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Beyond the Donor Years: Time for Co-Development in Global Health

Anne Radl from The Humanitarian Centre discusses ‘Partnerships for global health: pathways to progress’ a new report reflecting on the centre’s focus on global health over the last year.

“Everyone has something to teach and everyone has something to learn.”

This quote from Lord Nigel Crisp captures the key theme in the Humanitarian Centre’s latest Cambridge International Development report, ‘Partnerships for global health: pathways to progress’.

The report provides insights from global health leaders on why partnerships provide a good structure for reciprocal ‘teaching and learning’.  It also highlights examples of innovative partnerships—particularly those where the traditional ‘recipient’ of development aid has taken the leading role in providing ideas and ingenuity for global health.

Lord Crisp has long been an advocate of ‘turning the world upside down’—looking to ‘developing’ countries in the ‘global south’ for inventive health care solutions that could be adapted to the UK.  In this report, with an ever growing number of examples to learn from, Lord Crisp argues for a reconceptualization of international development as a whole:

I have argued elsewhere that we need mentally to ‘turn the world upside down’ because those of us living in the richest countries have a great deal to learn about health and healthcare from people who, without our resources and, without our vested interests, are innovating and dealing with problems that we are unable to address adequately. There are examples throughout the world which range from clinical practice to service design and from product development to policy making. In other words, everyone has something to teach and everyone has something to learn. We should learn to think not in terms of international development, but in terms of co-development.

In a response to Lord Nigel Crisp, Dr Ndwapi Ndwapi elaborates on the idea of ‘co-development’ from his experience of managing the strategy of the Ministry of Health in Botswana, traditionally an ‘aid recipient country’:

Donors must position themselves in a way that is not only conducive to giving but also receiving. … Ultimately, sustainability beyond the donor years depends not only on the self-reliance of the recipient, but also on the continued interest and interdependence of the donor country and its agents.

Beyond the ‘donor years’, the report is replete with examples of health care innovation that should assure the continued interest and interdependence of donor countries and agents, and engender a shift from thinking about ‘international development’ to ‘co-development’.

For example, Julia Fan Li and Dr Shelly Batra write about the great success of an Indian NGO, Operation Asha, adapting business franchising practices to get essential treatments the people that need them.

Several pieces in the report speak to the even greater potential to learn from our colleagues and partners working in the global south by continuing to support and grow ‘capacity building’ programmes.

Professor Nick Wareham, Director of the Centre for Diet and Activity Research at Cambridge (CEDAR) highlights a project in Cameroon that that is the first to objectively  demonstrate the difference between rural and urban physical activity and energy expenditure–a significant stepping stone to understanding how to build effective interventions to promote healthy physical activity in both settings.  The project leader, Dr Felix Assah, first became acquainted with Professor Wareham as a participant at the Cambridge Diabetes Seminar, which has trained around 1000 professionals from all over the world in the epidemiology of diabetes and public health.  Since their initial meeting, he has become attached to CEDAR and is now training public health researchers in Cameroon.

In ‘Getting in the Access Loop’, a collection of insights from publishers, funders, librarians and researchers on how African scientists can undertake and publish research more effectively, the authors demonstrate a  ‘virtuous circle’ for supporting the publication of African research.

Publishing success increases the global profile of African research, promoting a virtuous circle of enhanced competitiveness for international funds, enabling greater research output, and increasing the pool of world-class African mentors and role models for the next generation of African researchers. (Dr Pauline Essah and Professor David Dunne)

And a case study by Dr Michael Makanga of EDCTP shows how the establishment of four ‘Networks of Excellence’ for conducting clinical trials and promoting research in sub-Saharan Africa are already enabling advances in the prevention and treatment of HIV, malaria and tuberculosis.

With improved knowledge and capacity comes improved quality of clinical research and practice in sub-Saharan Africa, allowing Europe and developing countries to tackle poverty-related diseases more effectively.

While the report primarily focuses on successful partnerships for global health, it is also clear that partnerships do not inevitably lead to progress.  Dr Bruce Makay points out:

Some [partnerships] seem to me to be a waste of time, or worse. The word itself reduces the clarity of role and responsibility which is characteristic of most successful ventures. I was recently asked to change both ‘donor’ and ‘recipient government’ – words which make explicit the relationship between the two – to ‘development partner’. This muddies what can anyway be murky relationships between unsophisticated donors, secretive corporations, unaccountable NGOs and international agencies who have no mechanism for saying ‘no’ to anyone knocking at their door.

Dr Peter Singer suggests trust-building in partnerships between different entities—for example multinationals and NGOs—and demonstrates how methods such as ‘social auditing’ can help ensure transparency and accountability in partnerships from the very beginning:

Social auditing builds trust between the participants in a partnership, and between those participants and the community. This sort of trust building, given the history we have had with multinationals in the area of global health, is definitely going to be needed, because the participation of multinationals is going to be needed.

And it is clear, from this report, that the participation of multinationals and the private sector is going to be needed, as is the continued participation of the charity sector, and research and policy-making institutions. “Everyone has something to teach and everyone has something to learn” speaks to much more than just the relationships between partners in the ‘global north and south’: it calls for ‘co-development’ between different sectors—and between professionals working in different areas, like the environment or human rights.

Closing the report with an afterword, Helen Clark, Administrator of the United Nations Development Programme, calls for cross-sectorial partnerships, not only to address global health challenges, but to help understand the interconnectedness of the many global challenges facing us today:

Effective approaches to tackle global health challenges must be based on cross-sectoral partnerships, the focus of this current report. As well, they must be based on the linked core values of human rights, equality and sustainability. … Recognizing that good health is both an outcome of, and a precondition for, sustainable development requires us to reassess how we pursue sustainable human development and tackle global health challenges. For me, as Administrator of the United Nations Development Programme, sustainable development is not about trading economic, social and environmental objectives off against each other. It is about seeing them as interconnected objectives best pursued together.

Anne Radl is the Projects Manager for the Humanitarian Centre.  The Humanitarian Centre is an international development network affiliated with the University of Cambridge. We bring together NGOs, researchers, entrepreneurs, academics, business leaders, students and consultants working to reduce global poverty. The Humanitarian Centre exists to facilitate collaboration between sectors and disciplines, to share best practice, and to promote dialogue and learning.


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