Local Leaders: The GHI’s Focus on Country Ownership and Civil Society

A Guest Post by the International Women’s Health Coalition

In tough economic times, it’s more crucial than ever that U.S. foreign assistance investments garner significant returns. This truth is clearly in the minds of President Obama and Congress, as evidenced by the Global Health Initiative and the draft rewrite of the U.S. foreign assistance act’s focus on country ownership and involvement of civil society. These are proven strategies that have the potential to decrease global dependency on foreign assistance while achieving better, more equitable health outcomes and greater empowerment of people everywhere.

In early August, President Obama presented the Global Health Initiative to a group of young African leaders, affirming that “one of the things we’re trying to do is to build greater public health infrastructure, find what prevention programs are working, how we can institutionalize them, [and] make them culturally specific—because not every program is going to be appropriate for every country.” The move away from cookie-cutter programming is refreshing to organizations like the International Women’s Health Coalition (IWHC) that have been seeking the programmatic expertise of local grassroots partners for decades, and that know this strategy leads to the greatest results.

When resources are scarce, hard decisions must be made about which services and programs to prioritize. Engaging civil society can create a political base for the most strategic choices, and, on that basis, effective outcomes. Community-based civil society participation also helps us understand the adaptations to “best practices” needed to make them effective in a specific community, or, if necessary, can lead us to entirely different practices that will be most effective.

Cultivating country ownership over important issues, such as the health and rights of citizens, will lead to stronger governance and in time, more independent and prosperous countries. Done correctly, it will also create more accountability and may eventually minimize the need for foreign assistance. In the 1990s, we saw a country-owned health plan with heavy civil society involvement in action—and the results were overwhelming. When Bangladesh adopted its first Health and Population Sector Program (HPSP), the government conducted nationwide consultations among 34 civil society groups in five districts, enabling the voices of thousands of men and women, including the poor and those in rural areas, to be heard in the decision making and planning processes. Within five years of the HPSP’s initiation, the percentage of women receiving check-ups and care prior to childbirth doubled from 26 percent to 56 percent. Use of emergency obstetric care rose by nearly 25 percent. Female life expectancy increased by two years, and maternal mortality dropped by 26 percent.

By engaging with rural and impoverished women in the process, the right investments were made. Having policies informed by women, young people, and other specific communities that will receive these services will save the maximum amount of lives and ensure the most effective use of limited resources.

Yes, building the capacity of local governments and investing in the growth of emerging leaders through the Global Health Initiative and other U.S. foreign assistance efforts will require time and resources. In addition, engaging civil society requires knowledge of key civil society actors located outside of country capitals, and the space, time, and resources needed to ensure meaningful participation and input by these stakeholders.

Meaningful civil society engagement, coupled with significant government investments, will lead to the creation and maintenance of the infrastructure and resources needed to respond to the needs of citizens. Truly, this foreign assistance philosophy will reduce the need for foreign assistance and lead to a more peaceful and prosperous world for all, including the American people.

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