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January 17, 2012

Voices on Ownership: Administrator Rajiv Shah

 Administrator Shah Photo Credit Dominic Chavez

This is the first of a series of perspective pieces on country ownership from the “Advancing Country Ownership for Greater Results” roundtable organized last week by the Ministerial Leadership Initiative for Global Health (MLI), a program of Aspen Global Health and Development. This high-level dialogue included senior officials from developing countries, the US government, development partners and NGOs. These stories will run every day this week.

The first of four pieces covers the comments of USAID Administrator Rajiv Shah.

Rajiv Shah opened MLI’s meeting by saying that the US government was committed to country ownership, but that it needed to find ways to improve its support of country-led plans.

He cited several examples that showed how integral country leadership was in producing results. One was a 2011 Demographic and Health Survey in Ethiopia that showed a 30 percent reduction in under-5 mortality. He attributed that in large part to the leadership of Minister of Health Tedros Adhanom Ghebreyesus.

“What we don’t appreciate as much is the driving force for that result was Minister Tedros’ leadership and the Ethiopian political will to get that done by deploying 30,000 health extension workers, seizing upon what we call in our culture ‘low-hanging fruit’” and finding “opportunities to save children’s lives.”

Shah also mentioned a 50 percent reduction in child mortality in Bangladesh, pointing to the scale-up of getting vitamin A to children as one of the many factors in saving lives.  “This can only happen with country ownership, leadership, and commitment,” he said.

USAID, Shah said, would be releasing new information in the coming months about new modeling for measuring impact from various interventions. With these tools and with country ownership, he said, major successes can follow.

“We’re looking at the end of AIDS, looking at the end of child death from malaria, and more broadly we’re starting to see a vision – perhaps in 10 or 15 years – of eliminating completely preventable child deaths.” That would translate into saving 6 million children every year.

On the question of how donors could support country ownership when countries have imperfect systems, Shah acknowledged that this remained a large issue. He asked the group for help in thinking through this.

He said he would like guidance on the following issues:

-Ways to encourage countries to truly put forth their priorities instead of suggesting what they believe donors want. “We need to genuinely break that cycle and if we don’t, a lot of the talk on country ownership remains more rhetoric than reality. Ethiopia is a glaring counterpoint to that.”

-Whether building capacity in health ministries is a requirement in order for country systems to receive direct financing, or whether, “as we see in much of the private sector, capital investment is what creates that capacity. I would argue that if we looked over decades of aid, the theory that you invest in … parallel systems for the purpose of building capacity is largely a failure, while at the same time, the more loosely defined … traditional European model of budget support has not” built capacity.

-Whether the example of building up Afghanistan’s health system for nearly a decade is a model in other conflict countries. Shah seemed to think it was. “Overall, in nearly a decade, we have seen the single largest reductions in maternal mortality in the world, (as well as helping create) a transition of who is going to carry out the leadership from the international community to the Afghan Ministry of Health.”

Added Shah: “If you can do that in Afghanistan, and have the financial tools to protect resources, during a military conflict, we ought to be able to do it in other places and not be so squeamish in offering direct assistance.”

Other posts from Voices on Ownership

Minister Tedros Adhanom Ghebreyesus

Development leaders