The problem with “get governments to scale up and integrate” is that governments… suck. Corruption, incompetence, straight up theft, etc. mean that these interventions which were being provided, when taken over by the government just disappear in a few years.
Many people in the West feel that governments are maybe a bit wasteful and inefficient but on the whole good/okay. In developing countries, this is not always the case.
Also, as Karen Levy pointed out in her ep on the 80k podcast, adoption by LMIC governments effectively means the taxpayers of these countries are the ones to pay. Sustained service by an internationally funded charity represents a desirable wealth transfer to LMICs. Better than the charity graduating from being funded by EAs to being funded by LMIC governments would be for it to graduate to being funded by big funders with cheap counterfactuals like USAID.
(To play devil’s advocate to myself: If government adoption means capacity building in LMIC healthcare systems then that’s great compared to dependence on sustained service from international NGOs. Maybe the best of both worlds is government adoption with ongoing technical assistance and international funding?)
I definitely agree with and share the concerns over government adoption as a silver bullet of sorts on the charity’s side. Outsourcing all the costs when the government’s money and resources are more counterfactually precious than the charity’s is not the way we want things to go!
Our aim is closer to your last sentence: government adoption to leverage the cost-savings from delivery through their existing systems of training/data collection/material distribution, with MHI continuing to pay for the costs involved that the government wouldn’t incur anyway.
I don’t think adoption by LMIC governments removes the desirable wealth transfer to LMICs. I think most of the wealth transfers to LMICs will continue via other NGOs.
The problem with “get governments to scale up and integrate” is that governments… suck. Corruption, incompetence, straight up theft, etc. mean that these interventions which were being provided, when taken over by the government just disappear in a few years.
Many people in the West feel that governments are maybe a bit wasteful and inefficient but on the whole good/okay. In developing countries, this is not always the case.
Also, as Karen Levy pointed out in her ep on the 80k podcast, adoption by LMIC governments effectively means the taxpayers of these countries are the ones to pay. Sustained service by an internationally funded charity represents a desirable wealth transfer to LMICs. Better than the charity graduating from being funded by EAs to being funded by LMIC governments would be for it to graduate to being funded by big funders with cheap counterfactuals like USAID.
(To play devil’s advocate to myself: If government adoption means capacity building in LMIC healthcare systems then that’s great compared to dependence on sustained service from international NGOs. Maybe the best of both worlds is government adoption with ongoing technical assistance and international funding?)
I definitely agree with and share the concerns over government adoption as a silver bullet of sorts on the charity’s side. Outsourcing all the costs when the government’s money and resources are more counterfactually precious than the charity’s is not the way we want things to go!
Our aim is closer to your last sentence: government adoption to leverage the cost-savings from delivery through their existing systems of training/data collection/material distribution, with MHI continuing to pay for the costs involved that the government wouldn’t incur anyway.
I don’t think adoption by LMIC governments removes the desirable wealth transfer to LMICs. I think most of the wealth transfers to LMICs will continue via other NGOs.
CGD have some interesting work making the case that governments should focus on prioritising the most cost-effective health services, and donors, whose funding is less reliable should focus on additional, less cost-effective stuff—https://www.cgdev.org/blog/putting-aid-its-place-new-compact-financing-health-services