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Economic development, institutional analysis, health systems, corruption, evaluation
Bill Savedoff is a senior fellow at the Center for Global Development where he works on issues of aid effectiveness and health policy. His current research focuses on the use of performance payments in aid programs and problems posed by corruption. At the Center, Savedoff played a leading role in the Evaluation Gap Initiative and co-authored Cash on Delivery Aid with Nancy Birdsall. Before joining the Center, Savedoff prepared, coordinated, and advised development projects in Latin America, Africa and Asia for the Inter-American Development Bank and the World Health Organization. As a Senior Partner at Social Insight, Savedoff worked for clients including the National Institutes of Health, Transparency International, and the World Bank. He has published books and articles on labor markets, health, education, water, and housing including “What Should a Country Spend on Health?,” Governing Mandatory Health Insurance, and Diagnosis Corruption.
In a recent trip to the center of the world, I found myself confronting the big development questions in a low-income country with reasonably propitious circumstances. Papua New Guinea (PNG) is larger, richer, and growing faster than I had thought. It will go to the polls this very month to elect a new government. It is also facing all the dilemmas faced by most low-income countries since the 1950s—political fragmentation, resource curses, income inequality, and poor health. Have we learned anything to help it meet those challenges?
In April, I attended a very hopeful event sponsored by the World Bank entitled, “Tobacco Taxation Win-Win for Public Health and Domestic Resources Mobilization.” My optimism was buoyed by seeing people from different ministries, disciplines, and perspectives all recognizing the need to raise tobacco taxes and sharing ideas on how to reduce the death toll from smoking. Then the bubble burst. I got home and saw a Wall Street Journal article about the increasing profitability of cigarette corporations in the US domestic market—a reminder that, unbelievably, we are still on the defensive against this large, growing, and completely avoidable disaster.
Health technologies can reduce healthcare spending. On average, they don’t. Prominent examples—like the way polio vaccines eliminated the need for iron lungs—seem to drive a common faith in healthcare technology as a tool to “cure” costly health systems. But it actually works the other way around—health systems (policies, institutions, and markets) and human responses to them determine whether these tools will (or won’t) increase spending.
When the UN adopted the Sustainable Development Goals (SDGs) in 2015, they were met with a mix of hope, dismay, and derision. Until we see how people respond to these goals, judgments about their specificity, complexity, and usefulness are educated guesses. At a workshop last month, I got a glimpse of two ways the SDGs may be making a difference—focusing political attention and reorganizing aid relationships.
This introductory note is for funders that are considering the Cash on Delivery Aid approach for their operations. It offers answers to the most common questions that staff from government agencies and foundations have posed to the Center about testing this outcomes-focused approach. It provides specific sector examples and offers references to other resources and FAQs on the Center’s website that have more detailed information about designing and implementing Cash on Delivery Aid programs.
In recent years, donors have been making greater use of performance-based payment approaches to fund development programs. The UK Department for International Development, using the broader term being used across the UK government, has added “Payment by Results” (PbR) to the development lexicon.
While global development is about much more than aid, US foreign assistance is, and will remain, one of the most visible tools for US development policy in many countries. The US government spends less than 1 percent of its annual budget — about $23 billion — on nonmilitary foreign assistance across the globe. These programs have consistently come under fire for failing to achieve measurable and sustainable results, ignoring local priorities and contexts, perpetuating bureaucratic inefficiencies and inflexibility, and repeating mistakes over time. A paradigm shift within US aid agencies is needed. In this brief, we outline concrete proposals that would address many of the traditional shortcomings of US foreign aid approaches.
Climate change will have profound effects on development, poverty, health, and well-being in coming years. Rejuvenated by the recent Paris agreements, efforts to channel the international funding commitments need channels for cost-effective mitigation. The Green Climate Fund (GCF) represents the best current opportunity to address climate change effectively with international funding. Unlike other institutions, the GCF is relatively new and is still developing its policies and procedures.
A common objection to results-based programs is that they are somehow more vulnerable to corruption. This paper explains why results-based approaches to foreign aid may be less vulnerable to corruption than traditional approaches which track inputs and activities. The paper highlights corruption costs associated with failing to generate benefits and outlines the conditions under which one approach or another might be preferable. It concludes that results-based programs may be less vulnerable to corruption costs associated with failure because they limit the capacity of dishonest agents to divert funds unless those agents first improve efficiency and outputs.