|The Courier N° 147 - Sept-Oct 1994 - Dossier Public Health - Country report Swaziland (European Commission - The ACP Courier, 1994)|
by David Nabarro and Andrew Cassels
How can managers help those who finance developing country health services to make the best use of available resources for health ? Ifwe had examined this issue 10 years ago we would have used the 1978 Alma Alma Declaration as our starting point, drawing on government commitments to ensuring health for all their people by the year 2000. We would have stressed the importance of equitable primary health care (PHC) and considered how management inputs would lead to more poor populations accessing PHC. We would have called for donor agencies to provide additional resources to enable countries to achieve 'Health for All'.
But the 1993 World Development Report on Health (WDR 93) did not use the Declaration of Health for All as its starting point. The more restrained line in WDR 93 reflects the reality: there are insufficient public resources going into health care in the developing world to enable all the world's people to enjoy levels of health experienced by the most healthy. Health for All will not happen by the year 2000.
What is more, WDR 93 confirms that the public resources provided for health are often spent on activities which benefit only small sections of the population-not necessarily those most in need. Many of the activities are both expensive and ineffective. And there are real limits to what individuals can afford to spend on their own health care.
WDR 93 shows that there are technologies available to tackle the major causes of disability and suffering in the developing world. It argues strongly for higher levels of public investment in providing an essential package of care for all the world's people. It also points out that there is much to be done to improve health systems, to enable them to bring benefits to those who need them.
But given the inescapable scarcity of resources, real prospects of effective spending are needed if officials of hardpressed Ministries of Finance, bilateral donor agencies, development banks and UN agencies are to be convinced that resources should be provided. If people's access to essential health care is to increase, resources for health must be better managed. This requires substantial reforms of national health systems.
Management and reform of the health sector: some basic principles
Governments of developing countries seek to set priorities for health care and then find the most effective and efficient ways to pursue them. They hope that their plans will attract additional investment-from within the country (with the Ministry of Finance, perhaps, offering small increases in the share of the public purse that goes towards health) and, most importantly, from outside investors.
The main requirement is to spend the available resources well, so that people's health care priorities are tackled with services which they want to use, and which are effective. Unfortunately health professionals-quick to champion the needs of their individual patients or their sub-specialties-sometimes find it hard to set these priorities without giving greatest emphasis to their own specialisms and interests.
Whether or not the professionals and legislators like it, there will never be sufficient public-sector resources to pay for all the care that health professionals want to provide. Resources for heath care have to be managed so that they bring the greatest possible benefit to those who need care. A health sector that is not subject to skilful, transparent and strategic management is usually not able to provide the best possible care for the greatest number of people. It is an unattractive candidate for investment.
Britain's Overseas Development Administration (ODA) has been involved in helping countries to better manage resources for essential health care for some years. Like many other agencies, we have chosen to avoid easy, but potentially damaging, investments in specified narrow health outcomes with tightly earmarked ('vertical') inputs. We want to help our partner institutions, and decision makers, decide for themselves how bestt to allocate resource. We have also recognised that management training and systems development may not be enough to bring about sustained improvements in the planning and management of health care systems. There are institutional, bureaucratic, political and 'special interest' constraints to getting the best out of scarce resources. The challenge-confronted by investors in health, whether from within countries or outside-is to strip away the obstacles to effective planning and management.
Many Ministries of Health in developing or transitional countries are now examining ways to reorganize, reform or even dismantle some of the more restrictive procedures and institutions in their health services. In some cases this means taking the power for allocating resources for health away from health care professionals, whose primary concern is to act on behalf of individual patients, and giving it, instead, to people who act on behalf of society as a whole. And this leads to a split between the investor and the provider: a divide that can cause friction but will, in the long term, lead to more effective use of scarce resources.
The legislators who decide which reforms to implement, and the officials who have to implement them, face a tough task. Officials in the Ministry of Health will need to set clear priorities and be sure of robust political support, if they are to change their organisations and challenge vested interests. Alliances may be upset and friendships broken.
Universal characteristics of health sector reform
There is no single blueprint for how health sector reform should be undertaken. But there are some common issues, which we set out here on the basis of an analysis of work undertaken in ODA assisted projects.
To start with, what are the health sector problems that countries are trying to address ?
Scarce resources are used inefficiently: public money is being spent on the wrong things. The wrong services are being financed. Too much is spent on salaries compared to operating costs, and on tertiary rather than primary levels of care. Existing services are badly managed. Money does not go where it is needed and it is hard to monitor how it is spent. Systems for purchasing goods and services fail to ensure value for money.
People cannot get the health care they need: this may be because they are too poor, they happen to live in the wrong place, they are the wrong age or sex, or not in employment; because services are not available to treat particular problems or because services are simply badly planned and managed.
Services do not respond to what people want: people will not accept poorquality services uncritically just because they are there. In the public sector, people sometime face uncaring and inadequately trained staff, long waiting times and inconvenient clinic hours, and they lack any confidentiality or privacy. In the private sector, they are at risk of financial exploitation with no safeguards against potentially dangerous treatment.
Individuals and families face levels of expenditure if they fall seriously ill that can result in serious debt or an inability to access treatment at all.
Secondly, what are the reforms being implemented within health sectors ?
Reforms are concerned with changing health policies and the institutions through which these policies are implemented.
Redefining policies or implementing special PHC projects alone is not enough. In many countries, over the last 15 years, the implementation of primary health care has been dominated by pious policy statements. A few additional activities have been implemented to increase the delivery of priority health care interventions at the periphery. This is not sufficient. Institutional reform is a priority because existing institutions, organisational structures and systems fail to deal adequately with the management issues that we have described.
The precise agenda for reform cannot be set out as a blueprint. In practice it depends on the extent to which existing institutions, structures and systems deal with issues of efficiency, access, cost containment and responsiveness to public demand. The relative importance of these issues varies between countries. However, the need for systems to ration health care provision in line with national policy objectives is common to all. Monitoring change in relation to policy objectives will indicate whether or not institutional reform is successful.
The third point to consider is how we (as external investors) approach health sector reform.
We need to understand the context. Many of the problems that we have outlined are long-standing. But contextual factors can also provide triggers for reform. Political and economic changes and a shift in thinking about the role of government are likely to be more influential than information about disease patterns or population pressures alone. Countries emerging from a period of instability may be more ready for reform than those which have long-standing problems but in which systems of governance are relatively stable. A critical trigger may be the sudden change in the level of resources-recurrent resources-available for health care, as has happened recently in the countries of the former Soviet Union.
We must contribute to true partnerships and work together to define the essential characteristics of reformed health care organisations. Despite differences in the problems to be addressed and the components of national reform programmes, we can define some of these characteristics. These include shifting power from provider to managerial (and particularly societal) interests; developing the capacity to specify objectives, standards of performance, monitoring outputs and outcomes, and tracking the use of resources; and distinguishing the role of the investors, who are responsible for defining needs, specifying tasks and monitoring, from that of the providers.
Where, fourthly, do we look for ideas and experience ?
In the case of civil service and public-sector reform, in most countries health-sector reform will occur as part of, or in parallel with, changes in the civil service and other public-sector organisations. There is a considerable body of experience on which to draw.
As regards developments in financing the social sector, there is a growing body of knowledge about the relative merits of user charges, community financing, voucher systems and different forms of insurance to raise cash for social sector activities.
Where managed-market health care reform is concerned unregulated private markets are not capable of achieving the mix of objectives that health systems seek to satisfy. In designing reform programmes, there is a need to review the experience of countries in which governments have taken on the role of controlling and regulating the public and private markets in health care.
Lastly, what are the options for designing health-sector reform programmes ?
Any reform programme will have a number of complementary components. Those designing programmes do not need prescriptions. Rather, they need options for addressing key policy issues. Legislators will wish to choose options to be pursued -and they may not find the choice easy. There is a need for much consultation and dialogue.
Elements in a reform programme
A reform programme may include measures to improve the functioning of the civil service, such as plans for reducing total numbers of staff, new pay and grading schemes (including performance-related incentive pay and salary decompression), better job descriptions and appraisal systems, improved financial disbursement and accounting, and the establishment of executive agencies. Authority and responsibility for health care may be decentralized to elected local government or to sectorial agencies. The functioning of the Ministry of Health may be improved through organizational restructuring, with new and more efficient systems for financial management and accounting, for policy, planning and monitoring functions and for defining national disease priorities and selecting cost-effective clinical and public health interventions.
Autonomous operating units may be created. This may include establishing self-governing hospitals, autonomous districts/provinces with their own health management systems and contracts with NGO's and missions to provide an agreed pattern of service.
The options for health financing may be broadened: legislators will want to know the advantages and disadvantages of increased user fees (with and without waiver systems), community finance, social insurance schemes (usually government managed) and private insurance. An option is to introduce managed competition. Competition is only possible if the investor specifies the service levels required and seeks to purchase the best possible service from the provider which offers this service at the most reasonable price. In practice there may be more than one purchaser; purchasing may be manager led or client-led. Contracting out may be confined to support services or may also cover health care.
K working with the private sector is envisaged, special instruments are needed to help ensure that purchasers (government and people) get value for money from private providers through regulation, contracting and franchising of quality services, and vouchers that enable clients to receive subsidised care from a variety of providers.
In the end the choices made are likely to result from politicial decisions- even though specialists in health management provide information about options and help with implementaton. In practice specialists - whether from within a country or from outside-cannot expect to prescribe, or even to drive, the health sector reform process. Better management and health-sector reforms are achieved through politicial commitment and, in practice, a great deal of courage.
D.N. & A.C.
Post-conflict rehabilitation of the health sector by Joanna Macrae & Anthony Zwi
The global optimism for peace inspired by the end of the Cold War has not been realised in practice. Since the fall of the Berlin Wall the momentum for violence has been sustained or revived in countries such as Angola and Somalia, and new waves of conflict have shaken large swathes of the former Eastern bloc. The trend towards greater instability in some countries is counterpoised by trends towards greater stability. Afghanistan, Cambodia, Croatia, El Salvador, Eritrea, Ethiopia, Mozambique, Northern Somalia (Somaliland), South Africa and Uganda are but some of the countries making the precarious transition to peace.
Health is the first victim of war. Death and injury as a result of direct military action represent only a fraction of the health costs of conflict. The dramatic changes in the political, economic and social environments associated with war threaten personal health and the functioning of health systems. Widespread rape, displacement, the breakdown of the health-supporting infrastructure such as water and food supplies combine to generate high risk situations which increase populations' vulnerability to a range of health problems, including HIV, malaria, TB and water-bome disease.
The capacity of health services to respond to the subsequent excess mortality and morbidity is also diminished. Public sector financing of the health sector is severely reduced as military budgets drain the public purse, health workers are killed, injured or migrate, while planning and management staff become preoccupied with surviving the next emergency rather than with strategic initiatives for health.
The achievement of relative peace brings both political and financial opportunities for health development. New governments seek to build popular legitimacy; addressing social and health issues provides one means of doing so. In the post-conflict period international donors tend to shift from providing relief assistance to supporting longer-term development. This new aid, combined with the peace dividend, may release substantial resources for health. Despite these opportunities, communities,, governments and international agencies face formidable obstacles to reversing the long-term effects of conflict on health and health systems.
The London School of Hygiene and Tropical Medicine has launched a research initiative concerned to identify the key policy issues facing countries making the difficult transition from war to peace. A pilot study has been completed in Uganda in collaboration with Makerere University and HealthNet International, a sister organisation of Medicins Sans Frontières (Netherlands). Further case studies are being developed in Eritrea, Ethiopia and El Salvador.
Uganda case study
The Ugandan experience of health sector rehabilitation carries important lessons for other countries which have more recently emerged from prolonged conflict. The study highlighted the importance of accurately analysing the nature of the rehabilitation task and using this analysis to develop long-term strategies for health development. In a context of overwhelming health needs and a devastated health infrastructure, the tendency of government and international agencies in 1986 was to rush in and address the most visible aspects of the crisis- namely the destruction of the health infrastructure. The strategy adopted sought to rebuild the system to its preconflict levels, despite the dramatic decline in economic support to the health sector.
The rapid and substantial investment in the physical infrastructure and donor-supported vertical programmes has resulted in a health system which is both unaffordable and failing to meet priority health needs. The overemphasis on the infrastructural crisis facing the health system served to mask the deeper structural crisis associated with the breakdown of health financing, management and organisation during the war.
Identifying appropriate, developmental strategies for health sector rehabilitation in post-conflict situations will not be easy. Improving the national and international response to recovery will rely upon addressing the specific content of rehabilitation strategies (for example, to relieve war-related mental health problems), but, perhaps more importantly, it will require understanding the process of polity development in these situations. In a context where decision-makers face diverse and compelling pressures from politicians, the public and international agencies to do something, anything, as long as it's quick, the risks of policy failure are particularly high. Yet the opportunity costs of such policy failures are also particularly high: inappropriate rehabilitation strategies may create distortions in the health system which are difficult to redress in the long-term. Identifying mechanisms to diffuse these pressures through informed dialogue between these different actors will be crucial. In particular, encouraging representative community institutions to play a role in choices about health will ensure the viability and political sustainability of rehabilitation programmer.
As the research in Uganda, and more recently in Ethiopia has shown, achieving a healthy peace will depend less on patching up bullet-ridden buildings than on rebuilding civil institutions at the national and local levels, and restoring the right of women and men to control and influence health development.
JM & AZ.
Regional cooperation in health care
The example of the University of the West Indies by Blossom Anglin-Brown
The countries of the Common wealth Caribbean are often considered fortunate when compared with other developing countries .
They have made, in the past two decades, a contribution to world affairs which far outweighs their physical size. They have approximately six million Inhabitants, a high literacy level, and a political machinery which is democratic and stable. Their potential for continuing growth presents a challenge. The population is relatively young with at least 30% under 15 years of age in most of the countries concerned. Women of child bearing age (15-44) make up about 20% of the total while the proportion of elderly people is increasing. In some countries, the over 65s "count for as much as 12% of the population.
The current birth rate ranges from 15/1000 to 36/1000 while crude death rates ran at between four and 13 per thousand. The weighted mean for infant mortality is 21/1000 with a range of between five and 38 per thousand. Perinatal causes are ranked first among the principal causes of death among infants. In the general adult population, chronic, non-communicable diseases including cancer, cerebrovascular disease, heart disease, diabetes mellitus and hypertension are the leading causes of morbidity and mortality.
In terms of economic development, the percapita annual income ranges from EC$ 1400 to EC$ 17 600 (1 EC$ = 37 Us cents) and its distribution within countries is generally highly skewed. Unemployment rates are high, averaging about 20% of the labour force. The economies, in general display classic plantation-type features, with an emphasis on the production of agricultural products, mainly for extra-regional export, and on the import of finished goods including food and other basic essentials. Some diversification into sectors such as tourism, bauxite -alumina, light manufacturing, petrochemicals and service industries has taken place in recent years. In most of the islands, the agriculture sector remains the largest single employer of labour, followed closely by tourism.
With this narrow economic base, the recent global recession and successive devastating national disasters have had a profound negative impact on the economies of the Caribbean islands. This has been particularly the case for those countries that have large external debts, or whose agricultural base is made up of fragile food crops such as bananas. There has bean a general reduction in economic growth rates with some countries experiencing negative growth. A number of policy measures have been designed to achieve desirable, long-term structural adjustments to economies. Measures have included foreign exchange controls, import restrictions, devaluations, credit restrictions and the removal of subsidies, to name just a few. These policies have had deleterious effects on the delivery of health care to the people. The problems and needs of small isolated communities such as those of the Commonwealth Caribbean are not merely scaled-down versions of larger on". They differ qualitatively as well as quantitatively. Wide differences in size and population, geographical and functional isolation, shortages of equipment and essential drugs, deteriorating physical facilities and inadequacies in planning, communications systems and technological and administrative infrastructures, all add particular dimensions and challenges. The reality for these countries now, and for much of the foreseeable future, is that the standard of their medical services will depend more on how efficiently they can utilise available national and regional resources than on any substantial increases in such resources. Proper allocation of their own resources, the training and utilisation of appropriate groups, the availability of sufficient numbers of 'home-grown' health professionals, and planning based on research and accurate information about their own needs and resources, will have to form a major part of the solution to these problems.
Nearly 50 years ago, the reality of situation even then encouraged the formation of the University College of the West Indies, in conjunction with the University of London. In the succeeding years, Caribbean health planners have accepted the realities of small size and relative poverty and have made vigorous efforts to cope with their situation. Institutions such the University of the West Indies (UWI) and the Pan American Health Organisation ( PA HO)- the assembly of ministers responsible for health in the region - have made a significant contribution towards meeting the region's health service research and training needs. The UWI is a good example of an institution accepting its responsibilities as a regional body.
The College and medical faculty of the UWI were incorporated in 1948. The Medical School started with an annual intake of some 35 students, a figure which has since grown to 120. There are now teaching hospitals at the Mona campus in Jamaica as well as in Barbados and Trinidad. The University has gained international respect and the confidence of the region in the area of medical education.
Using telecommunications in training
The Faculty of Medical Sciences, based in Jamaica, Barbados and Trinidad, provides undergraduate and graduate medical training through high quality programmer. These annually provide well-trained doctors for the region. There are many other levels of professional training available. These include courses for nursing assistants, midwives, family planners, counsellors, physiotherapists, radiologists, laboratory technicians and family nurse practitioners. The UWI also has an advanced nursing training programme based in Jamaica. Here, students have been taught the skills of advanced nursing for more than 20 years. Many of the current leaders in the field are products of this programme. Graduate programmes in many medical specialisms are also available. These include internal medicine, surgery, obstetrics and gynaecology, child health, family medicine, nutrition, public health and epidemiology. There are also postgraduate programmes run by the Department of Social and Preventive Medicine, with the assistance of PAHO. These include family planning and nutrition.
The University has had wide experience in international collaboration in research training. The Medical Research Council (MRC) of the United Kingdom has facilitated training in conjunction with the Sick/e Cell Unit which has provided results worldwide on the presentation and management of sickle cell disease. The Tropical Metabolism Research Unit, generously supported, first by the MRC and later by Wellcome, has done important work on malnutrition and its complications, making that unit a leader in the management of malnutrition. Through the UWl's Distance Teaching Enterprise (UWiDTE), the University has made significant progress with the development of inter-country, distance education techniques, providing an added impetus for a regional system of health service research and training. Its telecommunications systems now link 14 countries through 20 tele-conference rooms. There is a high level of demand for the services of UWIDITE in regional training programmes in health systems research.
Other institutions which deserve a mention include the Institute of Social and Economic Research (ISER). The University has recognised that the diversity and heterogeneity of the social determinants of health can only be appreciated by students and physicians if they are brought to a better understanding of, and place greater emphasis on, the physical and social environment in which people's health is created or destroyed. In this context, the ISER has brought social analytic skills and insights to health service issues, with a particular stress on the accompanying cultural and environmental favors. The ISER operates on all three campuses.
There is also the Caribbean Regional Epidemiological Centre (CAREC) which is based in Trinidad & Tobago and whose work is geared towards the strengthening of epidemiology in the region. PAHO, in conjunction with CAREC, agreed at a workshop held in Washington DC in 1988, that there should be collaboration with the UWI in the development of postgraduate training programmes to strengthen Caribbean skills in epidemiology, and to extend these to the whole region. CAREC has improved access to, and the exchange of, information, and it promotes and supports regional research activities.
The Commonwealth Caribbean Medical Research Council/ (CCMRC) collaborates with regional agencies in planning and supporting Caribbean health systems research. A meeting is held annually in the Caribbean, on a rotation basis, at which members of the profession discuss and present highlights of research done in the region.
In their search for solutions to some of their nutritional problems, the Caribbean governments took a policy decision in the mid-1960s to approach the challenges in the field of food and nutrition in a regional, multi-sectoral manner. One of the mechanisms for this was the establishment of the Caribbean Food and Nutrition Institute (CFNI). The work of the CFNI is based entirely on the needs of the countries in the region. Emphasis is placed on strategies for arriving at informed decisions and actions through the promotion of inter-sectoral projects, the provision of timely analysis of current data and the empowering of communities to participate actively in their own locally targeted food and nutrition schemes. Two main programme areas have been identified: health/nutrition promotion and protection, and food availability, looking at consumption at the household level.
There are many regional professional groups in the Caribbean which meet regularly to discuss problems related to their particular speciality and also to form linkages, and thus boost the delivery of health care. Such groups include cardiologists, gastroenterologists, family physicians, dermatologists and medical technologists, to name just a few.
In Jamaica, the University Hospital of the West Indies, is strategically placed in the same area as the University on the Mona Campus. Equipped with 576 beds, it is staffed by members of the Faculty of Medical Sciences. It is a teaching hospital where undergraduates in the field of medical sciences are trained. They can also do their internships on the medical wards. The hospital has strong links with the wider region since problems which cannot be handled elsewhere in the Caribbean are sent there.
Medical students from any campus may complete the clinical requirements for their final examinations at another campus. Faculty members travel to each campus territory to interview those students who are presenting themselves for their final degree. The University also maintains norms and standards, with lecturers and external examiners often coming from Europe and travelling from one campus to another to give courses or examine students.
The UWI has been a model in promoting regional health collaboration. Sustained and effective scientific cooperation between geographically separate and politically independent countries is not easy. The strength of political will which lies behind the establishment of a system such as this, is something that always needs to be maintained. Affirmations of political will are only part of the solution. We have to be able to transform political support into joint action programmes. CFNI and CAREC in particular have shown that regional organisations can effectively fulfil research mandates and that networking among national organisations can be a useful mechanism if properly applied. For action to take place on many issues, the UWI has to continue to foster links with the Caribbean health ministries in national and regional health services planning and decision-making.
Mention must be made of PAHO in the Caribbean. For more than half a century, this organisation has directed Caribbean countries towards greater emphasis on the preventive and promotional aspects of health. It provides technical assistance where needed and guides health planners towards a sharper regional focus in management skills. PAHO has also done much to strengthen and extend the principles of primary health care in the region. The UWI has frequently benefited from support in the form of funding of specific health systems research projects and the associated personnel training
The challenges of the 1990s are awesome We recognise that, as a
University, the infrastructure for the improvement of regional health care is
already in place. We appreciate that to help achieve 'health for all by the year
2000', the divorce of theory from practice and the separation of the academic
milieu from the field of action must come to an end. Much will depend upon
general political, economic and social development As a region, we have to
accept what is possible and do what is necessary to achieve it The preparation
of human resources must encompass, as a priority the training of leaders. Even
more to the the point, it must entail the development of leaders who understand
the present-day health situation in the region and the challenges faced by the
sector and who can act upon this understanding in effective ways. The University
of the West Indies has the will to become an 'agent for change' in the
Caribbean, and it will continue to perform this role.
From sea to shore
Tackling the problem of post-harvest losses in artisanal fishing
If there were a direct correlation between the significance of a particular development action and the length of its tit/e, then the EDF-backod scheme featured in this article has been well named. For the 'Regional Priority Action Programme: Improvement of Post-harvest Utilisation of Artisanal Fish Catches in West Africa' has important objectives. It is the first of its kind to address the problem of post-harvest losses in the region's traditional fishing sector. It covers an area where demographic trends point towards ever-increasing food requirements. And based, as it is, on a strategy that promotes better use of catches rather than simply increased production, the Programme comes at an appropriate time. Across the globe, concern is growing about the depletion of fish stocks and international pressure is mounting for more effective management of the resource.
In fact, the EDF-supported Programme was first launched in January 1990 and the first two phases ('Pilot' and 'Transition'), funded under Lomé, III, have now been completed. These involved the execution of 23 activities and expenditure of more than ECU 1.5 million.
'From Sea to Shore'is the title of a summary report of these two phases, edited extracts of which we publish below. Drawn up by consultant Kay McConney, it gives details of the Programme-including a frank analysis of its weaknesses- and describes the stops taken to improve it. The Programme's third phase, which has a budget of ECU 8 million from Lomé, IV resources, will run from 1994 to 1998.
Features of the sector
The Programme to improve postharvest utilisation of artisanal fish catches in West Africa covers 16 ECOWAS member states. Close to one million people in these countries depend wholly or partly on artisanai fisheries for their livelihood. Women play a significant role, especially in processing and trading, although their contribution in economic terms has always tended to be underestimated. Aware that any serious development strategy for artisanal fisheries must, of necessity, include women, the Programme directly targets them as a beneficiary group and actively involves women's organisations in its planning and implementation.
Estimates of fishermen's annual earnings, drawn from spot surveys in a number of ECOWAS countries over the past ten years, range from $300 to $1800, depending on a variety of factors. In Ghana, a survey in 1990 revealed that vessel owners can expect an income of between $2000 and $3000 per annum. In the long term, the Programme seeks to improve the revenue-earning capacity of its beneficiaries by adding value to fish catches through better processing and storage techniques, technology and access to markets.
The artisanal fisheries sub-sector is traditional, labour intensive, risk averse and dependent on labour flow. These characteristics demand that the development strategy for the sub-sector be people-oriented and firmly based on a 'bottom-up' approach. The Programme attempts to take account of this in various ways. These include pursuing activities based on requests from the beneficiaries, involving them in planning, organisation and implementation, and taking an adaptive approach to technology transfer, thus minimising the risk of resistance to change and respecting the labour element.
For most ECOWAS countries, fish is a significant food source. It tends to be more readily available, and less expensive, than other dietary proteins and hence offers a competitive alternative.
Problems to be addressed and beneficiaries
With population growth close to 3%, fish consumption is expected to rise. There is a need to exploit cost-effective means of feeding the people, to reduce the outflow of scarce resources to finance food imports, and to develop the living standards of those who work in productive sectors such as fishing.
Improvements in management and more efficient use of catches required to meet consumption needs, whilst avoiding over-fishing. To date, the main focus has been on increasing production rather than reducing loss" or improving value. The Programme seeks to address this imbalance.
Currently, some 10-20% of the region's catch is lost in post-harvest. The main causes of this are poor storage at sea, poor handling and processing, inadequate storage on land and during transport, and a general absence of infrastructure. The sub-sector also suffers from poor communications and a lack of information about markets, products, prices, technology and so on. The Programme seeks to tackle these deficiencies by creating an information network, and developing ways of disseminating the information to the fishing communities as well as to state bodies, sectoral organisations and other fisheries development projects.
The Pilot Phase
The 'Pilot Phase', launched in January 1990, was managed by the Association for the Development of Maritime Activities (CEASM). It lasted 18 months and its purpose was to test whether regional cooperation through the exchange of experience among private sector operators and sector institutions was possible, and whether this was an appropriate way of approaching the Programme's goal. The vehicles for this exchange were study trips, practical training and study sessions. its purposes were essentially experimental- to seek out potential human and institutional resources, to promote the Programme and gain participation of beneficiaries at all levels, and to study what could be achieved on a small scale before making a commitment to a larger scale intervention.
At the helm was a Management Committee to which CEASM reported. This consisted of five Fisheries Directors (from Cote d'lvoire, Ghana, Mali, Senegal and Sierra Leone) as well two EC Commission representatives. At the outset, it established the broad parameters of the Programme, including the stipulation that it would respond to requests on a 'first come, first served' basis rather than allocating quotas by country. The Committee also determined the budgets, set out the programme of activities to be executed and was responsible for monitoring. To provide the necessary technical and administrative support, CEASM established a Technical Secretariat with a staff of four (two regional coordinators, a secretary and an administrative assistant). This was based in Abidjan, and was responsible for day-to-day operational management.
To capitalise on existing capacity in the region, contracts were concluded with other institutions with proven experience in technology transfer and information networks. Thesee 'Associated Partners' were supervised by, and reported to the Technical Secretariat, and responsibility for specific activities was delegated to them.
Pilot Phase results
The Pilot Phase saw the execution of five practical training sessions (on the use of Chorkor ovens', and dealing with insect infestations), four study tours (on marketing and fresh fish preservation) and two study sessions (on credit and organisation). There were 83 participants, more than half of whom were women, and six beneficiary countries.
There were three main Associated Partners for this phase. The Dakarbased institute of Food Technology (ITA) took charge of practical training in the use and construction of insulated containers in Gambia and Guinea. The aim was to improve storage know-how and technology. 22 containers were built and given to operators as test products.
The FAO regional fish marketing service (INFOPECHE) in Abidjan developed and maintained the databank on intraregional trade. Information was supplied by consultants in nine countries who had been contracted as network correspondents to carry out the required research. The data, principally on prices, products and trade, was then disseminated through 'Bonga', a bilingual bulletin published by INFOPECHE. This publication achieved a modest circulation of 200 by the end of the phase.
Finally, the Food Research Institute (FRI) in Accra was contracted to follow-up on the practical training provided on the use and construction of Chorkor ovens. It was also charged with publishing an extension manual on the subject. This work was aimed at addressing the problem of post-harvest losses resulting from poor processing techniques, but the results were disappointing.
The subsequent field evaluation reflected both the modest achievements and the difficulties encountered during the Pilot Phase. On the positive side, the basis was laid for further efforts in technology transfer and information sharing. Through training and dialogue, direct contacts between grassroots beneficiaries were also facilitated while relationships were established with technically capable regional resources,, both individuals and organisations.
On the other hand, despite the acknowledged fit between the Programme's objectives and the activities carried out, it had little impact on the ground. The time-frame for preparation was too short and request proposals were scanty on detail. Lack of time, care and proper criteria to assess these requests led to incorrect diagnoses and poor results.
Contact with economic operators was limited. The beneficiaries were mostly people with whom previous aid relationships had been established and the efforts of the Technical Secretariat to reach other operators were inadequate. There were also deficiencies in communication between the Secretariat and the Associated Partners. The latter were not apprised of the Programme's intermediate objectives, its other components or the general progress of activities. Reporting guidelines were unclear and inconsistent. This communication gap, combined with a lack of clear performance targets and indicators, contributed to a lack of quality control at all levels. Similar communication defects were identified in other areas.
At the root of these problems was a weakness in management machinery. Decision-making was centralised even if a decentralised approach was intended. The Technical Secretariat had little authority to revise programmes approved by the Management Committee in order to address the Programme's objectives more effectively. Flexibility to respond to signals from beneficiaries was, accordingly, inhibited.
Sobered by these critical observations, the management of the Programme and the Associated Partners changed tack in the phase that followed.
The Transition Phase
Aiming to build on experience already gained, the objectives set for the Transition Phase were to enlarge and diversify the information base, to extend the network of resource persons and institutions, and to help increase the professionalism of communities and grassroots organisations, thereby enhancing their capacity for self-promotion.
At the outset, the management began incorporating the recommendations of the Pilot Phase evaluation. The vague intermediate objectives were redefined. Quantitative performance indicators were set for most activities. However, qualitative indicators were not properly set or assessed.
At management level, basic decision-making structures were maintained but the Technical Secretariat was given more autonomy for operational decisions. The Secretariat sought to improve the screening process by providing clearer guidelines to beneficiaries on the information required and by giving priority to requests from organisations that could assure a firmer basis for collective planning. In addition, assistance in planning and the use of the logical framework methodology was given to Fisheries Directors and other parties involved in the preparation of proposals.
Transition Phase results
Progress was made at the management and administrative levels and the changes introduced led to improvements in the assessment of requests, the preparation of activities, and the means of measuring performance. The Technical Secretariat was better able to respond to signals from beneficiaries.
Learning from past experience, the Programme changed its approach to practical training which was now all carried out in the receiving countries. This was more cost-effective and more conducive to achieving sustainable results. A greater effort was also made to reach beneficiaries. More emphasis was put on using professional organisations and other contacts in the region rather than local administrations. Early signs were encouraging, and the Programme showed that it had the capacity to transfer lessons learnt to action.
The Transition Phase had 12 separate activities; six practical training sessions (on insulated containers, Chorkor ovens and insect infestation), two study tours (on professional organisation, and fresh and cured fish markets) and four study sessions (on credit, professional organisation, and tariff and non-tariff barriers). There were 217 participants, approximately half of whom where women, and ten beneficiary countries. Eight institutional partners were involved in the phase, four under long-term contract for on-going activities and four for 'one-off' activities.
The two long-term partners of the Pilot Phase, ITA and INFOPECHE, continued in their previous capacities. ITA followed up their work on insulated containers and a market element was developed. Carpenters trained in the construction of containers were now helped to find markets for their skills. An evaluation of the performance of the test containers produced during the Pilot Phase was also conducted. In Gambia, on-board containers did not fare too well at sea because of deficiencies in construction materials. The transport and land-storage containers endured better, but non-observation of usage instructions shortened the life of many. In Guinea, the on-board containers held up better because means to counterbalance the materials' deficiency were used. It was reported that carpenters trained in construction were regularly receiving orders. Similiar work to extend the technology was begun in Guinea Bissau.
INFOPECHE's role was enlarged to include other Programme publications, while it continued to manage the databank and the bilingual bulletin, 'Bonga'. Distribution of the latter was quadrupled to 800 by the end of the phase and it was developed from being merely a market newsletter to a voice for Programme activities more widely. To provide more timely market information, the frequency of market surveys was increased, and the section entitled 'Market Flash' was separated and published on its own during the intervening months when the bi-monthly 'Bonga' was not produced. The software was also revised and the content expanded to respond more comprehensively to information requests from beneficiaries. An average of four to five requests were received per month.
With the help of the Secretariat and other partners, INFOPECHE succeeded in producing a directory of contacts in the fisheries sector with 805 entries. Five investigative reports were also published.
The other two institutional partners in this phase were PARTICIP and INADES-INFORMATION. PARTICIP conducted three workshops on planning and the logical framework methodology for Directors of Fisheries and other beneficiaries involved in planning Programme activities. Although some participants were sceptical about the new logical framework tool, the results of these somewhat short workshops were moderately successful. INADES-FORMATION designed, produced and tested a training kit on the processing of fish. Three female extension workers from Benin, Burkina Faso and Guinea were trained in its use and results showed that further amendments to the kit were necessary.
More than a quarter of the activities undertaken during the two phases involved training in the use and construction of Chorkor ovens. There were, however, some disappointments on the ground. An evaluation carried out by INFOPECHE in Burkina Faso revealed that the results were less than positive because of poor assessment of environmental factors affecting sustainability. Laws concerning wire mesh (an important basic material) made its availability scarce and the cost of technology prohibitive. Lack of access to credit also inhibited the ability of interested persons to pay for this material. Furthermore, much of the trade in the area (Kompienga) was in fresh fish while the technology was for processing. Thus, immediately following the training, the newly constructed ovens were abandoned. The evidence from Niger was somewhat more encouraging. Although lack of raw materials prevented carpenters from applying their new skills in oven construction, there were some indications that masons were able to apply theirs.
Hauling in the catch the Five-year Phase
Following two experimental phases and three difficult years, the Programme enters the Five-year Phase with several strengths upon which to build. These include firm linkages with local institutions and resource persons, and a functioning policy where activities pursued originate from requests of beneficiaries. In addition, the latter are actively involved in planning and implementation. The Programme has a strategy that targets the very important female component at the post-harvest level, an approach to practical training that involves the development of markets for skills, and a directory of contacts in the fisheries sector that supports the effort to draw upon regional resources.
On the other hand, there are still weaknesses that affect both operational management and the Programme's strategic approach. Among them are, inconsistent use of planning tools, poor assessment of qualitative criteria, inadequate control and monitoring mechanisms, insufficient promotion of the programme itself, an under-developed approach to gender-awareness and insufficient communication among those involved.
As the Programme gears up for the Five-year Phase, which has the objective of reducing post harvest losses by 25%, due attention now needs to be paid to the pursuit of medium and long-term targets. The Technical Report, drawn from the experience of the first two phases, includes a lengthy list of recommendations which seek to address the identified deficiencies, capitalise on strengths and chart a course for the achievement of a range of targets.
The Phase will have a new institutional framework that is intended to strengthen the Programme's in-house technical resource base, management capability and operational efficiency. Four regional NGOs (Credit-Unions of Ghana, Creditip of Senegal, INADES-FORMATION of C"te d'lvoire and CEASM) have formed the West African Association for the Development of Artisanal Fisheries (WADAF) and this body has been formally recognised as the Programme's executing agency. It will be responsible for administration, technical support, and supervision of the Technical Secretariat. The Secretariat itself will be reinforced by a Director with proven management capabilities, a socio-economist, a communications specialist, a financial officer and clerical support staff. Its work will be audited and evaluated externally.
At the strategic level, the status of the former Management Committee has been upgraded to that of a Monitoring Committee. Its membership has been enlarged to involve a greater number of beneficiaries: representatives of economic operators, professional organizations, Associated Partners and Directors of Fisheries. It will be responsible for Programme policy, strategy and overall monitoring.
The new framework has been conceived with the goal of implementing future activities in a decentralised fashion that facilitates maximum involvement of operators and their professional organisations. This is seen as essential if the Programme is to succeed.
Developing effective means of motivating and mobilising local administrations and donors to improve infrastructure is also of paramount concern. Though the Programme currently lacks the competence to address the seemingly intractable problem of credit, it will have to take on a liaison role, cooperating with other competent bodies in this area. Progress is already being made in the areas of institution building and information sharing, but there is still some way to go before fully satisfactory results are achieved.
It is clear that the objective of a 25% reduction in post-harvest losses is an ambitious one for a five-year period. Experience has shown, however, that the Programme can survive even the roughest of seas. The first two phases may not have been plain sailing but they did demonstrate the resilience and determination of donor, management and beneficiaries alike, and this augurs well for the future.
ECDPM Round Table on partnership in development cooperation
Squaring the circle of recipient responsibility and donor accountability ?
One of the most powerful criticisms of development cooperation today is that those targeted for assistance are not actually given a sufficient stake in the process. While most agencies are committed in principle to maximising recipient involvement, an examination of what happens in practice suggests that the deployment of external aid remains largely donor-driven. Without a sense of 'ownership' on the side of the beneficiary, the received wisdom is that development actions are unlikely to be sustainable in the longer term. The solution, therefore, seems to lie in enhancing recipient responsibility.
The problem is that there is a potential clash here with the concept of donor accountability. If greater discretion is given to beneficiaries to propose, devise, implement and evaluate projects, for example, controls on the donor side must be loosened and this would obviously create difficulties. Both taxpayers and contributors to NGOs want assurances that 'their' money is being properly spent. If, in the interests of enhancing recipient 'ownership', the donor agencies have stepped bark, it is difficult to see how such assurances can be given.
So how is one to square the circle ? Can recipient responsibility be increased without a politically unacceptable loss of accountability on the donor side?
This was the key question addressed by the participants at the annual Round Table of the European Centre for Development Policy Management (ECDPM) which was held in Maastricht at the end of June. The event brought together a wide variety of distinguished practitioners in the development scene from both North and South, and we highlight here some of the main issues raised in the full-day plenary session.
The discussion was opened by ECDPM Director, Louk de la Rive Box, who began with a look at the concept of partnership - 'the cornerstone of the ACP-EU system'. This was a highly ambiguous word, he pointed out, and one could argue that it has now become an 'empty shell'. He also referred to the enrichment of development jargon with new words such as 'ownership', and 'accountability' and, in an attempt to set the tone for the discussions to follow, went on to stress the importance of applying these ideas 'in the real world'. In its work, the ECDPM focuses heavily on practical solutions to problems of development and Mr de la Rive Box appeared keen to avoid too many theoretical distractions. In this vein, he spoke of the 'absurd' gap between official discourse and reality. 'The world of development in practice has departed from the world of development in international conferences,' he argued, 'and, without change, there must be a fear that the aid sector will become obsolete.'
As regards accountability, the Director criticised the situation in which 'an army of people are producing reports to satisfy governments and parliaments'. Genuine systems of accountability, he insisted, should be based on results, not disbursements.
The plenary discussions which followed were divided into two sessions, each consisting of a 'keynote presentation' by one of the participants, commentaries by two other designated speakers ('discussants') and then a general debate.
The first keynote speaker was Simba Makoni, the former Executive Secretary of SADC, who is now managing director of a publishing group in Zimbabwe. In a characteristically direct fashion, Mr Makoni drew attention to some uncomfortable home truths about development policy. Citing Graham Hancock, the author of 'The Lords of Poverty', he spoke of the fact that 'most poor people never have any contact with aid'.
On the issue of reconciling donor accountability with recipient responsibility, Mr Makoni argued that it was unreasonable for beneficiaries to expect donors not to have an interest in how development money is spent. At the same time, he was critical of the attitude that 'he who pays the piper calls the tune'. Recalling his own experience in SADC, he spoke of problems that had arisen when he had declined to support projects which he had not regarded as priorities. The donors, he said, had complained to SADC member governments who, in turn, had put pressure on him for 'refusing valuable assistance'.
Criticising the tendency to measure success in terms of disbursements, Mr Makoni pointed out that this approach favoured 'big projects that gobble up funds'. The result was an advantage for big companies in the North and commensurately fewer benefits for the developing country. He also spoke of the complexity of donor systems, arguing that it was almost impossible for local officials to get to grips with all the procedural formalities.
In keeping with the meeting's aim of seeking practical solutions, Mr Makoni argued for the devolution of powers to staff in the field. Those working at donor agency head offices, he insisted, were too distant from the problems, not just physically, but also psychologically. Other measures recommended by the speaker included debt liquidation ('palliative measures are not enough') and greater emphasis on improving technical and managerial skills in developing countries.
The first 'discussant' was a man whose name has become well known in development circles. Willi Wapoenhans, former Vice-President of the World Bank, headed the Task Force established by the Bank in 1992 which produced the report entitled 'Effective Implementation: Key to Development Impact' (more generally known as the Wapenhans Report). This report, with its frank assessment of the shortcomings of World Bank programmer and its proposals for reform, has become a major talking point in the development 'community'.
Mr Wapenhans limited his remarks to a number of key issues beginning with the problem of 'aid fatigue'. It had to be recognised, he said, that budgets in the industrialised countries are under pressure. Referring to commitments made by the World Bank (and others) that funds would not be diverted to Eastern Europe, Mr Wapenhans suggested that, in practice, it would be very difficult to resist doing this. He also spoke of the possibility that the United Nations would 'take on a peacemaking role', and said that the cost of this was 'likely to come out of the same pot' as development aid. His conclusion was that resource for development would become increasingly scarce and this meant that new criteria for deploying them would be needed, with a greater focus on 'performance in utilisation'.
'What needs fixing'
The speaker also posed the questions 'what needs fixing' and, in seeking to answer this, spoke of the failure to build local capacities 'despite decades of technical assistance'. Mr Wapenhans wondered if this assistance, far from contributing to self-reliance, may have 'perpetuated dependency'. Additionally, he pointed to the fact that the developing countries' best resources were directed towards gaining commitments from funders but that this was not matched by effective local implementation. Given Simba Makoni's earlier statement about the bureaucratic complexities,, it certainly appears that current aid systems absorb a high proportion of available local talent-perhaps to the detriment of more directly productive activity.
Mr Wapenhans took issue with Mr Makoni on the subject of debt forgiveness, arguing that such a policy was not consistent with self-reliance. 'The development strategy of a country that refuses to service its debt,' he stated, 'must be in question.''
The next speaker was Sonja Gerlo, representing Belgium's minister for development cooperation. She relayed her minister's concern about the state of public opinion in the developed countries and suggested that more attention be given to information and awareness-raising. She also made the point that 'the whole aid sector is still too much a prisoner of past ideologies', before mounting a vigorous defence of the EU stance in the Lomé, IV mid-term review (which would later be the subject of some pointed exchanges). Ms Gerlo argued that the Union's aim was to consolidate its partnership with the ACP States but that this necessarily involved looking at past experience and adjusting to new realities. On prestige projects, Ms Gerlo said that it was not only the donors who were at fault. 'African leaders also want big projects,' she claimed, 'and the problem needs to be tackled on both sides.' in the discussion which followed, several participants, including MEP Maartje Van Putten and Achim Kratz of the European Commission, stressed the need for better donor coordination in order to reduce the burdens on countries that must currently grapple with a wide variety of systems. Catherine Garreta of the French cooperation ministry raised the related issue of internal inconsistencies in donor agencies which left their partners unsure of how to proceed.
For former World Bank official Stanley Please, a key issue was differentiation-not on the donor side but in dealing with the beneficiaries. In the past, cooperation agencies, with their standard operating guidelines, had failed to recognise that each country had its own set of problems requiring country-specific solutions. He also took a position which may have surprised some, in arguing that partnership arrangements should not include references to democracy and human rights. He cited, in this context, the
(economic) success of the Indonesian development model. A former trade minister of Rwanda, Francois Nzababimana, took up this point when he spoke of the difficulty of implementing political and economic reforms simultaneously.
Given the theme of the Round Table, it was not surprising that attention should focus on the experience of Sweden, a country which has taken radical steps to 'make space' for recipients in order to increase their stake in the development partnership. The keynote speaker for the afternoon session was Jan Cederpren, Deputy Director of SIDA, who described the new 'changing roles' policy adopted by his country at the end of the 1980s. Mr Cedergren explained how Sweden had come to the conclusion that it had taken too much control of the process in its bilateral cooperation. It had therefore cut its procurement activities by half and traditional technical assistance by two-thirds, transferring more responsibility in the proces to the developing countries themselves. There had also been an increase in delegation staffing levels with a commensurate reduction in HQ personnel.
Sweden (and Norway) appear to have gone much further than other development partners in the North to make recipient responsibility a reality. Mr Cedergren argued that this was the only realistic way forward and stressed that participation had to be built in at all stages of programming. Echoing the sentiments of Mr Please, he underlined the importance of being 'country-specific'. While acknowledging that he was not wholly comfortable with the idea of 'turning one's back on weak governments and administrations', he emphasized the need for 'good' governments, K development cooperation was to succeed. The lesson here appears to be that recipients who put their own house in order should be rewarded for their efforts.
Continuing on the same theme, Mr Cedergren suggested that there should be more involvement by beneficiaries in devising and implementing structural adjustment programmer (SAP''s). The process was too secret, he argued, and there should be greater transparency involving the participation of local parliaments.
Mr Cedergren concluded with an acknowledgement that increased recipient responsibility 'implies risk taking' but he clearly favoured this approach over one in which the partnership was undermined because of heavy demands made by the donors, in the name of accountability.
The session's first 'discussant' was Robert Dodoo, Head of the Ghana Civil Service. He aligned himself firmly with the Swedish position, expressing the hope that this would 'serve as a counterbalance' to views expressed earlier on the European Union's stance in the Lomé, mid-term review. Emphasising the importance of genuine dialogue, he argued that the partnership was currently too much donordriven. He also suggested that aid fatigue was not exclusive to the donors. 'Many recipients are tired of conditionalities,' he claimed, and some were even beginning to say that it may be time to go it alone.
At the same time, Mr Dodoo did not believe it was possible to shy away from issues of human rights, good governance and the rule of law. And, reflecting the new economic consensus which has formed since the end of the Cold War, he argued that development actions needed to be 'results-oriented, cost-effective and market-oriented.'
'Expect nothing of a beggar'
The Swedish view also found favour with Rashid Orlando Marville, who is the Ambassador of Barbados in Brussels, and one of the ACP negotiators in the talks on the mid-term review. Reiterating Mr Cedergren's statement that 'donor-driven development does not work', Mr Marville went on to deliver a sharp critique of the EU's negotiating position which, he claimed, would involve more responsibility going back to the donor. Accusing the Union of basing its approach on the worst -case scenario, he complained that 'the image is always Rwanda-not Botswana, Mauritius, Barbados or Fiji'. He continued, 'the recipient is left in the position of a beggar-and you can expect nothing of a beggar.'
Mr Marville agreed that some strings had to be attached to development assistance, citing elements such as human rights and good governance. But at the outset of the negotiations, he claimed, 'good governance' had been downgraded from a condition to a desideratum while 'free markets' had been elevated.
He also criticised the widespread use of European consultancies in development programmes. This, he said, was one of the most profitable aspects of aid for European countries, consuming a large proportion of aid resources.
Mr Marville's hard-hitting comments set off a lively debate with Achim Kratz (EC Commission) defending the Lomé, system for appointing consultants and pointing out that requests had to come from the ACP side. For large contracts, there were objective procedures and although smaller consultancies were allocated on the basis of a shortlist, the final choice was made by the ACP government who could, if they wished, add to the list. This drew ripostes from Mr Makoni and Mr Marville who both cited specific cases which, they believed, showed a divergence between theory and practice. Deogratias Ntukamizana of the Tanzania civil service added that consultants and long term advisers were naturally 'interested in perpetuating their own existence', thereby lending credence to Mr Wapenhans' earlier suggestion that technical assistance may perpetuate dependency.
Joseph Chantraine of the Belgian cooperation authorities argued, in response to Ambassador Marville, that there needed to be a single framework for the Lomé, Convention so as to avoid discrimination between ACP countries. This appeared to be against the general feeling that some form of country differentiation was required. He also wondered whether dialogue with governments was necessarily the same as dialogue with the people and communities whom aid is ultimately supposed to help.
Not all those present, of course, have a direct involvement in the Lomé, system and they had a number of more general points to make during the open discussion. Heather Baser of CIDA (Canada) agreed that procedures for financial accountability were often unduly burdensome. 'Staff in donor organisations', she suggested, 'probably have a control mentality which needs changing.' Mamadou Dia of the World Bank sought to elaborate on the 'ownerships concept, arguing that it needed to be applied at all stages. This meant, in the context of technical assistance, that the profile needed to be changed to support capacity-building. Hedy Son Metsch, who heads the evaluation section of the Dutch cooperation department, spoke of the way in which donors followed new trends or fashions. 'They try one concept, and when it doesn't work, they all move over to something else,' she observed, doubting whether this was particularly constructive.
It is clear from the above that there was a wide-ranging and frank debate about the general difficulties facing development cooperation and about the specific problem of reconciling donor accountability with recipient responsibility. On the second day of the meeting, the participants divided into three groups to discuss specific issues in greater depth. They then came back together on the final day to report on the results of this exercise. A comprehensive 'Round Table Report' will be issued by the ECDPM in the autumn.
Bearing in mind Louk de la Rive Box's plea at the outset for participants to focus on pragmatic solutions, the obvious question to ask is whether this aim was achieved. It is certainly true that while The Courier was present, most of the speakers complied with the ECDPM Directors wishes. The result was a useful exchange of practical views and ideas, and something that was refreshingly different from many of the more formal international meetings held to discuss themes of a similar nature. In its role as a 'think-tank' for development policy issues, the Centre undoubtedly succeeded with this event. Whether it leads to any substantive policy changes is, of course, a different matter, but at least it provided new food for thought for those who took part. And it is worth remembering that many of these are senior practitioners in the development field.