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So how do donors decide to phase out their programs and how do they manage that process? How do recipient countries manage the transition away from aid? And what can we learn from their experiences? To our great surprise, we found very little research that tried to answer these questions systematically across countries and donors. In many MICs, this rise in NCDs is happening on the landscape of an unfinished agenda of high mortality from infectious diseases and maternal and child health conditions within subnational pockets of poverty, leading to a double burden of disease.

The shift toward NCDs means that these countries must develop health systems that can provide not only episodic care but also long-term, complex healthcare capable of tackling multimorbidity [ 2 ]. In addition, the recent global health gains, including those in MICs, could be undercut unless urgent and aggressive action is taken to sharply curtail the global rise in obesity and other NCD risk factors [ 3 — 5 ]. These changing disease patterns are closely linked to a second shift—a multifaceted demographic transition. Ageing populations are placing growing demands on the health and social sectors.

This bulge is mainly due to significant success in lowering child mortality rates but not total fertility, which has declined at a much lower rate [ 7 ]. They face a range of poorly controlled health threats, including road injuries the top cause of adolescent death in sub-Saharan Africa , HIV, lower respiratory infections, interpersonal violence, and suicide [ 8 ]. In addition, migration related to conflict is affecting the demographic transition, placing a large burden on health services in some MICs such as Jordan where 1 in 12 people is a Syrian refugee and Lebanon where 1 in 6 is a Syrian refugee [ 9 , 10 ].

Transitioning Development Relationships

Such large influxes of migrants expand the population, exerting pressure on health systems that were often already struggling to provide services to the whole population even before the arrival of refugees [ 11 ]. The third shift is a movement toward a postaid world [ 12 ]. Over the next few years, more than a dozen MICs are expected to graduate from multilateral development assistance, i.

These MICs have reached, or will soon reach, a national gross domestic product per capita that disqualifies them from receiving aid. How will these upcoming graduate countries cope with this funding cliff? A recent analysis suggests that many will find it tough [ 13 ].

Journey to Self-Reliance - InterAction

The analysis compared 2 groups of countries. The second was an upcoming cohort of 11 countries expected to graduate from IDA, Gavi, or both in the coming years. To give one stark example, the mean annual maternal mortality ratio of upcoming graduates in the period leading up to graduation is 4 times as high as the average for previous graduates Fig 1. As seen in the figure, the mean annual maternal mortality ratio is particularly high for 4 upcoming graduates in sub-Saharan Africa: Nigeria, Angola, Cameroon, and Congo-Brazzaville also known as the Republic of Congo.

The previous cohort comprised countries that graduated from IDA between and or countries that either graduated or were in the last phases of accelerated transition from Gavi. The upcoming cohort is expected to graduate from IDA, Gavi, or both in coming years we assumed as the graduation year. The blue vertical bars represent the previous cohort, and the gray vertical bars represent the upcoming cohort.

For each country, an average annual MMR was estimated for this 3-year period prior to graduation. The black horizontal line shows the mean of this value not weighted for population across the cohort of upcoming graduates; the red line is the mean across the previous cohort. The average MMR for the upcoming graduates is per , live births versus 73 per , live births for the previous cohort. Figure from [ 13 ]. The upcoming graduates appear to have less domestic capacity to handle such shocks. One particular concern is the impact of such a transition on human resources for health.

The loss of external support can lead to gaps in staffing and technical capacity, weakening the health workforce and reducing the quality of health services [ 16 , 17 ]. Another concern is what happens to the quality and coverage of services delivered to vulnerable populations—such as prisoners, men who have sex with men, commercial sex workers, and injection drug users—when donors withdraw support. Such populations are at a higher risk of HIV infection, and prevention and treatment programs for these groups are heavily supported by donors like the Global Fund.

When donor exits are poorly managed, these populations can experience HIV resurgence [ 18 ]. Most of this additional spending will have to come from domestic sources. Yet many countries have so far seen little or no mobilization of domestic resources, in part because they have not prioritized health spending.

MFAN Releases Principles to Guide Country Transitions from Aid to Partnership

This broad participation involves the alleviation of poverty through economic, social, and political action; the cultivation of the private sector; and the cultivation of a society where people are able to dissent or lodge objections against their government. It has also become increasingly understood that the government should play a major role in building the organizational and physical infrastructure that makes this participation possible.

Thus from the late s into the s participation has undergone expansion from the microeconomic grassroots level to participation in politics, society, and the economy, but this should not be construed as mere expansion in scale; it is a shift in the very concept of participation.

Behind participation's conceptual shift lie the following contributing factors. First, since the late s a general trend has been visible around the world towards greater democracy and political pluralism though not uniformly : Witness the emergence of presidential and parliamentary elections one after the other under multiparty political systems in Africa and the cries for democracy from the burgeoning middle classes in Korea, Taiwan, and Thailand.

Another general trend is evidenced by structural adjustment policies and economic reforms in China and Viet Nam, and shifts to economic liberalization and transitions to market economies after the fall of socialist regimes in the Soviet Union and Eastern Europe. In its original sense, democracy means equal participation by members of society in the processes of making and carrying out societal decisions. In contemporary democracies, however, it principally means guaranteed participation in the process of electing representatives.

A problematic or controversial aspect of participation has emerged in recent years as the result of a spreading awareness that party politics is waning and that parliaments have lost their original function of representation. Forms of people's participation in politics have evolved: Not only do people take part in politics via elections; with the rise of pressure and interest groups, they also take part in politics on a daily basis through antipollution movements and consumer campaigns. As seen by the participatory democracy trend, participation is again to be understood as something of core value in a democracy [13].

In theory, a market economy is a place where individuals and enterprises economic agents engage in competitive games of production and distribution of goods based on price signals information and may enter or withdraw as they like from the free market. The market operates on a decentralized basis, with each agent making its own decisions. The market is in this sense by nature a form of participation promoter. Insofar as the process of determining economic actions is left to individual economic agents, and insofar as economic liberalization policies such as liberalization of foreign trade and domestic deregulation weaken oligopolies and reduce vested interests' rent seeking nonproductive activities such as exerting pressure on government to protect corporate vested interests , they encourage more economic agents to participate through market mechanisms.

In this sense, then, transition to a market economy and the trend toward economic liberalization are valuable as steps to ensure broader participation.

Participatory development and good governance report of the Aid Study Committee

Yet while participation has a central theoretical value in any democracy, the forms and degrees of political participation vary in practice, due to differences in cultures, traditions, and values among countries that have actually adopted democracy [14]. The same holds true in the economic realm. The maturity and environmental conditions in which markets are formed vary, even among countries that have adopted capitalistic free-market policies, due to their historical, social, and economic background, and participation in market economy activities exists in a great diversity of degrees and forms.

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In practice, feasible forms of participation are not uniform. They differ due to problems that surface within market mechanisms, such as monopolies and oligopolies, or an informal economy, arising from disparities in access to markets and information, in management capabilities of participating agents, or in scale of operations.

They differ also in line with the status of government tax, monetary policies, and other complementary governmental measures designed to palliate these problems and in line with the interrelationship between conventional economic mechanisms that mediate as initial conditions. Thus although broad people's participation is central to the values underlying the trend of democracy and economic freedom, extreme diversity of forms and degrees of actual participation is the rule. Thus it is good to bear in mind that no single form of participation can be used as a universal yardstick of democracy or as the hallmark of attainment of a healthy free economy. The insufficiency of organizational or institutional frameworks may impede participation by certain segments of society.

Then again, participation may engender conflicts of interests or cause new conflicts, and enormous amounts of time and money may be needed to build a consensus among the people involved. Together, these factors may make effective participation impossible in the short term. Hence efforts are necessary to make participants and organizations more aware of their responsibilities, to upgrade skills, to establish government legislative and institutional frameworks, and to build infrastructure.

And this must be accompanied both by adequate understanding of ties with customary political and economic systems and by wider access to education, better legal systems, and improved administrative capabilities. Aiming at a certain specific form of participation is not a panacea that will establish democracy and a free economy; it is important to create the conditions for participation that is tailored to the specifics of the history and society of the country or region in question.

In December , the DAC adopted a Policy Statement on Development Cooperation in the s identifying sustainable development, attention to the environment, and participatory development as its highest priorities in development assistance for the decade.

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This was the first policy statement released to the international community where the term "participatory development" was used. On the importance of participatory development, it says that stimulating people's productive energy, encouraging broader participation by all the people in the production process, and distributing profits more equitably must become central elements of development strategy and development aid. These efforts are premised on the following essential steps:.

The DAC spent almost five years discussing this Policy Statement and summarizing the opinions and activities of donors, and reported its results in an orientation paper published in December [15]. Bearing in mind the connections with development assistance, this paper summarizes principles and approaches and the current status of various donors' activities in accordance with specific action plans and underscores the need for regular review and exchange of information between donors in order to strengthen future ODA efforts in four independent areas: participatory development, democratization, good governance, and human rights.

Based on this orientation paper, the DAC set up an internal ad hoc working group on participatory development and good governance in May This ad hoc working group will carry out discussions where donors will exchange information about their experiences to permit practical feedback to the assistance field. It has identified five priority areas for discussion:. President Jimmy Carter's human rights diplomacy and Scandinavian countries' humanitarian aid in the s are some examples of aid that took the human rights of the poor into account even during the cold war.


The United States identified support for democratization as one of its priority areas and a universal principle of development aid beginning in The political declaration of the Munich Summit, in the section on the formation of a new partnership, also issues an appeal for these principles, stating "since the last meeting further dramatic changes have accelerated progress toward democracy, an economy based on market principles, and social justice.

Already the way has been opened to a new partnership of shared responsibilities, both in the united Europe and in the Asian and Pacific region as well as in other parts of the world. We are entering an era where cooperation is taking the place of conflict. In this new partnership, the world's development will progress as shared values take root based on the principles of political and economic freedoms, human rights, democracy, justice, and the rule of law. In the McNamara Report, the World Bank also regards fairer distribution of income and the means of production as important factors for sustaining and promoting development and proposes that priority financing be allocated to the regions with the most poor.

Based on the World Employment Program it established in the late s, the International Labor Organization spoke out at the World Employment Conference in to stress the importance of promoting job creation and the necessity of meeting basic human needs as political objectives.