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Accra meeting aims to create an aid system fit for purpose

26 Aug 2008

Tatum Anderson

Source: TropIKA.net

Progress towards making global aid more effective is still more rhetoric than reality. That was the consensus of a UK parliamentary group in the run up to a major conference on aid effectiveness taking place 2nd-4th September 2008. Many of the world’s governments, large funding institutions and civil society organisations will be represented at the gathering in Ghana’s capital, Accra.

The Third High Level Forum on Aid Effectiveness, will assess progress towards the Paris Declaration, a promise made by 100 countries in 2005 to reform the aid system and ensure donor money is provided and spent more effectively. But a report from the UK parliament’s International Development Committee, a group of ministers from different ends of the political spectrum, warned that there had been minimal success so far. The committee concluded: ‘Global progress has been patchy and slow. The Forum in Accra is an opportunity to shine a spotlight on this lack of progress.’

Research literature is littered with anecdotes about wasted aid – especially in the health sector, which is held up as a barometer for the entire aid system. Multiple donors often pile into the same country, bypass or even undermine existing government infrastructure and duplicate each others’ work. Recipient governments have devised strategic health plans but find that donor money has been earmarked for only a couple of diseases.

Recipient government staff time has been dominated by dealing with donor administration, rather than implementing the projects themselves. In 2007, for example, 49 developing country governments were expected to receive 14,054 donor ‘missions’ – almost one a day, according to figures from the Organisation for Economic Co-operation and development (OECD), representing rich countries.

Speaking at the XVII International AIDS conference in Mexico City earlier this month, Mphu Ramatlapeng, minister of Health and Social Welfare of Lesotho highlighted some problems in accounting for donor funds. ‘Each donor insists in having their own private implementation unit which manages their funds,’ she said. ‘This poses a tremendous strain on us because we have parallel requests, parallel reporting requirements, and they put a lot of strain on our already few human resources remaining in the Ministry of Health.’

The situation is borne of mistrust say experts. ‘If you look at perceptions of countries and donors they are mirror images of each other,’ says Julian Schweitzer, director of the health, nutrition and population department of the World Bank, a major donor. ‘From the point of view of [recipient] countries, donors are unreliable, the funding is spasmodic, project-driven not priority-driven and fickle. Donors see opaque budgets, no emphasis on results, unclear priority setting [in developing countries],’ he says.

Bringing order

The Paris Declaration was drafted to bring order to the aid industry. Unlike its predecessor declarations made in Mexico and Italy, the Paris Declaration was the first to stipulate measurable, quantitative targets for both donor and recipient countries to reach by 2010.

The Paris Declaration is based on five fundamental principles; ownership, harmonisation, alignment, managing for results and mutual accountability.

Broadly it stipulates that recipient countries should be allowed leeway to decide how best the money should be spent and funding should be based on their national strategies; it encourages donors to coordinate their activities better and use recipient countries’ existing infrastructure. In return, recipient countries must become more transparent and open about what they do with the money they receive.

There are also rules and specific targets that flesh out these principles. The concept of predictability encourages donors to deliver money they’ve promised on time, for instance. That is because only 66% of aid arrives on schedule. (Benin was due to receive $477m in 2007, but ended up with just $151m).

Other rules try explicitly to tackle some of the more insidious practices, such as tied aid. As a condition of giving money, too many donor governments often force recipient countries to buy technical assistance – consultancy services – from the country that provided the money for instance.

But half way towards the 2010 deadline, it is universally agreed that insufficient progress has been made. Lesotho’s Minister Ramatlapeng says in particular that even more influential institutions are yet to fully embrace the Paris principles. ‘If tomorrow you were to say to Lesotho, abolish the private implementation unit that belongs to the World Bank, everybody else will follow,’ she said.

The problems are true even in the health sector, which has tried to harmonise and coordinate its activities for many years, according to Brenda Killen, head of the aid effectiveness division at the OECD’s Development Cooperation Directorate. The OECD, which oversees the Paris Declaration, has measured adherence to targets in a 2008 global survey and tracks health extremely closely using a dedicated task team. It plans to release a report on health and aid effectiveness at the Accra conference.

‘The health sector has been chosen because links between aid-effectiveness and a real impact on a person’s quality of life are much clearer,’ Brenda Killen said. ‘The task team gathers evidence and uses it to change behaviour not only of the health sector but in other sectors.’

The team aims to measure the direct effect of donor and recipient government behaviour on those living in developing countries. Most recently it has been looking at how long-term, predictable aid improves child mortality.

She says there is a need to gather evidence that the Paris principles actually produce results. ‘We need to start to show positive impacts of aid in funding government plans [so donors do] not micromanage and track every single penny.’

In an initial assessment released ahead of the Accra meeting, OECD praised some recent initiatives aimed at moving the sector towards Paris principles. The report says UNAIDs’ ‘Three Ones’ initiative, has, promoted a more harmonised approach to the management of HIV, and has successfully included civil society.

Similarly, recent decisions by the GAVI Alliance and the Global Fund to Fight AIDS, Tuberculosis and Malaria, to move towards health-system strengthening show acknowledgement of the priorities developed by recipient countries.

And finally, recent research shows that innovative funding mechanisms, such as UNITAID and the AMC, provide new opportunities for long-term financing arrangements, it says.

IHP+ - a new initiative

Nevertheless the OECD reserves judgement on a new initiative that aims to embed Paris principles within the health sector.

The International Health Partnership Plus (IHP+) – developed by eight donor agencies and governments – encourages recipient governments and donors to reach a common agreement, or compact, on how to fund a country’s health plan. The country sets out its needs and donors, in theory at least, will agree to coordinate their activities to fund the plan and even fund gaps. (The first compact, is expected to be signed by Ethiopia and donors in Accra.)

A key pillar of IHP+ is that all donors will agree on a common accounting method and set of metrics, instead of imposing their own parallel systems.

But while the principle of IHP+ is welcomed, some are sceptical about how it might work in practice. That is because the IHP+ does not encourage donors to withdraw, if there are too many others in a single country (and a key target within the Declaration), or commit to funding gaps. There is also no reference to the Abuja Declaration – a promise by African heads of state in 2001 to dedicate 15% of their budgets to health.

But crucially say sceptics, there is a risk that donors are still trying to stamp their own identities on projects and funding particular elements that appeal to voters, instead of coordinating funding in alignment with a country’s strategy.

Ironically IHP+ was formed to harmonise all the separate harmonisation initiatives that had been launched by donor governments including UK, Norway, France and Germany last year, says Elaine Ireland, advocacy officer at Action for Global Health, a group of European NGOs that target the health sector.

‘The different donors want their names associated with these big initiatives. Donors need to be prepared to put aside their need for ownership if this is going to be genuinely effective’, she said.

It is therefore hoped that the spotlight on Accra will encourage countries to adhere more closely to the Paris principles.

An agenda for action

And crucially the conference will also try to get countries to sign up to a new agreement – the Accra Agenda for Action (AAA) – a document that tries to beef up many of the more vague rules or targets included in the original Paris Declaration.

One of the most pressing issues contained in the agenda, is making aid more predictable. Many donors commit funds on a yearly basis only. As a result many governments will not risk scaling up existing projects – such as putting more people on anti-retroviral drugs or recruiting more healthcare staff – if they cannot guarantee that the money to fund project expansions will still be there in a year’s time.

The Agenda proposes that donor commit funds for a longer time – for three to five-year periods. It also proposes more action on fragile states, tied aid, transparency and involvement with non-government organisations.

But even if countries agree to the AAA, it is unlikely that signatories to the Declaration will have implemented them all by 2010. That said, OECD’s Killen is confident that the aid system will be fit for purpose by 2015.