Tuesday, June 1, 2010
International Systems Blog 2 - Melissa Poh
The international development assistance for Health in impoverished countries faces challenges due to poor organisational structure and practices. Despite the increase in international development assistance for health, trends of diseases are evidently on the rise (Shiffman ,2008) among the low and middle income countries. Due to the inconsistent trends revealed in economic systems, investments in healthcare and education are given the backseat when budget is tight and there is a competition of resources. If healthcare is given the cuts in low and middle income countries, the beneficiaries will potentially increase total health expenditures by 30%, where previous subsidies found to be funded by doctors. The cause of the increase in cost of healthcare in low and middle income countries because 60-80% of their allocated health budgets are dependent on external sources (WHO, 2008). In addition, healthcare in low and middle income countries are less affordable as majority of the population lives below the poverty line and it has been proven that it is expensive to be poor. Transportation of healthcare to these people incurs higher costs due to inaccessibility. Due to a large discrepancy in monthly income between the rich and the poor, the impoverished possess very little purchasing power thus, poses a barrier for development assistance for Health to reach them.
The challenges faced by due to poor organisational structure and practices are as stated below:
1. There is a large number of initiatives focusing on specific diseases or issues instead of sector-wide strengthening.
a. The present setting is considered as incomplete, not synchronised and stirs uncertainty among stakeholders due to the careless handling of diversified initiatives (Sridhar 2009a).
b. There is a lack procedures of communication, transparency, clarification and assessments of operations within countries (Sridhar & Batniji 2008). In addition, they lack long term goals which in turn, questions sustainability.
c. Decisions and implementation of policies adopt the top-down’ approach and donor are driven towards personal benefits rather than the country's actual needs.
d. Turnover rates of health workers are high as other non-governmental organisations offer more attractive remunerations.
2. Lack of attention given to existing health institutions such as World Health Organisation, World Bank, UNICEF, IMF and WTO which results in weakened partnerships.
a. Establishing strong partnerships with reliable organisations ensure that issues that surface would be addressed appropriately. Organisations cannot function alone as they it is not possible to possess all resources.
b. Strengths of partners should be tapped on and tasked to relevant parts of the initiatives to ensure that resources and expertise are fully maximised.
c. Exchange of expertise and information can be accelerated with a larger pool of connections with relevant partner organisations.
3. Donors engage in priority-setting in accordance to personal interest instead of having the organisation’s best interest at heart. In addition, donors fail to report and communicate decisions and changes to stakeholders.
a. The beneficiaries’ needs would never be full met as quality of health assistance provided is compromised.
b. Unfair practices could stir up negative emotions among stakeholders resulting in resources wasted in dealing with conflict of interests.
c. Lack of trust for the people heading the initiatives will discourage people from receiving assistance. Hence, health issues are not addressed and diseases may become more widespread.
4. There is realistic difficulty in meeting rhetoric and funding horizontal interventions.
a. Horizontal interventions firms up the important care systems, develop quality of health systems and attend to basic non-disease problems.
b. Accurate statistics on horizontal intervention factors concerning the population numbers are not provided.
c. There is a lack of performance metric and measurements for assessment of the impact of initiatives.
d. Thus, poses difficulty for donors in projecting financial costs and allocating budget effectively.
5. Limited involvement of developing country governments receiving aid
a. Actual needs of the people in these countries will not be met due to the lack of a needs assessment
b. Country governments will feel intruded as their sense of belonging and knowledge of the best interests of their own country is challenged.
c. Misunderstandings may hurt bilateral ties between countries and aid provided will not be put to best use or may not reach intended beneficiaries due to pride and resistance from recipient country.
Recommendations:
A policy termed ‘country compact’ could be applied where partners function using a framework which adopts a single, focused, cost-efficient, results-oriented national health plan with the purpose of leveling-up the extent of impact. These policies should seek to achieve the health-related Millennium Development Goals targets. In addition, initiatives should be closely aligned to the Paris Declaration Principle on Aid Effectiveness.
To establish and improve connections with international partner organisations, transparency, accountability and accuracy of information provided is essential. In essence, statistics and assessments done on the recipient country and initiatives should reflect thorough analysis of information obtained. Clear interpretation of statistics allow organisation to know how they can offer assistance and allocate budget. Review of initiatives is proving feasibility and effectiveness on a long term basis.
To prevent conflict of interest, there should code of governance for donors and recipient countries to abide to. This is to ensure that both donor and recipient country stand on equal grounds. The rights of both parties will be duly respected and interests duly protected. When boundaries are not crossed, it motivates long term collaboration contributing to further development on both sides.
A set of measurements of the impact of initiatives should be drawn up and agreed by both the donor and recipient. Negotiation and accommodation should be applied by both parties to motivate mutually beneficial agreements.
In response to the lack of involvement of recipient countries, regular meetings should be held to keep involved parties updated. During these meetings, feedback and improvements of initiatives should be raised to better maximise the health assistance provided.
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