Global Health Watch 1 in one file

Health care systems | B1
the lack of coordination amongst donors and other external agents, more so
now with the recent proliferation of global health initiatives. Ministries of
Health in developing countries are faced with a circus of multiple external
initiatives and programmes (often focused narrowly on specific diseases or
interventions), donors, creditors and international NGOs (Figure B1.2) – this is
hardly conducive to nationally-led decision-making; coordinated and coherent
policy-making and planning; long-term development; or stable and efficient
administration.
Furthermore, external policies and programmes imposed from the outside
are inadequately tailored to local contexts. Policies, approaches and
conceptual tools are often produced within donor circles and then applied
worldwide – but supposedly ‘owned’ by recipients. Many agencies are staffed
by individuals who have little or no understanding of local culture and history,
a problem compounded by high staff turnover (Pfeiffer 2003).
Even in countries where a formal sector-wide approach (SWAp) has been
established to create a health sector strategy shared by all stakeholders and
to enable greater government leadership, the role of government can often
be cosmetic (Hill 2002, Foster, Brown and Conway 2000), while international
agencies preserve their own priorities, working styles, reporting formats, data
collecting forms, financial procedures and short funding cycles. Only where
there is firm government leadership, a clear vision based on a good understanding
of health care problems on the ground, and a demand from NGOs
and civil society for more national coordination, are countries able to resist the
imposition of top-down, blueprint models of health development.
Trade-related reforms
such as TRIPS and
GATS
International
NGOs
GPPIs
Ministries
of Health
Donors
World Bank
and IMF
WHO, UNICEF and
other UN agencies
Figure B1.2 The circus of external agencies and initiatives
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