On Monday the 21st, I went with our Global Health Program Director, Priti, to a panel discussion organized by the Center for Global Development.  It was titled “What is Country Ownership Anyway?” and addressed (you guessed it) issues of country ownership in development projects, what exactly that means, and why it’s vital to the success of foreign assistance.

Country ownership is a bit of an ambiguous term.  As Minister of Health Ghebreyesus of Ethiopia pointed out, it can mean very different things to very different people.  For some, it means that the country is the driving force behind the development project, and is integral in all stages, from planning to implementation and evaluation.  For others, it simply means that country authorities are informed of what aid groups are doing within their borders.  The consensus in the room seemed to lean toward the former option – that for proper country ownership, it is important for the country to have a say in the program design, goal, and implementation.

Minister Ghebreyesus compared it to the driving of a car, and said that the country needs to not only be in the driver’s seat, but also be the one deciding where the country is going, not just chauffeuring the passengers (the aid groups).  The aid groups are welcome to and should in fact warn of dangerous roads and potential roadblocks, but ultimately the driver decides which path to take.  It is, indeed, the locals who probably know the roads best.

After the talk I read a very illuminating article by Laurie Garrett published in Foreign Affairs a few years ago that gave me another perspective on country ownership.  A short section of it is available online, here.  The article deals much more with the importance of comprehensive health systems strengthening (as opposed to separate groups tackling specific health issues) than with country ownership, but it seems to me that the two issues are inextricably related.

Garrett lays out the way in which funders drive specific issues, like AIDS, TB, and malaria, and are able to raise money around very specific projects (for example, distributing antiretrovirals (ARVs) to people with AIDS).  Then, all too often, these projects build their own structure of clinics, information dissemination, and personnel, rather than integrating into existing national health systems in order to strengthen them and expand their capacity.  This causes a number of problems.  For one, it raises issues of access – if people must go to one clinic for AIDS treatment, another for prenatal care, and still another to vaccinate their children, they are much less likely to get all the types of care they need.  Second, it frequently weakens existing health systems. Garrett points out that one of the key ways in which this happens is by pulling qualified personnel away from their government or public positions and into the NGO sector in developing countries.  Although they still may be doing good work and making an impact, it causes an internal brain drain which is crippling for public programs.  And if the idea is to create sustainability within nations, it is more important in the long run to develop a strong interior structure than to make sure that foreign NGOs are well staffed.

This was exactly the same point that Minister Ghebreyesus brought up at the Monday panel – the detrimental effects of competing systems.  Not only does the lack of comprehensive collaboration rob personnel and sometimes resources away from the existing system, but it is also inefficient.  It means that programs are often starting over from scratch rather than improving on what infrastructure already exists.  Then, if the aid group loses funding or international attention turns elsewhere, the nation is left with two defunct systems rather than one that may still not be perfect, but has hopefully been strengthened and expanded by foreign assistance.

An important factor in remedying these issues is making sure that country ownership is the bottom line for any type of aid project.  Minister Ghebreyesus talked about the importance of the country being instrumental in all the stages of planning.  First they need to come up with a “wish list” of what needs to improve in their nation, even if that includes long-term goals that may not be immediately feasible.  Then they can come up with a plan of necessary steps that need to be taken.  Once that has been established, that is when they can enlist the help of NGOs or government agencies of other nations (like USAID, for example) to help in the areas that are needed.  This allows the country to prioritize and consolidate its efforts, and hopefully, to be able to use the aid available to it in a more efficient manner with more positive outcomes.

This type of coordination is by no means easy, especially where there is rampant corruption, issues of top-heavy bureaucracy, and many different actors at the table.  But it is necessary nonetheless.  I am hopeful that the fact that this and other issues of aid efficacy are being openly discussed is an indication of a trend toward cooperation and partnership that will improve the effectiveness of foreign aid around the world.