is that funding models need to be adjusted to appropriately align to the current context. Twenty years ago and many years beyond, and taking into account many variables including lack of systems then, the fact is that funding was less but the impact/results was greater, for example look at what the missionaries and volunteers did, they built some of the durable hospitals and schools we see today and provided basic furniture therein, trained medical personnel, sent many people to school nationally and abroad, but with way less money that we see being channeled to other countries by donors (examples on the work of missionaries can be found in some of the countries in Africa and I have taken these to be good lessons). While some impact is seen in other countries, it is also important to establish, where is the money going- is the current level of funding sustainable and for how long- could this money be used to develop sustainable and revenue generating infrastructures such as the HIVAIDS levy in Zimbabwe-with improvements it’s a good starring example despite all these challenges? What can we learn from the past regarding value for money and empowering governments and communities-? Yes, the costs may have gone up over the years, but we can also consider going back to simplicity and innovative ways that result in long term sustainability? 3. Please exploit the development of practical, simple and easy to monitor systems that can also make implementers accountable, for example how much money actually reaches the person who is being provided with ARVS or an orphan who is being sent to school. This unit cost can also help governments to budget with sustainability in mind and for a better future. 4. Please exploit how the multi nationals and private sector can also contribute towards the development sector.

Thank you Saraswati. It's very interesting to hear your perspective. I definitely agree with your final point: even if we don't ultimately conclude that aid workers should be paid less, aid agencies do definitely need to be at the very least thinking about and discussing this issue in an ongoing way.

Thank you for raising interesting topic. In fact, third world country people often raise question, why is development aid make smaller impact on people living in measurable condition but has greater economic and social impact on aid worker. There is always an argument that aid worker have short term job and needs to pay higher salary to get best out of it. A simple aid worker who has earned bit and pieces to live suddenly starts thinking about safety while traveling in country and needs a star hotel to accommodate, mineral water instead of spring water, feels uncomfortable walking along path where slum leave and covers nose while they see men and women in smelly dirty cloth. If people do not have commitment to work with these group why do people become an aid worker? just to live a comfortable life with little or no commitment to make people's life different. However, when it comes to distributing benefits to community people there are policies and argument made for how do we effectively reach them and distribute fund, why is there less debate on how much fund on aid should go to management and aid worker. Despite aid agency having agenda on management fees and structure, indirectly huge amount of aid is transferred to the country of origin. There is always a suspicion and an argument that why are there less factories and economic activities going on to raise and elevate poverty in a very rural area to uplift the economic status of poor and marginalized people? employment is determining factor for exposure and change people's life, though in some cases it might not be true but in larger picture it is in fact a powerful factor for change. I do not just argue that aid worker should be paid less but my argument is that how much and to what extent should the aid worker be paid should be discussed by aid agency.

I think we create a problem in this discussion with the use of the word 'aid' which has a defined meaning in the DAC/OECD context and in the public mind. Rather, the word investment might be better - we invest in disease control, climate change mitigation and other examples that Stephen gives primarily for good self-interested and not humanitarian reasons. Australia invests in tfe Northern Territory in Biosecurity management to prevent the entry of damaging invasive species for Australian public good reasons It helps the NT but we would hardly call it aid. Our private sector invest in mining in Africa that will generate private returns but will deliver substantial economic and social benefits to the countries concerned. Would we define this investment as aid if done by a government agency? I think an interesting discussion emerges from the transition of countries out of aid. We lost a big opportunity when Korea almost overnight fell out of the aid category and an extensive set of cooperative partnerships built up in aid arrangements were lost through the absence of sustainable partnerships because we had no successor arrangements in place.

Hi Robert, Thanks for the comment. We all agree that economic growth and policy reform is key to development. I do have to take issue however with your characterisation of both Sachs and Easterly's perspective. It is a real misrepresentation of the views of both men. First of all, there is not much value dredging up and getting into this tired Sachs-Easterly debate. Fact is, the soundbites that both men use to promote their ideas aside, they probably agree on more than either would care to admit. To characterise Sachs as all about charity and as ignoring policy reform and economic growth is just wrong - based both on his writings and action. And to say that Easterly has been a strong proponent of "systemic policy reform" is a very kind representation of what he has done in his career. Of course policy reform is needed: at the local level, at the national level and at the international level. The issue is which reforms and how to galvanise action on those reforms. Some would argue that to get international action (for example on reducing agricultural subsidies or trade reform), you need big goals and commitments to get some movement. Others emphasise community leadership to reduce barriers to getting programs going. I don't know if the SDGs are needed or will work. I do know that the MDGs - while imperfect - have had real impact and galvanised more action on child health, agricultural reform, HIV treatment, on primary education and - yes - on getting money flowing to support these programs. And, as an example, after just under a decade where the HIV response was funded by donors, now, for the first time, over 50% of the funds being spent on HIV (treatment and prevention) in developing countries is coming from developing country governments themselves. The development arena is complex and we have to examine these issues with the nuance and care befitting such complexity. Reducing perspectives on aid to two diametrically opposed simplistic strawmen doesn't help further the debate.

Ben, Thanks very much for this positive response, and the additional information you provide. In the interests of accuracy, I would note that the authors don't talk of "evidence" that the new programs will lead to XDR-TB, but rather point to "threats" that, if not dealt with, might lead to this unfortunate outcome. That's a very different claim, and not one I think you'd disagree with.

Hi Robert, That's a very good argument. But the comparison to the US doesn't really work (why don't we give aid to the US). Doesn't work because, as Stephen noted in his post, most of the most acute poverty in most developing countries is an order of magnitude more severe than poverty in the US. cheers Terence

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.