World leaders, governments, aid
agencies, and nongovernmental organisations (NGOs), will converge on
the Korean port city of Busan over the coming days to talk about
making development aid work better in poor countries, including
those affected by conflict. They meet at a time when the global
economy faces new turmoil and aid budgets are tight.
In Africa, economic growth has been
strong, at close to six per cent a year over the past decade.
Increased domestic revenue in fast-growing economies, coupled with
aid, has financed low-cost high-impact development activities such
as the training and deployment of thousands of health workers in
Ethiopia. As a result, there have been remarkable achievements in
many countries, including reductions in child mortality and progress
in getting more children into primary school.
But, things are different in
conflict-affected countries in Africa that are home to many of the
world’s bottom billion, those people who face the aftermath of
violence in their daily lives. Not a single poor conflict-affected
country has, to date, achieved any of the Millennium Development
Goals (MDGs) that are due by 2015. These countries have made weak or
uneven progress because they lack strong policies and institutions
and have tended to undergo dramatic collapses in economic growth. A
combination of growth, policy management, and decent public services
will help bring them back on track.
Meeting the staggering demand from
citizens for public services is fundamental to peace, stability, and
growth. Yet, services delivered by governments, often barely
established, often fall short, resulting in an ocean of unmet human
needs. Weak public health or education systems frequently do not
inspire the sort of teaching or healing that could make a real
difference. Governments and donors need to seize the opportunities
in conflict-affected states to rebuild these systems for results, as
well as to rope in every partner who has something to contribute by
way of reach or efficiency.
Governments can deliver key services
in places where the public system can be readily reformed to yield
results, but they can also oversee and fund the complementary work
of others. For instance, conflict-affected states often attract some
of the most dedicated NGOs in the world. If the convening power and
financial scale of governments and the work of these NGOs were to
converge into a coordinated national solution, the results for the
bottom billion could be rapid and spectacular.
There are nascent examples of this
in Africa. In South Sudan, a flexible unit in the Ministry of
Education (MoE) coordinates youth and adult education, critical for
those who have missed schooling at the right age, provided by a
range of NGOs and faith-based organisations.
The World Bank’s World Development
Report 2011 on Conflict, Security, and Development identifies these
“state-NGO and state-private sector programmes for service delivery”
as part of a new way of doing business in conflict-affected states,
critical for restoring confidence, transforming institutions, and
reinforcing the legitimacy of the state.
In the medium term, governments
could also harness private sector efficiency to deliver publicly
funded services. A recent example from Lesotho, not a
conflict-affected state but one with tremendous health needs, is the
government’s visionary partnership with a private healthcare
consortium to build and manage the brand new Queen Mamohato Memorial
Hospital, part of a network that includes referral clinics. Modern
healthcare, with built-in accountability for quality services, will
now be available to hundreds of thousands of Lesotho citizens
through this network.
This model may not work in every
conflict-affected state, but it is definitely possible as systems
mature and stability becomes the norm. New clinics in Lesotho’s
densely populated Maseru district have already seen demand for
services doubling, an encouraging sign in a country that is fighting
hard to improve its health indicators. Lesotho is definitely a space
to watch and learn from.
Another promising approach that
helps improve health services is results-based financing of
frontline healthcare facilities. Here, health centre teams are paid
based on the proven delivery of a set of services. Healthcare is
starting to turn around visibly in post-conflict countries like
Burundi and Rwanda, partly with their adoption of this approach-one
among many ways to improve results.
Regardless of who delivers services,
there must be transparency about effectiveness. Early results from a
recent survey led by think tanks in Africa showed that students in
public primary schools in one country were taught for only two hours
a day, while in another, only a third of clinicians were able to
correctly diagnose diarrhoea with severe dehydration. Precise,
actionable information like this can help countries make decisions
on where to direct reforms and to know whether their reforms are
working. Imagine if such information were available to guide efforts
in South Sudan, Sierra Leone, or Liberia.
The focus at the Busan conference on
conflict-affected states is timely with the clock ticking down
towards the MDGs in 2015, but success will lie in the relentless
pursuit of what works and in discarding what does not. Nobody should
have to tolerate schools in which students do not learn and clinics
where doctors and nurses do not heal, especially not people
long-wearied by war and conflict who have great needs, and, indeed,