Last week we held a debate in globalhealthU to discuss the merits of sustainable, small-scale projects versus those of a “big push” approach where government oversight was central. Not surprisingly given the nature of our organization, most of us favored the former approach. I’m writing to present the arguments of the minority in our debate.
For a week now I’ve been thinking about the result of our debate. I was amongst the very few who voted for a “big push” over a score of smaller projects, and I’ve become more and more convinced that while either approach is beneficial, the former is more efficient and productive. Not only that, but placing the government of a nation in charge of its own aid promotes a responsibility and healthy nationalism that can legitimize otherwise unstable regimes and be more palatable to those receiving the aid.
It seemed to me that the biggest objection to the “big push” was a fear of corruption. Frankly, this view is valid. There have been numerous examples of governments embezzling funds intended for relief or development. The claim I will make is that this is avoidable given proper oversight and planning by donor countries and organizations.
Imagine a foreign aid system in which large donations were given to countries in need only if they could present a reasonable and well laid out plan for sustainable growth. The donor nation would be responsible for occasional oversight and review; only those countries whose governments remained stable and honest would receive this sort of funding. The projects these countries proposed wouldn’t have to be only large-scale public works projects – small-scale community projects could be proposed in addition. The object is sustainable economic growth, not a plan for the government to make “busy work”. The essential elements of such a plan would be comprehensibility and accountability. The plan has to be well laid out and budgeted to avoid setback and fraud. Furthermore, it would have to be entrusted to governments that could handle the responsibility. This is a tall order, but absolutely possible.
If we make the reasonable assumption that a government can be relied on to manage its own aid plan, given the situation outlined above, then its clear that the “big push” option is optimal. Top down organization is more efficient. If a certain initiative is doing poorly, a “big push” option gives leeway for reallocation of funds to revitalize the project. The biggest appeal of this option is the development of a standardized, reliable infrastructure, including health system. Developing such a system avoids waste and provides the essential groundwork for a healthy economy. Importantly, it is very difficult to develop from the “small project” approach – a small provincial organization can’t hope to develop the kind of public work that a major, government led initiative can.
In summary, a “big push” is clearly the optimal choice for the developing nation. Unfortunately, it isn’t always an option. Insufficient funding, corrupt governments and an enormous number of NGOs all stand in the way of this choice. But if we have the option, are we not obliged to take it?