Developing countries need joined-up thinking to promote growth, and donor agencies must find ways to support this.
Next month, more than 2,000 participants are expected to gather in Montreux, Switzerland, for the First Global Symposium on Health Systems Research, organised by the WHO and other partners.
The popularity of the meeting reflects growing support for the idea that improving health requires more than pursuing discrete objectives such as the Millennium Development Goals (MDGs). Equally essential is an awareness of how different development goals relate to one another, such as the effect of economic growth on raising levels of public health.
In a similar way, a holistic approach is also essential for building the solid infrastructure and social systems needed to sustain scientific research and technological innovation in developing countries, as both activities cut across a wide range of different social and economic objectives.
Such an approach needs to include, for example, input from, and collaboration with, the ministries of health, agriculture and energy — and not just ministries of science and technology. It also requires development ranging from building robust educational systems to creating supportive patent policies, neither of which is restricted to one field alone.
A meeting organised in Geneva this week (26 October) by the Council on Health Research for Development (COHRED) heard that, despite the need for a holistic approach, introducing greater 'systems thinking' into the development agenda in general — and the health agenda in particular — is easier said than done.
One reason is that systems thinking challenges some of the conventional ways of delivering development aid.
The meeting heard several examples of the benefits of a holistic approach to delivering public goods and services. In Costa Rica, introducing this perspective to health care has made it much easier to ensure that medical services reflect user demand — since it addresses the total package of health needs — rather than supplier or researcher preferences.
One participant from Rwanda described how that country has adopted a systems view across its whole development strategy. Rwanda's efforts to promote science and innovation have involved joined-up thinking between ministries and agencies, avoiding previous traps, such as building up research institutes while ignoring the mechanisms needed to ensure research uptake.
Another speaker challenged the idea that the spread of mobile phones in Africa represented merely an imaginative technological leap. He suggested that they had spread so rapidly because mobile networks met a number of needs, from promoting the construction of a telecommunications infrastructure to finding effective mechanisms for providing financial credit to small-scale enterprises.
Other such 'tipping points' for development, he suggested, would only emerge from analysis of areas where multiple needs overlap.
Seeing the bigger picture
There was also much discussion of perhaps the biggest challenge for joined-up thinking in development planning, namely, how to bring together the public and the private sectors. As a report published jointly earlier this year by COHRED and the New Partnership for Africa's Development (NEPAD) pointed out, Africa will never be able to sustain its own health systems until, among other things, it has built up its own pharmaceutical and vaccine industries.
But if the advantages of a more holistic approach to development were on display at the COHRED meeting, so too were the hurdles. In developing countries, for example, intense rivalries for funding between ministries can undermine policies intended to promote collaboration in addressing development challenges.
Similarly, multilateral agencies, including the technical bodies of the United Nations, such as the Food and Agriculture Organization and the WHO, tend to see development problems through the 'vertical' lenses of their own specialised mandate. Cross-agency collaboration has had a chequered history.
Donor agencies find it easier to meet domestic demands for greater accountability by measuring the outputs of clearly defined projects, rather than assessing the impact of their funding on programmes that are more diffuse and long term (such as building up the infrastructure required to establish a strong scientific community).
Finally, efforts to establish closer collaboration between the public and private sectors pose their own challenges. These can range from conflicting definitions of public need to deep-rooted distrust of the activities of foreign-owned corporations (for example, in the pharmaceutical and agribusiness industries).
Supporting sustainable development
There are no easy solutions to any of these problems. But a first step lies in modifying the way the development process is perceived. It is not simply about providing aid money, or improving individual skills and livelihoods, but helping countries build up the complex systems on which social and economic development depends.
Carel IJsselmuiden, the director of COHRED, neatly summed this up by referring to a need to update the familiar Chinese proverb: "Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime."
The real challenge facing development policy, said IJsselmuiden, lay in moving on to a third stage: providing communities — and not just individuals — with the knowledge, resources and infrastructure required to fish in a sustainable away.
Achieving this objective means bringing a wider range of stakeholders to the table than is often the case, overcoming historical rivalries, and working together towards common objectives. The Paris Declaration on aid effectiveness has been one step in this direction by encouraging developing countries to assess and present their own needs holistically, rather than on the basis of what an individual ministry wants, and for donors to assist this process by harmonising their own aid efforts.
It would be a tragedy if current financial pressures on aid budgets, demands for easy-to-trace accountability, or the need for a quick political pay-off led to further fragmentation of both aid efforts and development policies. The future lies in the opposite direction.