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January 19, 2012

Voices on Ownership: Development leaders

 Mary Robinson Photo Credit Dominic Chavez

This is the third 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.

This third of four pieces covers the comments from several participants.

Mary Robinson, former president of Ireland and co-moderator of the session: “Country ownership is a profoundly human rights concept. The whole commitment to the human rights system for these five countries that signed up with MLI … was to progressively realize that the primary responsibility to provide health care is with governments. … In Sierra Leone, for instance, you see something enormously encouraging: President (Ernest Bai) Koroma’s initiative for free health care for pregnant women, breast-feeding mothers and children under five. We saw the untidy aftermath of that launch of free health care. Suddenly, there was a surge of women coming forward; we saw in a hospital in Freetown two women to a bed, but not a single health worker said to us, ‘This is a bad idea.’ They said they are exhausted, but they all know it has to happen. This all happened as a result of political will.”

Mark Dybul, former US global AIDS ambassador, and current co-director at Georgetown's O'Neill Institute for National and Global Health Law: “We all go to meetings where we talk about country ownership, creating progress, but fundamentally the existing structures of multilateral, bilateral organizations are not built to support country ownership. Until we step back and rapidly change that fact, we are going to be dancing around the issue for another 10 years. … In the United States, we still have junior Foreign Service officers lecturing Ministers of Health about how they should run their system. It’s a fact of how we are trained. The multilaterals are no better, often they are worse. Often, we have this patina of country ownership and say we believe, but we actually don’t and we don’t function that way.”

Pape Gaye, president and CEO of IntraHealth, a large development partner of the US government: “I agree mostly with Mark’s comments. Our principal responsibility as donors and implementers is really to focus on the hard task of leveling the playing field. That is fundamentally the issue. You, as a donor, have interlocutors who are in disadvantaged positions because of resources. The onus is on us to shift the dynamic. It is a question of survival in these countries. People are smart, flexible about … what we are looking for. I know what we have to do as INGOs (international NGOs); we have to reinvent ourselves. But do I have donors who agree with that? Do I have donors that will fund me and evaluate me with this new vision? … I think we are scratching the surface (with country ownership); we have a long ways to go.”

Paul O’Brien, vice president for Policy and Campaigns at Oxfam America: “This is partly about capacity, and partly about power. We are much more comfortable talking about the capacity side of it. … Maybe Minister Tedros is part of the problem. He’s the person we love to have on the screen. It’s kind of easy. We are comfortable to let him have his power. But we struggle with others. Do we want to give power to ministries that don’t have the capacity and political will? We don’t trust their power. Maybe some of the radical solutions we need to do is focus on are how do we invest in suboptimal ministries but transfer power at the same time? We need to say to them, ‘we need you as a champion as civil society laws.’ We as donors hold you as accountable to invest in press systems (and when there’s negative press), you have to do absolutely nothing.”

Dr. Salif Samake Photo Credit Dominic Chavez

Salif Samake, director of Mali’s Health, Planning, and Statistics Unit in the ministries of Health, Social Development, and the Pomotion of Women, Children and Family: “We cannot get country ownership by pushing the projects of donors. It’s very easy to say the government has to be in the driver’s seat. But people also have to agree to be in the car. In Mali, we are improving this dialogue. We have made progress with one national plan. We have agreement with 13 key partners. We have one common system of evaluation, one audit, and we have a joint assessment. But, in so many countries, donors are driving everything. Some donors go to the back of the car with the remote control. They are sitting there, but in real life they are driving things.”

Francis Omaswa, MLI senior advisor, executive director of the African Centre for Global Health and Social Transformation, and co-moderator of the session: “It appears that the US government is actually quite serious at a high level about transforming ownership to developing countries. They have struggles with their Congress, and we respect and understand that. The commitment is also on our side that civil society in Africa has risen up in many countries, and they are challenging governments on being accountable. It’s not going to be like in (the Book of) Genesis, where one day (God) said, ‘Let there be light,’ and there is light, and another day, ‘Let there be water,’ and there is water. It is going to take time; it is going to take patience.”

Other posts from Voices on Ownership

Administrator Rajiv Shah

Minister Tedros Adhanom Ghebreyesus

US government officials

Wisman on MLI: Skepticism faded, trust grew