During our previous discussion on reclaiming the "can do" attitude among African techno-professionals, we were reminded of the era of great expectations when African economies were performing well and social services were provided without the need for visible donor support. Then followed the era of decline when African economies collapsed and went into debt; becomingheavily donor dependent and earning the shameful classification of Highly Indebted Poor Countries (HPIC). I wish they had coined a more euphemistic title!
While the last decade has seen strong economic growth in Africa, in the foreseeable future, most African countries will still not be able to provide essential social services including health to their populations without donor support. Managing "donorship" has therefore become a major preoccupation and big business which is critical to the achievement of African health goals. Many high level conferences with as many resolutions have been convened to address the subject.
The subject of good donorship however remains vexed. Donors and aid recipients often have tensions and regularly trade accusations against each other. Aid recipients are concerned about the possible loss of ownership and leadership for priority setting to donors while donors are concerned that they want to see more results for their money and want a role in priority setting. The rules of engagement however, are well articulated in the Paris Declaration on Aid Effectiveness and the Accra Accord where "country leadership" is the core guiding principle of good donorship.
However the question that is at the heart of the debate is: "If countries lead, will donors follow?"
The Ministerial Leadership Initiative for Global Health (MLI) hosted a round table discussion with this exact title during the June 2011 Global Health Council meeting in Washington DC where I was one the panelists along with colleagues from Mali, Senegal, Sierra Leone, Nepal and the MLI Secretariat. I have been closely involved with several of the initiatives listed above, was a participant at negotiating the Paris Declaration and coordinated donors for the health sector in Uganda for a period of seven years. I have also been a small donor as head of the Global Health Workforce Alliance. Here is how I see this situation:
There is evidence from the work of MLI and elsewhere to show that where countries are clear and strong about what they want to achieve, donors actually follow and these are the countries making the most progress in achieving health goals. These achievements are incentives to donors to provide more support. Where countries do not have explicit health policies, are not strong and have no individuals able to articulate these clearly, donors argue for what they believe to work better, which gets interpreted as taking over ownership and country leadership. Donors have to account to their tax payers and need evidence of success and positive results from the aid recipients to justify additional allocations. Countries are sometimes desperate for the money and fear to lose it by appearing strong or challenging donor positions during negotiations. I have also seen donor representatives who are too strong, appear to know everything, are patronizing and push down their own positions on timid "beggar" countries sometimes in variance with official donor country guidelines. I have heard donors say that they want to be led regrettably, I have also seen countries where local partners to interact with donors are either too weak or are lacking commitment.
Clearly, the situation is complex. Building trust between donors and aid recipients is the key to a productive relationship. Yet nurturing this trust can be tough, has to be learnt, needs touch, takes time to earn and is easy to lose. Individuals of high caliber who are committed to genuine development are required from both sides and need to be prepared for their roles. Mutual respect and clear separation of roles are other pillars upon which this trust is built and sustained. Structures and instruments for managing the relationship are essential and should be institutionalized; examples include committees and other forums for regular reviews and for resolving conflicts which inevitably occur.
Africa will need donors for some time to come and I am convinced that "if countries lead, donors will follow". This is only possible where you have Africans who are committed, willing and able to lead and to be accountable. What do you think?