Making development work: Local ownership for stronger systems

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Jonathan D. Quick, MD, MPH

President and Chief Executive Officer

Management Sciences for Health

Development resources, strategically invested and wisely managed, can build local systems that have a large scale, lasting impact:  In Haiti, a four-way partnership between the Ministry of Public Health and Population, local NGOs, USAID and an international NGO (in this case, MSH) was providing access to healthcare pre-earthquake for 4 million Haitians (43% of the population). In Afghanistan, a similar collaboration saw child mortality fall by 25%, saving an estimated 25,000 children’s lives each year. In Afghanistan it was assumed that local leaders would reject family planning. But when listened to and respectfully informed, they embraced it. Under their leadership, contraceptive use increased by 24-27 percentage points in rural Afghan villages.

We are excited by the conversations taking place across the U.S. Government about development. These conversations matter:  to our citizens at home and to millions of people around the world. MSH welcomes this concerted effort by the Obama administration, not just to develop a whole-of-government approach to development, but to lay out principles for development that works.

What constitutes development that works?   Effective development helps people help themselves out of poverty, improves their lives and their well-being – now and into the future. This may seem obvious, but this human goal needs to be held up as an important end in itself. We urge the Obama administration to make development a distinct priority along with diplomacy and defense.

Perspectives differ on what makes development work. One fundamental debate is over who “owns” or should own development.  Some say, “Foreign governments and multilateral agencies provide generous resources, but too often push policies and programs that don’t fit local priorities and needs.” Others say, “International NGOs are effective and transparent, but they’re uncoordinated, expensive, and introduce unsustainable solutions.” And some believe “Local ownership can create sustainable local solutions, but local governments and organizations are ineffective and corrupt.” There are kernels of truth in each of these views but the real issues of development lie in the complex space between these extremes. Striking the right balance is the key.

For nearly 40 years, in over 120 countries, MSH has observed common elements in development that works. First, local ownership must exist at the outset. It can’t be grafted in after the fact. Partnerships need to be genuine, based on mutual respect. Second, developing local leadership and technical skills is fundamental to lasting success.   Projects may come and go, but the tens, hundreds, or thousands of local colleagues who have developed needed experience and skills remain as national resources.

We’ve incorporated these two lessons into a two-pronged approach to building sustainable health systems. We work with governments to build their leadership and governance capacity, and we simultaneously collaborate with government and civil society to build their capacity to deliver health services. We follow Lao Tzu’s ancient “Way of Leadership”:  “Go to the people…Start with what they know… Build on what they have… and when the task is accomplished… the people will remark… We have done it ourselves.”

Our experiences in Haiti and Afghanistan and elsewhere have proven that it is possible to build on the strengths of local and international communities and mitigate their weaknesses. It is possible to create synergies between local insight and global expertise.  Our success in Haiti and Afghanistan was built on respectful, authentic, dynamic collaboration. It was built on local ownership and international partnership. It was built on the principle of investing in people. And it was built with a focus on creating systems that would last well after the project was gone.

These concepts are, from a practitioner’s point of view, the highlights of the NSC’s draft recommendations to the President: First, let’s keep the JDQ Informal HeadShoulders 2004focus on the goal of development, helping people to help themselves out of poverty and to improve their own lives. Second, rather than getting caught up in extreme arguments, let’s build on what we’ve already learned about the contributions that different development partners offer. Finally, we want to see a direct voice for development community on the NSC to speak  out for this priority, to bring an evidence-based approach to development, and to draw on the expertise of the development community.

We are excited by the ambitious effort by the Obama administration to craft a common vision for the U.S. role in global development. We’re encouraged that local ownership and a systems focus are emphasized in the recommendations.

We look forward to gaining more insight into how the Obama administration plans to leverage the work of USAID and the State Department so they mutually inform and support one another. And we stand ready to support, advise, and partner with the U.S. government to advance effective development around the world.

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