In this discuss, we would be beaming searchlight on the role of donor funded programs in the institutional capacity development of the health system in developing countries. In recent times, several development programs have found their ways into the health system of many developing countries, all in the bid to support this ailing sector. This in itself has led to different programs taking place within the sector, and in most cases, in an uncoordinated and bizarre pattern. While these may all tend to support the health system, there is a great danger in having several programs running on parallel basis, often in a competitive atmosphere that add little impact to development. The question then is how to ensure that these activities are harmonized and focused in addressing issues and challenges geared towards ensuring sustainable health systems. Then, one compelling question that remains is; do the developing countries have the leverage to refuse development aid, where the country feels that it does not serve its interest? With so much money poured into aid in developing countries in recent times, yet poverty, disease, socioeconomic woes still exist. Could it be that these programs are not intended to support the systems or are there other unseen circumstances that persist?
In addressing these issues, one would have to look at the origin of these development programs. Whose interest do they represent? Are there more to these supports than meet the eyes? Agreed, these are difficult questions to answer, especially for a struggling economy such as seen in developing countries, where every donor monies counts. However, that does not shy away from the fact that these issues do exist. It is instructive to note that the key stakeholder in the program implementation, which is the population, deserves to be involved in decision making at the level of program design. Experience has shown that many of these programs often come with systemic design that paid no attention to the contextual issues of the health system in the country. Arguably, for a program to succeed in delivering on its mandate, contextual issues relating to the prevailing social, economic and political settings within which the program would operate would ultimately influence how the causal chains plays out. It therefore means that it is imperative that most programs operating in developing countries should consider this very important factor in view of the fact that the contextual issues may be diverse within the different ethno-cultural diversity of each country. The idea of one size fit all approach to program design and implementation in countries seems not to take this into consideration and often results in poor program implementation. Evidence has also shown that a program design that worked in one country may not necessarily work in another due to different inherent contextual issues.
Not forgetting the role of accountability and good governance. When the government owes accountability to the populace, it would ensure that programs initiated by donor agencies would be such that would have positive impact on the people. Such government would put in place machinery to monitor implementation of donor programs in the state, so as to ensure that the people benefits from such programs. I haven’t seen that yet in most countries, as the system seems to be helpless, and unable to hold program managers accountable for programs being implemented in their domain. This attitude in a way also has the tendency to breed corrupt practices in the system. This becomes more worrisome as the funding agencies are only interested in figures and statistic, and often pays no attention as to the perception of the population on the overall program impact.
My idea of a good program implementation is that in which the state plays a key role in program design and implementation, and where accountability is to the people. Involvement of the state in this way would ensure that there is proper transfer of skills and ownership of the process to the state. It is essential that every donor funded intervention should ultimately aim at incorporating a sustainable exit strategy that would ensure that the state develops the capacity to continue with the intervention even after the exit of the program. With such strategies, the capacity development would be sustained, and developing nations would gradual edge forward in the development index.
Mega blessings .
Osita
