Dr. Margaret Chan

Part one of the 8-part series In the Driver’s Seat: A Series on Country Ownership of Health Programs. Dr. Margaret Chan, a medical doctor and native of China, was appointed Director-General of the World Health Organization in November 2006. Her term will run through June 2012. 

Q: At the Pacific Health Summit in London earlier this year, you said: "We are not recognizing the importance of country ownership. Parachuting in and telling them what to do isn't the right approach.’’ Why hasn’t there been more done to give ownership to countries for their health programs?

A: First, let me say, the good news is global health has received a lot of political attention, commitment, and investment. In the ‘90s, there was $2.5 billion in overseas development assistance for global health. That has gone up to $5.6 billion in 2001, and 2006, we had more that $16 billion. The question is, is this money being put to good use? It has created a lot of duplication and competition. We have collectively not learned the lessons of the `90s. In 2003, in Rome, we started a whole discussion on this, which paved the way for a meeting in Paris in 2005, where we asked the question, are we getting results of development aid dollars? That started countries and civil society identifying principles good for development and to get more development aid.

The first principle in the Paris Declaration is ownership. Frequently, developing countries are not allowed to set their own agenda based on their own needs of their populations. If donors are not supporting them to build their capacity, starting with the Ministry of Health, they are also not holding them accountable. Then there is no way to improve governance and get rid of corruption. That was 2005, now it’s already 2010. I have to say there is some improvement in terms of ownership, alignment, harmonization, but we are not there yet.

Q: Why is pushing country ownership so important to you?

A: If countries don’t own their health programs, I personally believe there is no responsibility and no accountability. If donors go in and do their own projects, and make sure they get visibility, put up their national flag, and keep referring to their initiative, without recognizing the country, that does not lead to a sustainable program. Countries are not happy. In some cases, they are angry. In one example, in Malawi, officials are able to tell donors, `If you are not supporting my national priorities, not investing in national plan, then you shouldn’t be here.’ We want to see countries develop a plan with the donors that include indicators, measurements, and evaluations on how programs are doing. But one country now says that it has 880 indicators that donors ask them to report on. We should reflect on that. In one year, one country had to entertain 730 missions. Are we helping them or taking away their time to manage their programs?

Q: What needs to happen now?

A: Some good things are already happening. People are realizing that we must build ownership by helping build capacity, by mutually accepting responsibility, and in the case of public health, working very closely with the World Bank, UNICEF, UNFPA, the Global Fund, GAVI, UNAIDS. We hold ourselves accountable. We can work together. In India, for instance, there are special areas for our collaboration. India has huge capacity, and has made huge investments in health. The amount we invest in India is very small compared to their investment. But what we can do is share information, knowledge and best practices from other parts of the world. Another example is Nepal, where donors are using a Joint Pooling Arrangement as a new mechanism of being in partnership together. The first principle is mutual accountability, where we come together in a consultative manner to agree to a national health plan, giving ownership to the Ministry of Health. It is up to the development partners to provide funding support, or support in kind. Some donors … are also helping Ministries of Health build capacity so that, for example, instead of separate procurement systems, we have one system. We start to integrate programs. Then we are acting as a catalyst.

In the Driver’s Seat: A Series on Country Ownership of Health Programs

Part 2: Shah: 'We want real outcomes in health'

Part 3: Ethiopia’s Tedros: No ownership, no scale

Part 4: Wisman: Donors need to `take a little risk’

Part 5: Omaswa from Uganda: `Donors want a controlling say’

Part 6: From Nepal: `We build step by step’

Part 7: From Mali: `We have a lot of control now’

Part 8: Sturchio: 'The focus should be on outcomes'