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January 31, 2011

Analysis: Margaret Chan on country ownership

   Dr. Margaret Chan

What’s on the mind of the world’s top global health official?

Dr. Margaret Chan, Director-General of the World Health Organization, has set several priorities in her work. But it’s clear from a little-noticed speech earlier this month before the WHO Executive Board that one of her top goals is to speed up the transition to country ownership of health programs.

“Decades of experience tell us that health initiatives survive long enough to deliver sustainable results only when they are nationally owned and aligned with national priorities and capacities,” she told the board.

Dr. Chan said that donors should work with government rather than trying to set up parallel but duplicative structures for aid.

“Self-reliance is realized only when programs are delivered in ways that strengthen existing systems, infrastructures, and capacities,” she said.

Her push comes at a time when MLI’s countries and other developing nations have increasingly asked for additional help to support country priorities in health. But it also comes when several developing countries have built records of success when they lead initiatives and receive support from donors and partners.

One key example is in Sierra Leone, where the willpower of President Ernest Bai Koroma pushed through the implementation of free health care for pregnant and lactating women and children under five. President Koroma closely monitored progress as the Ministry of Health and Sanitation enacted the policy, which led to nearly four-fold increase in the use of life-saving malaria drugs among children under the age of five.

In Sierra Leone, despite some donors’ initial hesitancy, President Koroma pushed ahead with free health care because it was his top priority. Donors followed his lead. Partners such as DfID and MLI helped enact this vision, but the visionaries and overseers were Sierra Leone’s President and Ministry of Health team.

Dr. Tedros Adhanom Ghebreyesus, Ethiopia’s Federal Minister of Health, is well-known for insisting that donors follow his priorities rather than donors set the agenda. He explained in an interview with the Ethiopian Journal: “The particular needs and circumstances of individual countries will differ from country to country and it is the respective governments and people of those countries who are best-positioned to identify, prioritize and devise appropriate programmes to address them. This, in essence, is what country ownership is all about.”

Sometimes figuring out a government’s priorities can prove to be a challenge. And often adjusting to a new country-donor relationship won’t happen immediately.

As MLI Director Rosann Wisman put it, “Some of these countries aren’t used to partners asking what they want.” 

But, as Chan said to the WHO board, donors and developing countries need to build country-led health systems in order to make them last a long time.

It’s not a new concept, she said. “How far do the duties and responsibilities of WHO extend?” she asked. The answer was obvious: Only as far as member states want.