Sudden deep collapse is still possible, especially as oil extraction actually begins to decrease and we collectively refuse to downsize. Beyond a point the qualitative nature of a system changes; and that’s where we are headed because we do not as a culture see the connections between energy, economy, finance and politics.

The underlying logic of harmonizing “toward” the World Bank’s support I believe is that it is typically focused more on health system strengthening than the funding which flows toward disease goals (e.g. Global Fund, PEPFAR, US President’s Malaria Initiative).
You suggest that the World Bank’s evaluation results call into question whether their lead should be followed in harmonization. As Owen points out, it’s all about comparing existing options.
The Global Fund evaluation, coming in at over 800 pages, was read by few. However, the findings were rather more damning than the World Bank’s. And especially so with respect to the effect of GF support on health systems.
I wrote a brief synthesis of it on the CGD Global Health blog.
http://blogs.cgdev.org/globalhealth/2009/06/give-the-global-fund-a-gold-star-for-their-hard-hitting-evaluationnow-comes-the-hard-part.php

It is a good question because it demonstrates my point very well.

As you say, JP, the Government of Ethiopia has trained 30 000 health workers. This has so far been a remarkable success, and one of which the Government is rightly proud.

The Government of Ethiopia knew exactly what it wanted to do, and it raised the money mainly from its own local revenues, plus support directly from donors and through global funds such as GFATM and GAVI.

So what value did the Global Fund add? It took money from donors, took off some overheads (which are growing out of all recognition at the Global Fund), then delivered the money to the Government of Ethiopia alongside all the other money direct from donors. It got a seat at the table, took up some more time of Ministers and senior officials, and justified its existence by adding some more hoops to jump through. Then it claims this as a “result”.

(Of course, this process is simpler in Ethiopia, whose Health Minister is the chair of the Global Fund, than it is for other countries.)

It is easy for almost any organisation to quote examples of things it funds, and say that this demonstrates that it produces results. Well that depends on what the alternative was. If the money would never have been spent on development, then it is fair enough to count this as a success. But if the money would alternatively have been used for development in some other way, then it is far less clear cut.

The Ethiopian Government did not need the advice and support of the Global Fund for its Health Extension Workers scheme. There are more than enough donors here offering advice. (Indeed many of the donors now claiming to have been part of the success opposed the scheme at the outset, because they thought the health workers should have been given more extensive training).

It would have been better for the money to have been given by the donors directly, without the overheads of the Global Fund and without the costs to the government of having to deal with yet another donor, than getting the same money via yet another organisation taking its cut and claiming part of the credit.

So, to the question of the evidence of the harm done by the Global Fund – again, it depends what you think the alternative is. But compared to the first best alternative of the money flowing directly to the Ethiopian government, without the overheads and strings of the Global Fund, there is no doubt that the strings attached to Ethiopia’s health aid have imposed huge costs and inefficiencies. (See http://www.owen.org/blog/2717 for more details).

Owen

Agree on the joint platform, though. What’s the point of “harmonizing” with the Bank when 75% of its health projects in Africa are unsatisfactory by its own criteria.

The number of intermediary structures is because of a lack of fragmentation: nobody is “their own man” they are just part of a coordinated crowd.

There is added value and instant gratification in it for a donor if he would choose for developing expertise and specialize instead of just joining the crowd.

Belgium has put as a rule for its bilateral programmes to have maximum 2 sectors in a country. The effects on the impact are immediate. Also on the visibility of Belgium. Where it used to be a minor donor in every sector, now they manage to be a player in a few crucial areas of development.

The other option is that sponsors of global initiatives need to “vaccinate” against bureaucratic capture by setting time limits on initiatives. Even when global efforts start with a well defined mission and achieve that mission, they never seem to go away. Why did the donor community have to invent a new mission for UNAIDS? It had been successful beyond anyone’s expectation circa 1996 in raising funding and awareness for AIDS. Now it is just a bureaucratic holdover complicated the landscape with Global Fund, PEPFAR, national programs, etc.

Fascinating article Owen, confronting the un-confrontable.

G

That is a smart and challenging idea. Makes me think of work in organizational sociology when trying to understand the incentives of folks working within such a system. However, I think instances of “collapse” are quite rare. Equilibrium would seem to be more of the same inefficient division of labor. Makes me want to read the book.

You are right about the proliferating number of aid organizations. And I am not talking about NGOs or private firms that implement aid projects, though they are also likely proliferating; I am talking about the growth of more bilateral and multilateral aid agencies giving more and smaller projects. So far, we have identified and collected data on about 90 donor organizations that are directly (bilateral) or indirectly (multilateral) dispensing development finance whose ultimate source is the tax dollars of citizens in donor countries. We know of about 20 additional bilateral aid programs for which we have no data. On project size, there were two papers at the AidData Oxford conference last week that described and then attempted to explain this trend. Here is a link to the papers if interested.

http://aiddata.org/oxford/agenda

Great post. You might be interested in an Aid on the Edge post on the broad theme of complexity and collapse in the context of the 2009 Copenhagen summit.

http://aidontheedge.info/2009/12/01/an-equation-for-copenhagen-conformity-rapid-change-collapse/

Ben

Whether motivated and accountable leaders can emerge in all contexts is debatable. In some places the overlapping interests between political leaders of all stripes, media interests and ‘civil society’ leaders – the elite, simply – depend on careful management of gullible donors and their elaborate schemes. And this can mitigate against anybody breaking away from the pack and really challenging the status quo. Which isn’t to say it can’t be done…..

I sometimes think it would be interesting (if terrifying) to try and calculate how many expensive expat man-hours are being spent on donor coordination groups (at last count there were 30 of these such groups in Mozambique), where from my limited experience more time goes into sharing information about what each donor is doing, and creating complicated matrices, than actually dividing up the work.

I hold some hope that improvements in information flows will help at various levels. But these potential dynamics for enhanced accountability seems fairly easily manipulable. Whichever agency is willing to spend a lot on PR/ advocacy can easily influence popular perceptions in their favor. The Global Fund is very effective on this score.

I think your ideas about how to turn this complexity into a pluralism that can support meaningful choice and competition at different levels should be much more discussed.

Not sure how time consuming it’d be, but perhaps you could post a blog entry on each “level” of the aid system where you suggested new arrangements/ models in your “Beyond Planning” paper? I think it’d expose even more people to your ideas. Aid practitioners…as you know…often don’t have time to read papers.

Justin – I understand your point of view. But I suspect that the combination of waning public support, frustrations in developing countries at the old way of doing things, and the proliferation of alternative models may drive change that is faster and more radical than those who are immersed in the aid industry currently recognise.