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	<title>Comments on: Linking aid to results: why are some development workers anxious?</title>
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	<link>http://www.owen.org/blog/2852</link>
	<description>Thoughts on development and beyond</description>
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		<title>By: Linking Aid to Results: Why Are Some Development Workers Anxious? (Guest post by Owen Barder) &#124; Nancy Birdsall &#124; Global Development: Views from the Center</title>
		<link>http://www.owen.org/blog/2852/comment-page-1#comment-5616</link>
		<dc:creator>Linking Aid to Results: Why Are Some Development Workers Anxious? (Guest post by Owen Barder) &#124; Nancy Birdsall &#124; Global Development: Views from the Center</dc:creator>
		<pubDate>Mon, 01 Mar 2010 22:30:09 +0000</pubDate>
		<guid isPermaLink="false">http://www.owen.org/?p=2852#comment-5616</guid>
		<description>[...] I am pleased to share with our readers at Owen’s request this discussion of Cash on Delivery Aid, which appeared yesterday on his blog, Owen Abroad. [...]</description>
		<content:encoded><![CDATA[<p>[...] I am pleased to share with our readers at Owen’s request this discussion of Cash on Delivery Aid, which appeared yesterday on his blog, Owen Abroad. [...]</p>
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		<title>By: Kate</title>
		<link>http://www.owen.org/blog/2852/comment-page-1#comment-4903</link>
		<dc:creator>Kate</dc:creator>
		<pubDate>Fri, 18 Dec 2009 13:04:49 +0000</pubDate>
		<guid isPermaLink="false">http://www.owen.org/?p=2852#comment-4903</guid>
		<description>Isn&#039;t there a questionable logic to this -  if you are targeting aid towards the governments that produce the best results, doesn&#039;t that miss out those most in need?

&lt;em&gt;

&lt;strong&gt;Owen replies:
&lt;/strong&gt;
Kate - CAFOD made a similar point in their brief on Cash on Delivery aid.  &lt;a href=&quot;http://www.owen.org/blog/2864&quot; rel=&quot;nofollow&quot;&gt;Take a look at their brief, and my response, here&lt;/a&gt;.

My view is that we need a simple mechanism (like Cash on Delivery, though it needs to be tested) that funnels aid to governments that can use it well, with the minimum of hassle and interference from outside; and a different funding mechanism for governments that cannot, or will not, provide services to the poor. In the latter case, it is unlikely that providing them with a lot of money will do the trick - that&#039;s rather like pushing on a piece of string.  For them, the interventions might not involve a lot of money, but some combination of support for civil society and capacity building (though done well, unlike most capacity building in development).  Giving a lot of money to governments that don&#039;t deliver deprives the citizens of countries that could use the money of services, while doing little if anything for the citizens of the country that can&#039;t or won&#039;t deliver.&lt;/em&gt;</description>
		<content:encoded><![CDATA[<p>Isn&#8217;t there a questionable logic to this &#8211;  if you are targeting aid towards the governments that produce the best results, doesn&#8217;t that miss out those most in need?</p>
<p><em></p>
<p><strong>Owen replies:<br />
</strong><br />
Kate &#8211; CAFOD made a similar point in their brief on Cash on Delivery aid.  <a href="http://www.owen.org/blog/2864" rel="nofollow">Take a look at their brief, and my response, here</a>.</p>
<p>My view is that we need a simple mechanism (like Cash on Delivery, though it needs to be tested) that funnels aid to governments that can use it well, with the minimum of hassle and interference from outside; and a different funding mechanism for governments that cannot, or will not, provide services to the poor. In the latter case, it is unlikely that providing them with a lot of money will do the trick &#8211; that&#8217;s rather like pushing on a piece of string.  For them, the interventions might not involve a lot of money, but some combination of support for civil society and capacity building (though done well, unlike most capacity building in development).  Giving a lot of money to governments that don&#8217;t deliver deprives the citizens of countries that could use the money of services, while doing little if anything for the citizens of the country that can&#8217;t or won&#8217;t deliver.</em></p>
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		<title>By: Jeff</title>
		<link>http://www.owen.org/blog/2852/comment-page-1#comment-4896</link>
		<dc:creator>Jeff</dc:creator>
		<pubDate>Fri, 18 Dec 2009 03:53:54 +0000</pubDate>
		<guid isPermaLink="false">http://www.owen.org/?p=2852#comment-4896</guid>
		<description>I&#039;m an experienced development worker who would love to see pay for performance/cash on delivery implemented and effective.  Many of us are sick of all the undue focus on processes and to little focus on results.

But let&#039;s be clear.  This is still mostly an untested concept.  There are lots of devils in lots of details yet to be discovered.   The key area is how you define and measure results.  If not defined properly you still end up paying for processes (redefined as results) and not getting outcomes that matter.   Reread your own blog on Targets, Owen, and all of those issues you rightly raise describe the risks involved in pay for performance.

  There are other issues of attribution.  Will donors feel good about paying for results when there is evidence that it had nothing to do with what the government or implementing agency did, but was just good luck?   And the opposite case-- what if the implementing agency made a serious, best practice effort but didn&#039;t get the desired results due to factors beyond its control-- war, environmental disaster, etc.

&lt;em&gt;Jeff - I agree with this - especially that it is untested and that the devil is in the detail.  I think we should test it.  (Some of the points you raise are partly addressed in &lt;a href=&quot;http://www.owen.org/blog/2864&quot; rel=&quot;nofollow&quot;&gt;my response to the CAFOD brief&lt;/a&gt;.  &lt;/em&gt;</description>
		<content:encoded><![CDATA[<p>I&#8217;m an experienced development worker who would love to see pay for performance/cash on delivery implemented and effective.  Many of us are sick of all the undue focus on processes and to little focus on results.</p>
<p>But let&#8217;s be clear.  This is still mostly an untested concept.  There are lots of devils in lots of details yet to be discovered.   The key area is how you define and measure results.  If not defined properly you still end up paying for processes (redefined as results) and not getting outcomes that matter.   Reread your own blog on Targets, Owen, and all of those issues you rightly raise describe the risks involved in pay for performance.</p>
<p>  There are other issues of attribution.  Will donors feel good about paying for results when there is evidence that it had nothing to do with what the government or implementing agency did, but was just good luck?   And the opposite case&#8211; what if the implementing agency made a serious, best practice effort but didn&#8217;t get the desired results due to factors beyond its control&#8211; war, environmental disaster, etc.</p>
<p><em>Jeff &#8211; I agree with this &#8211; especially that it is untested and that the devil is in the detail.  I think we should test it.  (Some of the points you raise are partly addressed in <a href="http://www.owen.org/blog/2864" rel="nofollow">my response to the CAFOD brief</a>.  </em></p>
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		<title>By: Luis Enrique</title>
		<link>http://www.owen.org/blog/2852/comment-page-1#comment-4894</link>
		<dc:creator>Luis Enrique</dc:creator>
		<pubDate>Thu, 17 Dec 2009 21:18:15 +0000</pubDate>
		<guid isPermaLink="false">http://www.owen.org/?p=2852#comment-4894</guid>
		<description>I think I&#039;ve mentioned this before, but it seems relevant here and I was reminded of it after attending a conference on &#039;public service behaviour&#039; (PSB). PSB is something that workers in the public sector are thought to possess, often by people who object to private sector style financial incentives coming in an obliterating all the nice PSB. But what is PSB? One answer is that you care about helping people, but if you cared about helping people you could choose to earn a lot of money and then donate to charitable organisations, or pay lots of taxes, rather than working trying to help people yourself. So maybe there&#039;s something about what motivates people in &#039;doing good&#039; jobs that has to do with wanting to do it themselves. 

I&#039;m not sure this is terribly insightful, it&#039;s just another way of describing/explaining the resistance to cash on delivery aid you report. I&#039;m not sure whether one would say this tendency is so strong that you ought to give up on cash on delivery aid and go home, because the donors are never going to wear it, for this reason, or whether it simply explains how you have some barriers to over come, which can nonetheless be overcome. 

There now follows a cheap point - what would your CoD education donors do if it turned out the recipients were effectively educating their young citizens in creationism, and that homosexuals ought to be executed? It&#039;s not so easy to focus on effectiveness and leave policy to recipients, when policy is what you are being effective &lt;i&gt;at&lt;/a&gt;.</description>
		<content:encoded><![CDATA[<p>I think I&#8217;ve mentioned this before, but it seems relevant here and I was reminded of it after attending a conference on &#8216;public service behaviour&#8217; (PSB). PSB is something that workers in the public sector are thought to possess, often by people who object to private sector style financial incentives coming in an obliterating all the nice PSB. But what is PSB? One answer is that you care about helping people, but if you cared about helping people you could choose to earn a lot of money and then donate to charitable organisations, or pay lots of taxes, rather than working trying to help people yourself. So maybe there&#8217;s something about what motivates people in &#8216;doing good&#8217; jobs that has to do with wanting to do it themselves. </p>
<p>I&#8217;m not sure this is terribly insightful, it&#8217;s just another way of describing/explaining the resistance to cash on delivery aid you report. I&#8217;m not sure whether one would say this tendency is so strong that you ought to give up on cash on delivery aid and go home, because the donors are never going to wear it, for this reason, or whether it simply explains how you have some barriers to over come, which can nonetheless be overcome. </p>
<p>There now follows a cheap point &#8211; what would your CoD education donors do if it turned out the recipients were effectively educating their young citizens in creationism, and that homosexuals ought to be executed? It&#8217;s not so easy to focus on effectiveness and leave policy to recipients, when policy is what you are being effective <i>at.</i></p>
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		<title>By: James Richardson</title>
		<link>http://www.owen.org/blog/2852/comment-page-1#comment-4892</link>
		<dc:creator>James Richardson</dc:creator>
		<pubDate>Thu, 17 Dec 2009 19:34:44 +0000</pubDate>
		<guid isPermaLink="false">http://www.owen.org/?p=2852#comment-4892</guid>
		<description>O

This reminds me of the debate in the UK voluntary sector when NCVO (National Council for Voluntary Organisations) published a book on &quot;Outcome Funding&quot; from the US-based Rensselaerville Institute and invited the authors over to the UK.

Not sure what came of it all, but it certainly provoked strong views on both sides of the debate.

Looks from their website like it is still available:

http://www.rinstitute.org/publication_detail.php?prodid=2

James</description>
		<content:encoded><![CDATA[<p>O</p>
<p>This reminds me of the debate in the UK voluntary sector when NCVO (National Council for Voluntary Organisations) published a book on &#8220;Outcome Funding&#8221; from the US-based Rensselaerville Institute and invited the authors over to the UK.</p>
<p>Not sure what came of it all, but it certainly provoked strong views on both sides of the debate.</p>
<p>Looks from their website like it is still available:</p>
<p><a href="http://www.rinstitute.org/publication_detail.php?prodid=2" rel="nofollow">http://www.rinstitute.org/publication_detail.php?prodid=2</a></p>
<p>James</p>
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		<title>By: Ennis</title>
		<link>http://www.owen.org/blog/2852/comment-page-1#comment-4891</link>
		<dc:creator>Ennis</dc:creator>
		<pubDate>Thu, 17 Dec 2009 18:08:05 +0000</pubDate>
		<guid isPermaLink="false">http://www.owen.org/?p=2852#comment-4891</guid>
		<description>Any sense of whether donors will pay for governments to experiment with different approaches? Paying for results is a good thing, but nobody knows how to get to these results, so presumably some trial-and-error will be required. Yet even without the measurement costs, just changing the way business is done isn&#039;t cheap. Is there startup money in this proposal?</description>
		<content:encoded><![CDATA[<p>Any sense of whether donors will pay for governments to experiment with different approaches? Paying for results is a good thing, but nobody knows how to get to these results, so presumably some trial-and-error will be required. Yet even without the measurement costs, just changing the way business is done isn&#8217;t cheap. Is there startup money in this proposal?</p>
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		<title>By: LH</title>
		<link>http://www.owen.org/blog/2852/comment-page-1#comment-4890</link>
		<dc:creator>LH</dc:creator>
		<pubDate>Thu, 17 Dec 2009 18:04:26 +0000</pubDate>
		<guid isPermaLink="false">http://www.owen.org/?p=2852#comment-4890</guid>
		<description>Thank you for an interesting post and the comments. I wholeheartedly agree that we should be looking for more effective approaches to aid and that we should also examine the consequences - intended and unintended - of the new approaches. 

I have seen issues with the measurement, as mentioned in the first comment. For example, GAVI takes a performance-based measurement approach and I&#039;ve seen countries falsely inflate their numbers so as to secure more GAVI support. My personal observations are backed up by a Lancet study (http://www.aegis.com/news/ap/2008/AP081240.html). I&#039;ve also seen countries falsely deflate their numbers to maintain eligibility for GAVI funds. I&#039;m not blaming GAVI for this; they are well aware of the limitations of the funding approach. 

I think April also makes a good point. If we look at education reform in the US, we see a good example of what she&#039;s talking about. The Bush administration instituted a pay-for-performance approach by funding public schools based on standardized test performance. The result is that teachers teach to the test rather than teaching students to be critical thinkers. Another result is that courses that don&#039;t directly affect test scores (e.g. music, health) are the first courses to be cut, despite their importance to developing well-rounded, productive members of society. 

I&#039;m not saying that performance-based aid is a bad idea. I am saying that we should think about how the mechanisms provide incentives and what they provide incentive for.</description>
		<content:encoded><![CDATA[<p>Thank you for an interesting post and the comments. I wholeheartedly agree that we should be looking for more effective approaches to aid and that we should also examine the consequences &#8211; intended and unintended &#8211; of the new approaches. </p>
<p>I have seen issues with the measurement, as mentioned in the first comment. For example, GAVI takes a performance-based measurement approach and I&#8217;ve seen countries falsely inflate their numbers so as to secure more GAVI support. My personal observations are backed up by a Lancet study (<a href="http://www.aegis.com/news/ap/2008/AP081240.html" rel="nofollow">http://www.aegis.com/news/ap/2008/AP081240.html</a>). I&#8217;ve also seen countries falsely deflate their numbers to maintain eligibility for GAVI funds. I&#8217;m not blaming GAVI for this; they are well aware of the limitations of the funding approach. </p>
<p>I think April also makes a good point. If we look at education reform in the US, we see a good example of what she&#8217;s talking about. The Bush administration instituted a pay-for-performance approach by funding public schools based on standardized test performance. The result is that teachers teach to the test rather than teaching students to be critical thinkers. Another result is that courses that don&#8217;t directly affect test scores (e.g. music, health) are the first courses to be cut, despite their importance to developing well-rounded, productive members of society. </p>
<p>I&#8217;m not saying that performance-based aid is a bad idea. I am saying that we should think about how the mechanisms provide incentives and what they provide incentive for.</p>
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		<title>By: C Montes</title>
		<link>http://www.owen.org/blog/2852/comment-page-1#comment-4889</link>
		<dc:creator>C Montes</dc:creator>
		<pubDate>Thu, 17 Dec 2009 17:49:14 +0000</pubDate>
		<guid isPermaLink="false">http://www.owen.org/?p=2852#comment-4889</guid>
		<description>Agree, April...</description>
		<content:encoded><![CDATA[<p>Agree, April&#8230;</p>
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		<title>By: April</title>
		<link>http://www.owen.org/blog/2852/comment-page-1#comment-4887</link>
		<dc:creator>April</dc:creator>
		<pubDate>Thu, 17 Dec 2009 13:34:46 +0000</pubDate>
		<guid isPermaLink="false">http://www.owen.org/?p=2852#comment-4887</guid>
		<description>Great blog post Owen.
I definitely think COD aid merits piloting and studying. It has great potential to change aid relations for the better.
Still, I have a nagging worry that comes from my familiarity with some negative repercussions of enhanced results focus in some health programs.  What I&#039;ve seen is that often an enhanced-results focus (with results measured in the most common and feasible ways - usually from household surveys) can lead to applying less systemic and less sustainable approaches to health problems. System-strengthening efforts that may benefit many health problems at once (say, improving drug supplies management and distribution systems; or changing the rules so that health workers with less training can do a broader range of tasks; or increasing the formation of health workers) won&#039;t show up very easily in most of the results we monitor (since we rely mainly on household surveys, our results tend to be stuff like incidence of specific symptoms, or stated ownership and use of bednets, and services utilization).  Because of this, an intense results focus often leads to focusing on more vertical and less sustainable approaches (e.g. campaign style immunization programs vs strengthening immunization within routine services; bednet handouts vs working to generate demand and use, as well as supply systems).
Perhaps COD aid will generate pressure to come up with better results metrics and measures - though there is much effort already, and I&#039;m not aware of any great strides forward. 
One important thing that needs to happen for us to do better in this regard is starting something like DHS surveys but for the health service/ product provision system.  The info that you can get on systems functioning from households will never allow us to really reward sustainable health systems strengthening.</description>
		<content:encoded><![CDATA[<p>Great blog post Owen.<br />
I definitely think COD aid merits piloting and studying. It has great potential to change aid relations for the better.<br />
Still, I have a nagging worry that comes from my familiarity with some negative repercussions of enhanced results focus in some health programs.  What I&#8217;ve seen is that often an enhanced-results focus (with results measured in the most common and feasible ways &#8211; usually from household surveys) can lead to applying less systemic and less sustainable approaches to health problems. System-strengthening efforts that may benefit many health problems at once (say, improving drug supplies management and distribution systems; or changing the rules so that health workers with less training can do a broader range of tasks; or increasing the formation of health workers) won&#8217;t show up very easily in most of the results we monitor (since we rely mainly on household surveys, our results tend to be stuff like incidence of specific symptoms, or stated ownership and use of bednets, and services utilization).  Because of this, an intense results focus often leads to focusing on more vertical and less sustainable approaches (e.g. campaign style immunization programs vs strengthening immunization within routine services; bednet handouts vs working to generate demand and use, as well as supply systems).<br />
Perhaps COD aid will generate pressure to come up with better results metrics and measures &#8211; though there is much effort already, and I&#8217;m not aware of any great strides forward.<br />
One important thing that needs to happen for us to do better in this regard is starting something like DHS surveys but for the health service/ product provision system.  The info that you can get on systems functioning from households will never allow us to really reward sustainable health systems strengthening.</p>
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		<title>By: Amy Pollard</title>
		<link>http://www.owen.org/blog/2852/comment-page-1#comment-4884</link>
		<dc:creator>Amy Pollard</dc:creator>
		<pubDate>Thu, 17 Dec 2009 11:38:22 +0000</pubDate>
		<guid isPermaLink="false">http://www.owen.org/?p=2852#comment-4884</guid>
		<description>Owen, thank you for your interesting and full response to the CAFOD briefing on Cash on Delivery Aid (COD) in your previous post. This provides some interesting points for the debate. However I am a bit confused by your assertion that the risks identified in our briefing “are not primarily about the consequences for development but rather risks to the privileged position enjoyed by professional staff in aid agencies and NGOs”.

Your post raises some interesting points about why COD may be seen as a threat to a few people who work in government donor agencies and raises important points about incentives for such staff. However, to suggest that individuals within CAFOD are feeling these threats is to misunderstand the work of CAFOD.

We are a partnership agency. We do not implement programmes directly but work with local civil society, particularly agencies of the Catholic Church. A large part of the work we do is to help these groups hold their governments to account so a move to COD aid, if it works as you say, could help support this work. I don’t think that roles within CAFOD would change significantly if this system was adopted.

A discussion on incentives is a valid dimension but CAFOD’s arguments should be taken as a contribution to the debate rather than seen as motivated by this.

&lt;em&gt;Thanks Amy. I did not mean to imply that you personally, or anyone at CAFOD, felt threatened by results-based aid.  I have never discussed results-based aid with you or anyone else at CAFOD so I would have no basis for thinking that.  But the issues raised in your paper - which are consistent with some of the concerns expressed by other people in other forums - mainly boil down to the question of whether developing countries should be able to decide for themselves how to deliver services and to whom, and be accountable for that; or whether donors should continue to try to intervene in that process.  Those are concerns that I hear raised by development professionals whose work might be affected by moving to results based aid in the way I describe.  (They are people in NGOs as well as government agencies.  I have heard several people in NGOs oppose results-based aid because the government, given a choice, might not choose to deliver services through them.)  It is the motives and interests of these people that I am talking about, not yours.  And, as I hope I made clear in the post, I think very highly of people who work in development, and there are many people who would take a very different view from the generalisation that I have presented here.&lt;/em&gt;</description>
		<content:encoded><![CDATA[<p>Owen, thank you for your interesting and full response to the CAFOD briefing on Cash on Delivery Aid (COD) in your previous post. This provides some interesting points for the debate. However I am a bit confused by your assertion that the risks identified in our briefing “are not primarily about the consequences for development but rather risks to the privileged position enjoyed by professional staff in aid agencies and NGOs”.</p>
<p>Your post raises some interesting points about why COD may be seen as a threat to a few people who work in government donor agencies and raises important points about incentives for such staff. However, to suggest that individuals within CAFOD are feeling these threats is to misunderstand the work of CAFOD.</p>
<p>We are a partnership agency. We do not implement programmes directly but work with local civil society, particularly agencies of the Catholic Church. A large part of the work we do is to help these groups hold their governments to account so a move to COD aid, if it works as you say, could help support this work. I don’t think that roles within CAFOD would change significantly if this system was adopted.</p>
<p>A discussion on incentives is a valid dimension but CAFOD’s arguments should be taken as a contribution to the debate rather than seen as motivated by this.</p>
<p><em>Thanks Amy. I did not mean to imply that you personally, or anyone at CAFOD, felt threatened by results-based aid.  I have never discussed results-based aid with you or anyone else at CAFOD so I would have no basis for thinking that.  But the issues raised in your paper &#8211; which are consistent with some of the concerns expressed by other people in other forums &#8211; mainly boil down to the question of whether developing countries should be able to decide for themselves how to deliver services and to whom, and be accountable for that; or whether donors should continue to try to intervene in that process.  Those are concerns that I hear raised by development professionals whose work might be affected by moving to results based aid in the way I describe.  (They are people in NGOs as well as government agencies.  I have heard several people in NGOs oppose results-based aid because the government, given a choice, might not choose to deliver services through them.)  It is the motives and interests of these people that I am talking about, not yours.  And, as I hope I made clear in the post, I think very highly of people who work in development, and there are many people who would take a very different view from the generalisation that I have presented here.</em></p>
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		<title>By: C Montes</title>
		<link>http://www.owen.org/blog/2852/comment-page-1#comment-4883</link>
		<dc:creator>C Montes</dc:creator>
		<pubDate>Thu, 17 Dec 2009 10:39:27 +0000</pubDate>
		<guid isPermaLink="false">http://www.owen.org/?p=2852#comment-4883</guid>
		<description>Great blog! 

Who can oppose rewarding outcomes? BUT measurement is tricky/dodgy even in the UK &amp; reliable measurement requires democratic accountability and feedback and a lot of transparency. Not always ;-) present in developing countries. This is not mentioned in your blog, neither by CAFOD -I think.  

I feel like a reactionary and it does not feel good. However, my long and tedious work on performance management (including UK govt. targets) and on data (as a little boy in the Central Bank of Peru) leave me no option but to be a bit skeptic of cash on aid delivery without democratic accountability.</description>
		<content:encoded><![CDATA[<p>Great blog! </p>
<p>Who can oppose rewarding outcomes? BUT measurement is tricky/dodgy even in the UK &amp; reliable measurement requires democratic accountability and feedback and a lot of transparency. Not always <img src='http://www.owen.org/wp-includes/images/smilies/icon_wink.gif' alt=';-)' class='wp-smiley' />  present in developing countries. This is not mentioned in your blog, neither by CAFOD -I think.  </p>
<p>I feel like a reactionary and it does not feel good. However, my long and tedious work on performance management (including UK govt. targets) and on data (as a little boy in the Central Bank of Peru) leave me no option but to be a bit skeptic of cash on aid delivery without democratic accountability.</p>
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