MLI Unveils its Call To Action for Country-Led Development at Annual GHC Conference
Five countries – four in Africa and one in Asia – issued a “Call to Action” on Tuesday that pushed for greater country ownership of health programs and more flexibility from donors to match programs with national priorities, saying that this dramatic shift in the donor-recipient relationship would save money and lives.
The Call to Action – titled “Country-Led Development Practical Steps Forward” – was signed by leaders of health ministries in Ethiopia, Mali, Nepal, Senegal and Sierra Leone, and released at the Global Health Council’s annual conference. It was a natural outgrowth of four years of support from the Ministerial Leadership Initiative for Global Health (MLI)- an organization that is part of Aspen Global Health and Development at the Aspen Institute.
MLI’s approach of backing ministry priorities helped programs such as Sierra Leone’s free health care for mothers and young children; Nepal’s intensive training that made ministry officials crackerjack negotiators, and the start of Ethiopia’s new way to manage health care that asks all workers from janitors to doctors to take a stake in the improvement in the quality of care.
“I always advocate for country ownership, because if countries own their own business, commitment comes with that,” said Ethiopia’s Health Minister Tedros Adhanom Ghebreyesus. “This document is about making country ownership a reality and gives both countries and donors a real roadmap for countries to take control of their programs. We need stronger leaders in countries who set forth a vision and then make sure their health programs live up to that vision.”
Said Sierra Leone’s Health Minister Haja Zainab Bangura, who is attending the Global Health Council meeting: “I believe in country leadership and country ownership. It is only by being in the driver’s seat that you can drive your country in the right direction. We know our problems best.”
The Call to Action follows global commitments to country-led development found in the Paris Declaration for Aid Effectiveness in 2005 and the Accra Agenda for Action in 2008, as well as in the global International Health Partnership (IHP+) Compact. But the ministers of health said that in many cases both parties – donors and recipients – haven’t followed those principles and the result is that developing countries are managing a hodge-podge of programs that are often duplicative or do nothing to fulfill country priorities.
“In order to improve the health of our populations, we must take the lead,” the document says. “Strong leadership fosters accountability, demonstrates the government’s commitment and is a prerequisite for country-led development. … Our experience confirms that countries must become the captain of the entire effort, steering the design, implementation, monitoring, and evaluation of their master plans with supportive assistance from partners.”
It continued: “These same players must work together to ensure robust monitoring of progress toward country-led development, holding one another accountable through mutually set indicators, and seeking opportunities for dialogue and continuous learning from one another.”
Jeffrey Sturchio, CEO and President of the Global Health Council, said the MLI approach of listening to country’s priorities and then following through on those requests was a model that should be nourished by donors and developing countries.
“The Paris Principles and Accra Agenda set out a clear vision of country-led development, but to make this vision more than words on paper require persistent, pragmatic leadership,” Sturchio said. “The Ministerial Leadership Initiative is significant because it placed the focus squarely on country priorities and kept it there, developing a sense of trust and shared accountability. MLI set up a robust process of learning by doing, and setting an example for other development partners to walk their talk, listen carefully and adapting their assistance to the needs and gaps identified by their colleagues at the country level.”
Many donors, including the United States, are moving toward supporting more country ownership. The Obama administration’s Global Health Initiative has incorporated country ownership as one of its core principles. Rosann Wisman, MLI’s director, said now was the time to ramp up those plans. She said they should be aligned with the Call to Action.
“This document is tied to our experiences in five very different countries that share one common vision: They want the best health care possible for their people and they are convinced that by coordinating all health programs, they can deliver on their commitment for quality health care,” Wisman said. “The Call to Action really is saying: This is what works because we have tried it and found success.”
The Call to Action includes three principles: Government leaders, including ministers and their senior teams, must be clear about their priorities; development partners must be flexible, willing to listen and follow the priorities defined by country leaders; and countries must be given greater opportunities to learn from each other, developing ongoing relationships between leaders.
In Nepal more than 60 members of the ministry have been trained to become better negotiators under a MLI-supported program. These talented negotiators throughout the ministry have helped in negotiations with donors and development partners to better explain the case for expanded support for country priorities.
Senegal’s Health Minister Modou Diagne Fada said that his country wanted more leadership training, which MLI helped provide. He said, “With that support, the ministry has put together more coherent, efficient and effective plans for our resources.”
And Mali’s Health Minister Madeleine Ba Diallo said the next step is for other countries and for donors to start making the Call to Action a reality in the developing world.
“We give all our support to this Call to Action,” she said. “We are entering a period where our relationships in Mali with donors and partners are improving by great leaps. But more needs to be done. The five countries all believe the way forward is for countries to set clear visions and then to pursue those priorities in order to save lives and improve the health for all.”
Francis Omaswa, the former director general of health services for Uganda’s Health Ministry, one of the co-chairs of the Global Health Council conference, and a MLI senior adviser, said he now could look at the MLI-partner countries and see how they are supporting and learning form each other because of the MLI program.
“Strong country leadership can do anything,” he said. “Global coordination will continue to be disjointed, but implementation at country level is up to us. Where there are strong leaders, donors will follow.& We need to be accountable to our people.”
The Ministerial Leadership Initiative for Global Health, which is part of the Aspen Global Health and Development at the Aspen Institute in Washington, D.C., is committed to country-led development and nurturing country priorities in health. It is currently working in five countries – Ethiopia, Mali, Nepal, Senegal, and Sierra Leone – and has received generous support from the Bill & Melinda Gates Foundation and the David and Lucile Packard Foundation. MLI works in partnership with Results for Development Institute in Washington, D.C.