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Key Text Improving the Delivery of Health and Education Services in Difficult Environments: Lessons from Case Studies

Author: C Carlson et al
Date: 2005
Size: 25 pages (298.4 KB)

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Summary

How can service delivery interventions be improved in difficult environments? This report by the United Kingdom Government's Department for International Development (DFID) analyses the situation in a range of so-called 'difficult environments'. It argues that, while it is commonly acknowledged that poverty alleviation requires more aid, better trade and progress on debt relief, there is little information on the most effective aid instruments and channels in supporting pro-poor basic social services. It makes recommendations for changes in the way aid is delivered.

500 million people live in countries that have been categorised as difficult partners or environments. The international community has recognised that the human cost of not engaging with difficult partners is unacceptably high and that new approaches are needed to meet the needs of poor people living in these countries. Current international strategies to address the basic quality of life of poor people in such environments face considerable implementation challenges. Most analysis on the best ways to achieve the Millennium Development Goals (MDGs) generally emphasises the need for more aid, better trade and progress on debt relief. But little is said about the best ways to achieve these goals.

Changes in the way that aid is delivered are needed both on the policy level and on the operational level. On the policy level:

There must be an overarching policy that drives the service delivery agenda and ensures that there is good coordination between different actors.
In difficult environments this leadership may need to be instigated externally at first, where national governments are unable to take on co-ordination themselves.
However, even weak governments can help set the policy environment and work through other agencies to ensure adequate service delivery.
Building the capacity of state and non-state actors should be integrated into programmes in difficult environments. Organisations can, thereby, incorporate a long-term perspective even while providing short-term interventions.
DFID must follow through on its obligations to protect the human rights of the most vulnerable groups living in difficult environments.
This should be done either through direct intervention with those committing abuse or through close liaison with specialist human rights organisations by providing support for monitoring and advocacy work.

On the operational level, there need to be changes in several areas, including the following:

Greater attention needs to be given to building the capacity of government staff and civil society to be more strategic.
Effective delivery of services in difficult environments requires long-term funding commitments. Funding streams must avoid the short termism of humanitarian aid as countries move from emergency crisis to longer-term development.
Sustainable systems can be nurtured within difficult environments. Assistance should assume that local capacity does exist. Sustainability can be fostered by ensuring much greater local involvement different levels in planning, delivering and monitoring services.
Programmes in difficult environments must be targeted to meet the needs of groups that are marginalised and hard to reach.
This involves bearing the increased costs of reaching these groups while also ensuring that targeted programmes are coherent with mainstream programmes.

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Source: Carlson, C et al, ‘Improving the Delivery of Health and Education Services in Difficult Environments: Lessons from Case Studies’, DFID Health Systems Resource Centre, London
Author: DFID Health Resource Centre (HRC), http://www.dfidhealthrc.org/index.html