Comments

Hi Sam, Good post. I would add two points: 1. I don't know what parts of the Pacific Minister Bishop has been to, or which hills she has scaled, but Coke was scarce in the parts of rural Solomons I travelled through. Rural health clinics, on the other hand, while under-resourced, were present, could provide first aid, and were possibly the cause of the decline in Malaria that was frequently commented on by people I spoke to. 2. Beyond that: Coke and medicines are, conceptually, two very different things. Coke is a private good (we don't worry too much if people can't afford it); medicines are merit goods (we hope to live in a world where anyone can access the medicines that they need). With private goods it is comparatively easy to leave it to markets to deliver (and if they don't it's not usually the end of the world). With merit goods there is often a need for government subsidies to make sure that everyone has access. But having the government subsidising private delivery networks brings with it accountability and political economy risks of its own. (How do we know the private sector is actually delivering what it says it has? And can we be sure that the potential for profit is not causing it to exert undue influence on what should be technocratic or democratic decisions about distribution?) This doesn't mean we should never engage with the private sector in delivery, but it does complicate matters considerably, particularly in poorly functioning polities. Thanks for a good post on what sounds, at first glance, to be a poorly thought through decision. Terence

Hi Jo, That's a very good question. As you note, DFAT/AusAID has been doing elements of health system strengthening for a long time and the evidence of positive impact in PNG and Solomons is probably limited. The strategy does not directly cite successes from the Pacific. A couple examples of positive results from Indonesia and Cambodia are noted. Others have critiqued the focus on health systems noting that the global results are not amazing - but the Lancet paper tries to address that - and I really don't see any alternative to focusing on health systems. No one ever said it was gonna be easy!

I abhor cuts to Australian Aid but are Afghan health and education programs sustainable in the present security climate?

Thanks Joel. I've been meaning to read the health strategy and your blog means I can cross it off the list. It offers a comprehensive summary. A question. Australia has engaged with some countries over quite long time periods to strengthen their health systems, such as Fiji and the Solomon Islands. Did the strategy reflect on, or incorporate, any learning from past DFAT (AusAID) experience in this area?

We the people of Gulf must mentally change our attitudes of asking MPs for money please..!! Money will never get us out of the way instead. You eat and use money but you will never change and improve in all areas of physical lives, therefore, we must all cry, beg and ask for services and new developments.

It's true Dr. Amanda, I agree with you that mobile phone sms is one cheapest and fastest way of sending and receiving data on time. It truly covers the gap for poor internet services, poor postal services, poor telephone link etc... Practically, mobile phone sms is very helpful regarding timely data. Thank you Tina

Large numbers, but getting substantially smaller. Having said that I concede the point re average income -- as I made clear in my post, but possibly not in my comment, distribution does matter. Have a good weekend.

'This is contra to your claim that a “very large number are being left behind”'. It all hangs on the definition of 'very large numbers'. In India, about which I know a little, the numbers are very large despite a reasonable social security system to preserve a 'floor'. Where we differ is where you say '[for] aid work the foremost issue remains one of raising average levels of income'. For many aid workers and organisations (even centre-left political parties) it is about a poverty focus and 'lifting the floor'. The 'rising tide does not lift all boats', contra to the views of centre right political parties.

Hi Patrick, Thanks for your comment. My understanding of Ravallion's floor measure is different from yours. As I understand it, he derives (rather than observes) an estimate of the level of consumption that the least well off person globally (or someone approximating to that person) is consuming. This is the value that has not shifted a lot; however, actual proportion of the world's population living at very low levels of consumption ($1 a day ; even 50c a day) has fallen markedly in recent decades (to the extent we trust the data, which I think we can to a degree). This is contra to your claim that a "very large number are being left behind". You can see the falling share of the World's population on slides 31 and 32 of <a href="https://crawford.anu.edu.au/sites/default/files/events/attachments/2015-06/martin_ravallion_-_poorest_left_behind_anu.pdf" rel="nofollow">Ravallion's talk</a>. And, philosophically, for a Utilitarian like myself, as opposed to a Rawlsian, this improvement is more important (with a few caveats) than lifting the floor. Methodologically, I'm still unclear as to how Ravallion can detail a reduction in people living off a consumption level (50c/day) under what he calculates the floor to be (between 47c&87c) and not also see a shift in the floor itself, although I think the issue is hinted at on slide 25 -- which illustrates a falling floor even in a world where poverty has decreased. This points, at least to my thinking, to a significant issue in Ravallion's approach (although I may be missing something, I concede). Beyond all that, please recall that I am in favour of reducing poverty, and think unnecessary economic inequality a bad thing. I just don't believe economic inequality is the most important form of inequality aid workers should be worrying about. Thanks again. Terence

I'm glad I stumbled onto this page and found people with common interests. I totally agree with Dr Watson. I represent the Christian Health Services in PNG. Most, if not all, of our health facilities are located in the remotest part of the country, and you can imagine the issues we are facing with Data Flow/Data Collection. For my case, SMS Data Collection is most definitely the way forward for us. The only problems I foresee is the User Training and the size/structure of data that can be allowed via text messaging. Time does not permit me to go into detail, but currently I am implementing DHIS2, a Health Management System, that has a module for SMS data collection. I just came here to say thank you for your article, and that it gave me the morale that I needed. Alistairs Christian Health Services PNG

Terence, the key point that Martin Ravallion made (at the conference and here at the ANU) is that the 'floor' (the % of very poor) has not moved much in 20+ years. Now that should be of concern to all aid practitioners as that is about the very large number being left behind (and yes most are women, so gender is a key issue in this).

Thanks for the summary - very useful. I'm glad to see DFAT heading in this direction. We've seen some great successes in Indonesia with health systems strengthening projects, so this is quite heartening.