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September 22, 2010

Sturchio: 'The focus should be on outcomes'

   Dr. Jeffrey L. Sturchio


Part eight of the 8-part series In the Driver’s Seat: A Series on Country Ownership of Health Programs. Dr. Jeffrey L. Sturchio is president and CEO of the Global Health Council. He also is a member of the Modernizing Foreign Assistance Network, which aims to modernize the system for prioritizing and managing U.S. global development efforts. 

Q: Why is country ownership important?

A: If you just look at the tradition of foreign assistance, billions of dollars have gone into this system the last 50 years, but countries haven’t been fully developed. The way things were being done just wasn’t working. Now, there’s an effort by donors and those in developing countries to figure out how to do development work much better.

Q: So what needs to happen?

A: The most important thing is to listen to the experts and officials in the countries that donor agencies are trying to help. It’s obvious that donors can’t fix the problem in these countries on their own. That notion that foreign assistance has to support the long-term economic and social development efforts of those countries was enshrined in the 1961 Foreign Assistance Act (which led to the creation of the U.S. Agency for International Development). In the years since, we seem to have ignored that element in the act itself of building up a country’s development efforts. There’s not enough building capacity.  I also see more attention now on how much aid is given. That somehow has to be replaced with an emphasis on outcomes. How the aid is delivered is more important than how much aid is given.

Q: What about concerns regarding corruption if countries control more of the funds?

A: Fundamentally, one has to keep one’s eyes open, but you shouldn’t throw the baby out with the bath water. You must address the issues of corruption where it arises. I think it comes back to the points of accountability and performance. If there are clear strategies in what the country is trying to achieve, you have to measure if they are achieving those goals. If not, find out why. The focus should be on outcomes, really monitoring how money is being put to use, and what impact it is having. That strategy is an antidote to corruption.

Q: What to you see as the next steps for developing countries?

A: What many are doing now – Rwanda, Uganda, and Botswana are among the leaders in this area – is to have clearly developed strategic plans, plans that have been adopted by the politicians and officials. Then they can hold donors' feet to the fire: If you support us, this is what you need to do. They should embrace efforts for monitoring and evaluation, and demonstrate to donors they are moving in the right direction. Also, they should insist on donors only giving them aid … in areas that help them improve capacity to do things on their own. They have to be in the driver’s seat.

In Botswana, what they did with their HIV/AIDS program was to fully implement the "Three Ones" – one national framework, one coordinating body, one plan for monitoring and evaluation. They clearly outlined the roles development partners were supposed to be playing. There was a forum where they regularly compared notes. That is the way country ownership should work. Every one knows their role, the process is transparent, and there’s a clear emphasis on outcomes.

Q: How does this process affect reaching the MDG goals?

A: It’s fundamental. One of the problems we’ve seen with foreign assistance in the last 50 years is that aid money flows in and tends to substitute money already there, instead of complementing existing efforts. And there are lots of examples in which when the money leaves, the efforts wither. So country ownership of programs is critical. You need to focus on what people themselves feel is the important issue. If you have a strategy focused on what people in the country feel is how they can find their way out of poverty, if that’s in place, it’s going to help achieve MDGs in a much more powerful way than the old way of development assistance.

In the Driver’s Seat: A Series on Country Ownership of Health Programs

Part 1: WHO's Chan: 'Some countries are angry'

Part 2: Shah: 'We want real outcomes in health'

Part 3: Ethiopia’s Tedros: No ownership, no scale

Part 4: Wisman: Donors need to `take a little risk’

Part 5: Omaswa from Uganda: `Donors want a controlling say’

Part 6: From Nepal: `We build step by step’

Part 7: From Mali: `We have a lot of control now’