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Countries Leading. Donors Following?

August 04, 2011

In June, I was moderator at a session during the Global Health Council’s conference in Washington, D.C., titled, “If countries lead, will donors follow?” On the panel were senior officials from five ministries of health: Ethiopia, Mali, Nepal, Senegal, and Sierra Leone. The five ministries had just put out a call to action for more country ownership of health programs.

I knew all five from my work with the Ministerial Leadership Initiative for Global Health (MLI), housed at Aspen Institute and part of Aspen Global Health and Development. I had coached them, along with a couple of dozen others in the ministries, on how to tell their stories in a compelling way.

So when we got together before the session, I was confident. These five were superstars — not a term I throw around. Not only do they excel in their work but they also can tell a story that will make you sit up straight. I asked if they could come up with a story of an instance in which they led, donors didn’t follow, and then describe what happened.

They all smiled. Some shook their heads. “We have many stories,” said Dr. Medhin Zewdu, the director-general of the Office of the Ministry of Health in Ethiopia.

That day, on the panel, they each delivered sharp, three-minute, detailed, memorable stories to an overflow audience that cheered them afterward.

Medhin talked about Ethiopia’s ambitious plan to train and send to communities 30,000 health extension workers along with the need to build hundreds of new facilities — but donors didn’t want to fund the facilities.

Dr. Kisito Daoh, chief medical officer of Sierra Leone’s Ministry of Health and Sanitation, talked about starting free health care for pregnant women, children under five, and breast-feeding mothers — but donors, at first, were very skeptical.

In Nepal, Dr. Banshidhar Mishra, former State Minister for Health for the Ministry of Health and Population, said donors didn’t want to go along with a cash incentive program for mothers to give birth at health facilities.

Moussa Mbaye, Secretary General of Senegal’s Ministry of Health and Prevention, talked about setting up programs on the community level to treat malaria and a having a hard time bringing donors along.

And Dr. Salif Samake, director of planning for the ministries of Health, Social Development and Women’s Affairs in Mali, said the whole donor-recipient system was tough to navigate: “Donors are not always playing the game because there is a lot of fragmentation,” he said.

In most of the cases, donors changed their views and began working toward the ministries’ goals. These were hard-won examples of a term that many in global health now throw around almost glibly — “country ownership.” But what does country ownership mean? How does it happen? What does it look like?

I have a pretty good idea. Over the last four years, MLI, which is funded by the Bill & Melinda Gates Foundation and the David and Lucile Packard Foundation, has been in the middle of a living laboratory that pushed forward country leadership in concrete ways in its five countries. MLI started with questions to ministry officials: Where are your gaps? Where do you need help? What priorities aren’t getting off the ground?

Then those at MLI listened. They started acting on the countries’ priorities, following country guidance. With MLI’s help, Mali pushed ahead with a community-based health insurance scheme; Senegal strengthened its reproductive health program and is rolling out new financing schemes to improve performance; Sierra Leone rolled out its free health care program and communicated it to audiences around the world; Nepal trained a deep bench of skilled negotiators; and Ethiopia started installing a new way to manage health care more productively.

They are making progress. Along the way, many senior ministry leaders learned how to talk about the work so that not only people in Freetown and Addis Ababa would understand, but also that those overseeing policy in Washington and London and Tokyo would become excited about it, too.

It’s a brave new world out there in global health. Ministries can lead the way. Donors can follow. The stories are coming.


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