Academia and Aid Effectiveness in Global Health

“Between now and 2015, we must make sure that promises made become promises kept. The consequences of doing otherwise are profound: death, illness and despair, needless suffering, lost opportunities for millions upon millions of people.”  — United Nations Secretary-General, Ban Ki-Moon

Abstract

What is the role of academia in promoting or hindering aid effectiveness? This  article aims to address the crucial role played by academia in the past two decades especially after the Paris, Ghana and Busan high-level meetings on aid effectiveness. Academic institutions are at the crossroads especially at present in reference to areas of global sustainable development and improving aid to those in need. The role of academia and educational institutions cannot be underestimated in the development of the Millennium Development Goals (MDGs) agenda which have been recognized as the turning point in focusing on improving societal well-being through teamwork and partnering at the grass-roots level. The power of academia in transforming the landscape of donor largesse and funding has been recognized by multiple stakeholders, especially the private sector and the United Nations. This recognition has culminated in multilevel partnering with academia. An example of this is the initiative launched in 2009 by the United Nations known as United Nations Academic Impact (UNAI), a global forum which has been able to leverage the expertise and skill sets of its academic partners in improving assistance and in improving it at many levels to those who need it the most. That being said, as every other industry, academia is not 100 per cent successful in improving aid effectiveness in global health. Often there are pitfalls and outcomes may not be as effective as desired, but this should not be an impediment for donors, foundations,  governments , non-governmental organizations (NGOs) and United Nations agencies to partner with academic institutions in increasing aid effectiveness and service delivery in promoting  global health. 

Introduction

The role of academia in the past two decades has undergone a great transformation in not only being an instrument of education, and bringing new evidence of effective practice to the field of global health but also in the development of a workforce to promote aid development in various settings globally and implement projects that improve the health of various populations.

In recent years there has been a tremendous increase in donor investment to fund projects particularly to fight specific diseases such as AIDS, malaria, and TB in low-income countries around the world. The various donors which include foundations, the private sector and governments are interested in making sure that the allocated funds are being used effectively in promoting sustainable development which is synonymous with aid effectiveness. This proactive stance taken by the donors has been a major contributor to the development of a new field which is known as ”evidence- based advocacy” and is being recognized as a powerful indicator to measure aid effectiveness. Donors make decisions about project funding which is based on the data they receive and review as this indicates the success or failure of proposed projects. The skills and expertise needed for data collection and analysis is usually found in academic institutions. (Pierce, 2006)

Ruth Katz, former dean of the School of Public Health and Health Services at George Washington University sums up the role of academia aptly in her quote ”faculty helps produce the research, the evidence that is the basis for global efforts.” (Pierce, 2006)

Faculty and researchers at various universities in North America and Europe serve as visiting scholars or consultants on various projects in many low- and middle-income countries.

Similarly, faculty from developing countries visiting the academic institutions in North America and Europe will help to maximize the role of  academia in being an important cornerstone for aid effectiveness.

Role of Academia

At present in lieu of the ongoing conflicts in countries and between nations, the role of academia is crucial in bringing together various players from different diverse ethnic groups and fields in building bridges through peaceful negotiations. To illustrate the power of academia in being crucial for promoting peace and sustainable development, graduates from universities and colleges bring to their communities the knowledge and skills learned at these institutions  to develop stable societies. These graduates and alumni often go on to work in leadership positions and can help to bring about effective leadership and good governance, which can be instrumental in attracting donor investment.

Geology for Global Development is a non-profit which can be best described as a “think tank” and has been successful in bringing adversarial or warring countries (India and Pakistan)   together in working on issues of concern for them through effective academic settings. An example is the recently held conference in June 2014 in Leh, the Ladakah region in the Himalayas, which was jointly organized by the Geological Society of London in collaboration with the Institute of Energy Research and Training at the University of Jammu, India. This initiative in the Himalayan region focused on the education and engagement of students and faculty on the following issues: access to clean water, climate change, and energy conservation. Initiatives such as these are crucial in promoting neutral working environments for mutual cooperation and promoting donor investment (Geology for Global, 2014) .

Examples: Think and Act Locally with Global Outcomes:

The authors have been involved with grass-roots work highlighting the principle of local action for a global outcome. A partnership effort was established by Dr. Padmini Murthy (one of the authors) with the Callista Mutharika Foundation which was started by the former first lady of Malawi to promote safe motherhood practices in Malawi. In June 2011 Murthy had the opportunity of meeting H.E. Callista Mutharika, wife of the President of Malawi, at a high-level meeting in the United Nations and learned about the high rates of maternal mortality in Malawi. This meeting was instrumental in Murthy spearheading the NYMC Safe Motherhood Project, in organizing a student effort to raise funds and supplies for Malawi. In the span of one year the team collected 150 boxes of medical supplies and assembled 250 Mama Kits and USD $13,200 to build a maternity waiting home for high-risk pregnant women in Malawi. Since the team worked with the foundation and the wife of the Permanent Representative of the Permanent Mission of Malawi to the United Nations, there were no overhead expenses and the collected funds were completely earmarked for the project. In response to the 2014 Ebola pandemic, students of New York Medical College have partnered with African Views, an NGO to collect supplies and raise funds to assist the health-care providers in Liberia. Recently, Padmini Murthy and students of New York Medical College  working with the Zontas Club of Pittsburgh, Batavia-Genesee Count, Afya Foundation and Global Links were able to the ship out 900 birthing kits, and much-needed supplies to aid the victims of the 2015 Nepal earthquake.

These above-mentioned projects illustrate the role of academia played in promoting aid effectiveness and efficiency in the arena of global health.

Paris Declaration and Beyond

At the Second High-Level Forum on Aid Effectiveness (2005) it was recognized that aid could—and should—be producing better impacts.  The Paris Declaration was endorsed in order to base development efforts on first-hand experience of what works and does not work with aid. It is formulated around five central pillars: Ownership, Alignment, Harmonisation, Managing for Results and Mutual Accountability. (Organization for Economic Co-operation and Development, n.d.)

The power imbalance in the development cooperation is an important issue that needs to be dealt with and academia is an effective catalyst in reducing this imbalance. The commitments in the Paris Declaration advocate for partners in development to cooperate in a mutual partnership, and this translates into the need for recipients to take more responsibility in development strategy. (High-level Forum, 2005) The aid effectiveness agenda has been at the forefront after the High-level Forum in 2008, which was the follow-up to the Paris Declaration and which was held in Ghana and Busan. (High-level forums 2008 and 2012)

During the events that led to the development of the Paris Declaration and the consequent High-level talks, several local civil society organizations including members from academia were proactive advocates for the inclusion of civil society players to be active partners in the development partnership, since they felt their participation was disregarded in the Paris Declaration. In a retrospective review, the debate on aid effectiveness has been an important item for discussion on the agenda of the international community and this culminated at the high-level forum with the outcome being the Paris Declaration in 2005 (Whitfield & Fraser 2009). However, the year of aid effectiveness started in 2003 at the Rome Declaration where the stakeholders made a commitment to harmonize and align aid.  As a follow-up to this at the High-level Forum 2 the commitments of the Rome Declaration were reaffirmed, and the following five partnership commitments were agreed upon:

1. OWNERSHIP - Partner countries exercise effective leadership over their development policies and strategies, and coordinate development actions;

2. ALIGNMENT - Donors base their overall support on the national development strategies, institutions and procedures of partner countries;

3. HARMONISATION– Actions of donors are more harmonized, transparent and collectively effective;

4. MANAGING FOR RESULTS - Managing resources and improving decision-making for results;

5. MUTUAL ACCOUNTABILITY - Donors and partners are accountable for development results. (High-level forum 2, 2005).

Academic institutions have been playing an important role in working to reaffirm the five partnership commitments which have been listed above. For example, the Consortium of Universities for Global Health (CUGH) has been at the forefront in establishing guidelines and a framework to facilitate aid effectiveness for its partners and other stakeholders working in the field. The mission of CUGH as described by the organization is: 

“Dedicated to creating balance in resources and in the exchange of students and faculty between institutions in rich and poor countries, recognizing the importance of equal partnership between the academic institutions in developing nations and their resource-rich counterparts in the planning, implementation, management and impact evaluation of joint projects.” (CUGH, 2014)

This statement has been translated into action by its academic partners in North America, who have been instrumental in launching projects in developing countries to improve the health status of communities. Some examples of partnerships which have been effective will be discussed in the section titled partnering with a purpose.

Partnering with a Purpose

Examining the role of academia in promoting aid effectiveness is illustrated in the partnering with non-governmental organizations, foundations and  United Nations agencies. Aid effectiveness has become a significant buzz word in development rhetoric and academia has emerged as an important player in the arena.  In this connection the concept of ”Partnership Approach‟ has emerged, as a strategy of how manage development assistance.  (Andersen & Therkildsen 2007.)

As observed donors base their development assistance on different interests, Hyden (2008) considers the partnership approach, more as a mutual partnership, with focus on both donors and recipient countries commitment to ”ownership‟ and the alignment partnership approach presupposes a high level of trust between partners, in the sense that there is a social contract rather than a business contract, where partners have more at stake. The recipient countries strategy has to trust that donors are willing to align to their development strategy. The role of academia as mentioned previously in the chapter is crucial in this process of checks and balances and creation of a favorable environment for the process. 

 Pfizer has been partnering with universities to train health care workers in Rwanda which is an example of the effective team work between academia and the private sector in promoting aid effectiveness. (Pierce, 2006)

Other examples of partnering with a purpose which has been successful is the HIV Equity Initiative launched in 1998 by Partners in Health (PIH) in Haiti and this has the unique distinction of being the first programme in the world to provide free services and HIV/AIDS treatment to socially disenfranchised populations, and members of academia have been active partners in this initiative  and many of the other projects undertaken by PIH. (PIH, 2009)

The Academic Response

Academia in recent times has begun to shape global health training programmes to educate and empower health professionals through cross-disciplinary didactic and experiential and by providing a hands-on learning experience which includes service delivery. As a result academic programmes in global health have been established in the global north and global south and have included well-rounded curriculum which focuses on both qualitative and quantitative research methodology, data collection and analysis, and social science, (Garrett L., 2007) These programmes also include the principles of behavioral science, technology and practice of public health incorporating the social determinants of health. Some examples of innovative courses included in the curriculum in schools which train the next generation of global health workers include gold standards for global health practice, training community health workers  and the development and political economy to name a few.

In an effort to bring academics, diplomats and other stakeholders together, in June 2007, the Graduate Institute of International Studies, Geneva (HEI), welcomed 18 participants, with professional backgrounds in both diplomacy and health and representing 10 countries, to the first Summer Program on Global Health Diplomacy.

This programme was designed to be interactive and the participants were able to engage with a faculty of health professionals and diplomats to share views and professional experiences from their work. The goals of the course were to focus on health diplomacy as it relates to health issues that cross national boundaries and are global in nature; and discuss the challenges facing health diplomacy and how they have been addressed by different groups and at different levels of governance. In recent years health diplomacy is seen to play an important role in aid effectiveness as it is instrumental in addressing the interdependence / interface between foreign policy and health which attempts to create policy coherence between the various stakeholders. (Kickbusch et al, 2007)

Academia has an important role to play in shaping the governmental and non-governmental emphasis on health in international relations at present, especially in lieu of the various conflicts such as the ongoing armed conflicts and societal instability in Afghanistan, Iraq and the Middle East and recognizing this the World Health Organization (WHO) has been working with academic institutions globally to address maternal and child health. This partnership has resulted in the establishment of the maternal and child health division within the Colorado School of Public Health’s Center for Global Health, designated by the  WHO as a WHO Collaborating Centre for Promoting Family and Child Health. This center has been collaborating with WHO and the Pan American Health Organization (PAHO) with a focus on the following  areas:

• Assist countries in reducing health inequality and excessive morbidity and mortality among mothers, infants, children and adolescents;

• Accelerate vaccine research and implementation;

• Train vulnerable communities and countries in disaster preparedness in ways that will meet the needs of children; and

• Train doctors, nurses, midwives and other birth attendants in the Helping Babies Breathe Program, to reduce neonatal asphyxia. (Center for Global Health, n.d.)

The above-mentioned objectives are crucial in making donors aware of the outcome of their investment and also are instrumental in compiling data driven outcomes which are needed for monitoring and evaluation and for replication of  projects which meet the criteria of being designated  as best practices.

The landscape of global health, diplomacy, donors aid recipients, sustainable development and foreign relations has changed in the past decade and thus the global community needs a new lens on what is effective in global health and how to view the dynamic and fluid landscape of global health. This lens is academia.

Aid workers and academics can collaborate well in enhancing aid effectiveness and sustainable development. Many academic institutions have included the field of developmental studies in their curricula. It is not uncommon to have academics take on the dual responsibility i.e. teaching at an institution and also of working in the field as aid workers and mentoring students and local stakeholders in data driven service delivery. The Asia Foundation embarked on a multi-year collaboration in 2012 with the London School of Economics named the “Justice and Security Research Program” (JSRP) to look into the “theories of change” which focuses on the ultimate impact on the health status of the global populations. This initiative by the foundation has been instrumental in providing a platform for academics and aid practitioners to engage with each other, both in an intellectual and a practical manner. “On the one hand they allow practitioners to directly tie research to their actual programs on the ground. On the other, they allow academics to look at the relative causality of aid programs in relation to wider social change.” (Arnold, 2013). This collaborative project has resulted in identifying areas where academia and aid workers can work in teams effectively to strengthen the quality of development assistance provided and maximize aid effectiveness. In addition, the findings provided as a result of such research have started to influence programmatic management, within Asia Foundation country offices and can be used effectively to attract donor finding. (Arnold, 2013)

Recognizing the dynamic and powerful resources academia offers in 2009 the United Nations launched the United Nations Academic Impact (UNAI) and launched a global partnership with universities to promote aid effectiveness and sustainable development. Institutions globally are partnering with United Nations agencies and donors to ensure aid effectives and sustainable development. One of the mechanisms used is that they committed to advance the following 10 principles listed below:

1. A commitment to the principles inherent in the Charter of the United Nations as values that education seeks to promote and help fulfill;
2. A commitment to human rights, among them freedom of inquiry, opinion and speech;
3. A commitment to educational opportunity for all people regardless of gender, race, religion or ethnicity;
4. A commitment to the opportunity for every interested individual to acquire the skills and knowledge necessary for the pursuit of higher education;
5. A commitment to building capacity in higher education systems across the world;
6. A commitment to encouraging global citizenship through education;
7. A commitment to advancing peace and conflict resolution through education;
8. A commitment to addressing issues of poverty through education;
9. A commitment to promoting sustainability through education;
10. A commitment to promoting intercultural dialogue and understanding, and the “unlearning” of intolerance through education. (United Nations Academic Impact, 2014)

The authors recommend the adoption and incorporation of the 10 UNAI principles into the service delivery mechanisms by all academic institutions which work in global health as the gold standard of academic practice.  

Conclusion

The landscape of global health, diplomacy, donors aid recipients, sustainable development and foreign relations have changed rapidly since the past decade and thus the global community needs a new lens on what is effective in global health and how to view  this dynamic and fluid landscape, and this lens is academia. The role played by academia is becoming more prominent in the post-2015 development agenda and the United Nations. Recognizing the positive impact that academia has in promoting aid effectiveness, the various United Nations agencies have been appointing renowned academics as advisors and consultants to promote this agenda and to take it from theory to practice.

Aid workers and academics can collaborate well in enhancing aid effectiveness and sustainable development. Many academic institutions have included the field of developmental studies in their curricula. It is not uncommon to have academics take on the dual responsibility i.e. teaching at an institution and also of working in the field as aid workers and mentoring students and local stake holders in data driven service delivery. The theories of change have focused on the socioeconomic determinants prevalent in society and have been important in providing a platform for academics and aid practitioners to engage with each other, both in an intellectual and a practical manner. “On the one hand they allow practitioners to directly tie research to their actual programs on the ground. On the other, they allow academics to look at the relative causality of aid programs in relation to wider social change.”(Arnold, 2013). Arnold’s collaborative project has resulted in identifying areas where academia and aid workers can work in teams effectively to strengthen the quality of development assistance provided and maximize aid effectiveness. In addition the findings have started to influence programmatic management, within the Asia Foundation country offices and can be used effectively to attract donor finding. (Arnold, 2013)

Some of the perceived disadvantages of academic partnering in aid effectiveness may include increased costs, narrow research which some donors feel is too complicated and time consuming. In addition academic research methods and evaluation may be viewed as being complicated and cannot be shared before translating it into a format which can be easily understood by all the stakeholders. This may contribute to an additional expense and time before a clear picture of the success or failure of the project is known. Some donors may hesitate to seek academic input for the projects they are funding due to the so-called inflexible and impractical outlook of the academic institutions and their faculty.

However, the advantages of partnering with academia in the opinion of the authors outweigh the disadvantages due to its impact in demonstrating evidence-based interventions and preparing the future global health professionals.

 In conclusion, academic institutions can be effective partners working at many levels with various stakeholders such as the private sector and foundations, in maximizing aid effectiveness and in ascertaining that the allocated funds contribute to the long-term sustainable development of communities.  This can be summed up well by this quote ”If we can work toward instilling some of the rigor, objectivity and ethics of academia into the more practical, decisive, dynamic world of international development, both will be better off.” (Svenson, 2001)

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