`We want to be led'

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December 05, 2010

John Donnelly

Dr Thomas Kenyon

This is the 11th in a series of posts from the Ministerial Leadership Initiative for Global Health's Learning Collaborative Forum in Ethiopia:

With all the talk in international development about `country-led’ or `country-owned’ programs, and the shift in donor-recipient relations, a seasoned US global health diplomat got right to the point on the matter:

“We want to be led,” Dr. Thomas Kenyon, the country director of the US Centers for Disease Control and Prevention program in Ethiopia, told the MLI Learning Collaborative Forum Friday in Addis Ababa. “We very much welcome that. We see our investments go very much further when that is the case, and I’ve had experiences in other countries, not here, where we didn’t have that leadership and our investments didn’t go as far as we had hoped.”

Kenyon, who was the deputy global AIDS ambassador under the Bush administration, helping oversee programs in 15 priority countries, was one of several donors and development partners who spoke about country-led health programs and their experiences with the issue.

A critical factor, Kenyon said, was to create open communications between donor and recipient. After hearing from leaders in the five Ministries about the benefits of countries setting priorities and asking donors to support those goals, Kenyon said it was important for developing countries to clearly define what they wanted from partners and to provide a vision and later evidence on how that would improve health outcomes. He also said that the US government was well aware of countries’ desires to exercise more coordination and control of its health priorities.

“For the US government, global health has come to a new level,” he said. “It is actually health diplomacy now. It begins with our president, come down to the secretary of state, and comes to the field with ambassadors. I share your optimism. We have an extraordinary opportunity in the years to come where we can make a difference.”

Ethiopia, along with other developing countries, still has a ways to go, he said, rattling off a string of health statistics, including that Ethiopia has a half-million deaths in children under five years old every year; and it has 60,000 AIDS deaths and 50,000 TB deaths every year.

`Rally around' health plan

“That’s what we’re here to address. That’s what the host is trying to address,” Kenyon said. “We all have to rally around a strong health sector and development plan.” CDC provided Ethiopia with $128 million this year toward strengthening the country's health system.

Kenyon also backed the MLI approach to leadership development, which for the last three years has been directed at building leadership among the senior technical people in Ministries and not just the top two or three leaders.

“We’ve been talking about how do we as partners support capacity building around leadership,” Kenyon said. “Leadership comes at many different levels. We often work at the technical and operational level. Those positions have to have leadership, too. Those people have to be surgical with their skills.”

He added, “I don’t think there’s a Leadership 101 course. Some people are natural leaders. But those leadership skills necessary in Ministries need to be clearly defined. We are helping build leadership in response to the requests that the (Ethiopia Health) Ministry makes.”

Dr. Francis Omaswa, senior MLI advisor who facilitated the session, welcomed Kenyon’s thoughts.

“`We want to be led,’ that is what struck me most from your statement, and really that’s the spirit of Paris Declaration, the Accra statement, IHP, and so on,” Omaswa said, referring to a string of donor-recipient compacts that encourage more country ownership of programs.

Are good intentions enough?

Kenyon wasn’t the only donor representative or partner to speak on the subject.

Negussu Mekonnen, the country representative for Management Sciences for Health (MSH), said often donors “with good intentions” arrive with projects on their own in countries.

“The issue is when we implement these projects, we, meaning the development partners, forget to incorporate from the beginning the ownership concept,” Mekonnen said. “We feel doing the job is quite enough. We could do the job very well because we are better funded and we can hire better qualified people – sometimes taken away from Ministry departments -- but that is no guarantee for sustainability. I guess we need to have a SOP, a standard operating procedure, to make sure our intervention will end up being owned by the recipient country.”

Mekonnen continued: “We have exit strategies for our projects, but that is not the same as country ownership. Ownership is at the Ministry level all the way to the health facility level. We need to make sure any intervention will include country ownership.”

A challenge to the Carter Center

Teshome Gebre, the Carter Center's country representative for health programs in Ethiopia, told of a visit in February 2007 from his bosses in Atlanta to Ethiopia Health Minister Tedros Adhanom Ghebreyesus. Gebre said the purpose of the visit was to bring to Tedros’ attention the Center’s work on neglected tropical diseases, such as trachoma and guinea worm, and to seek his support.

Tedros listened to the Center’s team and then told him what he wanted, Gebre said.

“He said he didn’t want to undermine our own issues, but he said, `My priority now is malaria, and we are now in the process of procuring something like 20 million long-lasting treated bed nets, due by July 2007. Therefore now all my ears, eyes, focus is on achieving that. If you can help me, I would appreciate it.’”

Tedros told the group the government and donors had procured 17 million long-lasting nets, leaving a 3 million bed-net gap. He asked if the Carter Center could assist the Ministry and buy the nets.

Gebre said that Tedros also told them, “‘If you treat a child with trachoma and the next day that child catches malaria and dies, what meaning does that have for the development of the country? The priority should be to save lives.’”

The Carter Center leaders talked about Tedros’ request, Gebre said, ``and all of a sudden we came back with 3 million nets.”

Minutes later in the MLI session, Tedros, sitting just 15 feet away from Gebre, said that he appreciated very much the Carter Center’s donation – and its flexibility.

Underscoring its importance, he remembered exactly how it happened: “We had our discussion in February 2007, by July 2007 we had resourced it, by September 2007, those bed nets started to flow to the country.”

Live-blog from Ethiopia:

Part 1: MLI Live-blog from Addis Ababa

Part 2: ‘Its Always Good to Think Big’

Part 3: Mali’s Path to Community Health Insurance

Part 4: ‘A New Dawn’ in Health Care in Sierra Leone

Part 5: Want to Bargain? The Nepalis can Help

Part 6: From Mali to Nepal: The Trail of a Negotiator

Part 7: Ethiopia’s New Plan: ‘It’s going to Really Improve this Place’

Part 8: Ethiopia and the Importance of Family Planning

Part 9: Gang of Four: Table Talk with Reproductive Health Directors

Part 10: Ethiopia’s Tedros: Four Steps to Owning Health Programs

Part 12: ‘We Became Beggars”