Anar Ulikpan
This post is one of the two introductions to this week’s international health policies newsletter.

No country is completely independent in today’s globalized world. When it comes to health and development, that is even more the case. Interdependence, like biodiversity, is necessary and essential despite the inevitable disadvantages. Drawing on my experience at the Mongolian Ministry of Health and with various international agency funded projects (knowing both sides of the fence, so to speak) I want to share some of my thoughts and observations on the relationship between donors and recipient countries and their approaches in working together for health. However, the more I learn about current development relationships, health and development, the more new questions seem to pop up rather than answers found.

Globally, a number of initiatives and strategies such as Sector-wide Approach (SWAp), IHP+, Health 8 (H8) have been introduced in recent years in order to improve the effectiveness of development aid. These initiatives are all mainly based on (or inspired by) the Paris Declaration (or vice versa) despite their differences in name, origin and signatory parties. However, these donor initiatives are often limited by set time frames and focuses, while Governments must constantly look at a health system as whole. They don’t have the privilege of focusing on only their areas of comparative advantage like donor agencies do. How to find the right balance and approach to arrive at a win-win situation? How can they work together, as eventually equal partners for development, and thus go beyond the typical ‘Donor and Recipient’ relationship?
We may need to take some distance first and look at how development is interpreted in different nations. Obviously, understanding country or community values is very important to grasp what development could mean for particular countries or communities.

Asian values are often defined in line with Mahathir and Lee’s views, rulers of Malaysia and Singapore respectively. In their view, Asian values emphasize the community rather than the individual, prefer order and stability to personal freedom, insist on hard work and respect for political leaders, and hold the belief that government and business need not necessarily be natural adversaries. Lee even claims that (too much) freedom and civil rights can hamper economic growth. Asian values, defined this way, conflict to some extent with Western values, especially with those that seem to put excessive emphasis on the individual rather than the community, or display a lack of social discipline and great tolerance for eccentricity and abnormality in social behaviour. As a newly emerging democratic country, Mongolia sits somewhere on the fence, in between the two values systems: transiting from collectivism to individualism; from authoritarianism to democracy. Therefore, Mongolia often faces development dilemmas resulting from the co-existence of differing value systems. How often do donors take these invisible but essential domestic values really into account when developing their strategy, styles and approaches in exchanges and negotiations with developing countries? Hard to say. At the same time though, we don’t want to fall into the trap of ‘culture relativism’, whereby some human rights risk to get trampled upon under the banner of ‘local values’. A balance has to be found, but often this turns out to be a difficult exercise.
If development is to be “owned” it will also need sufficient time and space. Donors should never underestimate the appropriate time and process needed for institutional change. Development is not something that can be donated or borrowed but it is typically generated locally, something that takes time, and evolves through its patchy ways of challenges, failures, lessons and successes. My Mongolian experience allowed me to see the development relationship through the lens of a recipient country. I noticed that if external partners push too much, the very essence of ownership risks to get lost somewhere along the way. Moreover, there is a danger that the reform process will be seen as a burden rather than being owned and led by the Government itself. The question should always be: what is our ultimate goal? To meet donors’ timeframes and expectations or to meet our own people’s health expectations?

Nevertheless, it is to be applauded that currently high importance is given to country ownership and sustainable development. It is reported that IHP+ and SWAp countries are showing progress in terms of ownership and support for a national health plan based on a country’s own priorities (rather than donor initiated agendas). These new approaches also brought donors together under a single umbrella called “national health plans” and promote cooperation rather than competition amongst different donors which used to be the case in the past. Can the current momentum be sustained, even if some of these initiatives cease to exist in the future?

I hope to find some of the answers in Busan.


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