Country Ownership Research Articles

The CAPACITI Decision-Support Tool for National Immunization Programs

ObjectivesImmunization programs in low-income and middle-income countries (LMICs) are faced with an ever-growing number of vaccines of public health importance recommended by the World Health Organization, while also financing a greater proportion of the program through domestic resources. More than ever, national immunization programs must be equipped to contextualize global guidance and make choices that are best suited to their setting. The CAPACITI decision-support tool has been developed in collaboration with national immunization program decision makers in LMICs to structure and document an evidence-based, context-specific process for prioritizing or selecting among multiple vaccination products, services, or strategies. MethodsThe CAPACITI decision-support tool is based on multi-criteria decision analysis, as a structured way to incorporate multiple sources of evidence and stakeholder perspectives. The tool has been developed iteratively in consultation with 12 countries across Africa, Asia, and the Americas. ResultsThe tool is flexible to existing country processes and can follow any type of multi-criteria decision analysis or a hybrid approach. It is structured into 5 sections: decision question, criteria for decision making, evidence assessment, appraisal, and recommendation. The Excel-based tool guides the user through the steps and document discussions in a transparent manner, with an emphasis on stakeholder engagement and country ownership. ConclusionsPilot countries valued the CAPACITI decision-support tool as a means to consider multiple criteria and stakeholder perspectives and to evaluate trade-offs and the impact of data quality. With use, it is expected that LMICs will tailor steps to their context and streamline the tool for decision making.

Export spillover from foreign direct investment in China during pre- and post-WTO accession

This study investigates the effects of export spillover from foreign direct investment (FDI) before and after China’s World Trade Organization (WTO) accession, with particular consideration of the FDI source country and firm ownership structure. It uses a Chinese manufacturing firm-level panel dataset, for the period 1998–2007. In general, there are no spillover effects among state-owned enterprises (SOEs). This study finds negative horizontal and positive vertical spillovers associated with FDI from Hong Kong, Macao, and Taiwan (HMT) among non-SOEs. Furthermore, non-HMT FDI, which is predominantly from the Organisation for Economic Co-operation and Development (OECD) countries, have statistically significant positive horizontal and vertical spillover effects on the export performance of private Chinese firms. Positive forward spillovers occurred only after China joined the WTO, while positive backward spillovers existed during both the pre- and post-WTO periods. China’s entry into the WTO intensified the forward linkage of production, implying that greater availability of high-quality inputs produced by non-HMT foreign multinationals benefited the export performance of private domestic firms.

Progress in the face of cuts: a qualitative Nigerian case study of maintaining progress towards universal health coverage after losing donor assistance

In the coming years, about a dozen middle-income countries are excepted to transition out of development assistance for health (DAH) based on their economic growth. This anticipated loss of external funds at a time when there is a need for accelerated progress towards universal health coverage (UHC) is a source of concern. Evaluating country readiness for transition towards country ownership of health programmes is a crucial step in making progress towards UHC. We used in-depth interviews to explore: (1) the preparedness of the Nigerian health system to transition out of DAH, (2) transition policies and strategies that are in place in Nigeria, (3) the road map for the implementation of these policies and (4) challenges and recommendations for making progress on such policies. We applied Vogus and Graff’s expanded transition readiness framework within the Nigerian context to synthesize preparedness plans, gaps, challenges and stakeholders’ recommendations for sustaining the gains of donor-funded programmes and reaching UHC. Some steps have been taken to integrate and institutionalize service delivery processes toward sustainable immunization and responsive primary healthcare in line with UHC. There are ongoing discussions on integrating human immunodeficiency virus (HIV) services with other services and the possibility of covering HIV services under the National Health Insurance Scheme (NHIS). We identified more transition preparedness plans within immunization programme compared with HIV programme. However, we identified gaps in all the nine components of the framework that must be filled to be able to sustain gains and make significant progress towards country ownership and UHC. Nigeria needs to focus on building the overall health system by identifying systematic gaps instead of continuing to invest in parallel programmes. Programmes need to be consolidated within the overall health system, health financing priorities and policies. A comprehensive and functional structure will provide continuity even in the event of decreasing external funds or donor exits.

The effects of polio eradication efforts on health systems: a cross-country analysis using the Develop-Distort Dilemma.

Vertical disease control programmes have enormous potential to benefit or weaken health systems, and it is critical to understand how programmes’ design and implementation impact the health systems and communities in which they operate. We use the Develop–Distort Dilemma (DDD) framework to understand how the Global Polio Eradication Initiative (GPEI) distorted or developed local health systems. We include document review and 176 interviews with respondents at the global level and across seven focus countries (Afghanistan, Bangladesh, Democratic Republic of Congo, Ethiopia, India, Indonesia and Nigeria). We use DDD domains, contextual factors and transition planning to analyse interactions between the broader context, local health systems and the GPEI to identify changes. Our analysis confirms earlier research including improved health worker, laboratory and surveillance capacity, monitoring and accountability, and efforts to reach vulnerable populations, whereas distortions include shifting attention from routine health services and distorting local payment and incentives structures. New findings highlight how global-level governance structures evolved and affected national actors; issues of country ownership, including for data systems, where the polio programme is not indigenously financed; how expectations of success have affected implementation at programme and community level; and unresolved tensions around transition planning. The decoupling of polio eradication from routine immunization, in particular, plays an outsize role in these issues as it removed attention from system strengthening. In addition to drawing lessons from the GPEI experience for other efforts, we also reflect on the use of the DDD framework for assessing programmes and their system-level impacts. Future eradication efforts should be approached carefully, and new initiatives of any kind should leverage the existing health system while considering equity, inclusion and transition from the start.

Reinforcing locally led solutions for universal health coverage: a logic model with applications in Benin, Namibia and Uganda

Development assistance for health programmes is often characterised as donor-led models with minimal country ownership and limited sustainability. This article presents new ways for low-income and middle-income countries to gain...

Recognizing the hidden: strengthening the HIV surveillance system among key and priority populations in Mozambique

High quality, representative data from HIV surveillance systems that have country ownership and commitment are critical for guiding national HIV responses, especially among key and priority populations given their disproportionate role in the transmission of the virus. Between 2011 to 2013, the Mozambique Ministry of Health has conducted five Biobehavioral Surveillance Surveys among key populations (female sex workers, men who has sex with men and people who inject drugs) and priority populations (long distance truck drives and miners) as part of the national HIV surveillance system. We describe the experience of strengthening the HIV surveillance system among those populations through the implementation of these surveys in Mozambique. We document the lessons learned through the impact on coordination and collaboration; workforce development and institutional capacity building; data use and dissemination; advocacy and policy impact; financial sustainability and community impact. Key lessons learned include the importance of multisectoral collaboration, vital role of data to support key populations visibility and advocacy efforts, and institutional capacity building of government agencies and key populations organizations. Given that traditional surveillance methodologies from routine data often do not capture these hidden populations, it will be important to ensure that Biobehavioral Surveillance Surveys are an integral part of ongoing HIV surveillance activities in Mozambique.

Public sentiment is everything: Host-country public sentiment toward home country and acquisition ownership during institutional transition

Under strict scrutiny of public governance primed by international relation tensions, geopolitics, and the rise of social movements and public activism in the globalized economy, public sentiment is exerting increasing pressure on multinational corporations (MNCs). Utilizing the context of inward acquisition, a sensitive cross-border action that often triggers sentiment of host-country nationals, we theorize from the public sentiment perspective and the public thermostat analogy that foreign acquirers will adjust their ownership levels in target firms according to how they perceive to be acceptable and legitimate as expressed by host-country nationals’ public sentiment toward their home country. Using a sample of 410 acquisition deals from 22 foreign countries/economies into China during 2010–2017 and a sentiment analysis of 100,902 blog posts, we find that a host country’s public sentiment toward the acquiring firm’s home country is positively related to acquisition ownership levels, and has a mutualistic symbiotic interaction with the host region’s marketization level. Our study contributes to the study of informal institutions by proposing public sentiment as a new form of informal institution that is normative-cognitive whilst affective, and can be mobilized and communicated broadly and timely via a public sphere to confer social, political, and cognitive legitimacy to MNCs.

A Multilateral Track for Sustainable Development Along the Belt and Road: Aligning Country Ownership with International Rule of Law

A Multilateral Track for Sustainable Development Along the Belt and Road: Aligning Country Ownership with International Rule of Law

Current status of trachoma elimination in Africa

Background: Trachoma is a disease of the eye caused by infection with the bacterium Chlamydia trachomatis. It is among the oldest diseases known to mankind, being mentioned in the Ebbers Papyrus and found in the eyelids of Egyptian mummies. It is a public health problem in 44 countries globally and is responsible for the blindness or visual impairment of about 1.9 million people. As of June 2019, an estimated 138 million people live in trachoma endemic communities globally of which over 50% are in Ethiopia alone, and about 40% are in other African countries. Trachoma can be eliminated as a public health problem using a package of interventions known as the “SAFE strategy”, comprising Surgery for TT, Antibiotics to clear ocular C. trachomatis infection and Facial cleanliness and Environmental improvement (particularly improved access to water and sanitation) to reduce transmission. Methods and materials: Through the Global Trachoma Mapping Project (GTMP) and later on using the Tropical Data platform, 2076 district-level population-based baseline surveys, 927 impact assessments and 402 surveillance surveys were conducted. Three Crossborder Partnerships have been established to strengthen collaboration among neighboring countries and synergize elimination efforts. Results: Several encouraging achievements have been recorded thus far in Africa. Morocco and Ghana have been validated by WHO as having eliminated trachoma as a public health problem while Togo has presented its elimination dossier to WHO and is pending validation of its claim. In addition, nine countries are on the final stages of implementation and are preparing the evidence to present their dossiers for validation. These achievements would not have been possible without the generous support of several bilateral, multilateral and private donors including governments and people of the affected countries. The trachoma elimination program is a good model of public private partnerships. Conclusion: The elimination program is making steady progress in all known endemic countries. Country ownership and leadership is key in the process. Among the challenges confronting the country programs are difficulty of attaining the elimination threshold in some hyper-endemic settings, risk of recrudescence of active disease, difficulty of finding trachomatous trichiasis cases in remote villages, insecurity and funding shortfalls in the face of declining morbidity.

Determinants of willingness to participate in community-based health insurance among People Living with HIV in South-East Nigeria

Background: Despite free antiretroviral treatment at designated facilities, many People Living with HIV (PLHIV) in Nigeria continue to face catastrophic health expenditures (CHE) due to direct non-medical and indirect costs of illness. Waning donor funding and poor country ownership of HIV care programs are challenges to the sustainability of care for PLHIV. Community-Based Health Insurance (CBHI) presents a viable alternative for funding HIV care services. The aim of this study was to assess the determinants of Willingness To Participate (WTP) in CBHI among PLHIV in a large tertiary hospital in South-east Nigeria. Methods and materials: A cross-sectional survey was conducted among 371 PLHIV on treatment at Federal Teaching Hospital Abakaliki Nigeria using an interviewer-administered questionnaire. Descriptive, bivariate and multivariate logistic regression analyses were conducted using SPSS version 20. Statistical tests were conducted at 5% level of significance. Results: Respondents were mostly males (51.8%) with mean age of 45.4 ± 10.3. The mean monthly income of respondents was N26, 665.77 ± 15,171.50 ($74,070 ± 42.14). Majority were willing to participate (825%) and to finance their participation in CBHI (65.2%). Major reasons given for unwillingness to participate in CBHI were poor understanding on how the system works, lack of regular source of income, health insurance not needed and fear of poor management of resources. On bivariate analysis, WTP in CBHI was associated with gender (p < 0.001), marital status (p < 0.001), employment type (p = 0.006), family size (p = 0.001), educational level (p < 0.001), monthly and monthly income (p < 0.001). Predictors of WTP were female gender (AOR = 2.9; 95% CI: 1.6–5.7), being currently unmarried (AOR = 4.3; 95% CI: 2.3–7.8), self-employed (AOR = 2.2; 95% CI: 1.2–3.9), family size greater than 5 (AOR = 3.1; 95% CI: 1.7–5.9) and having less than a secondary school education (AOR = 4.3; 95% CI: 2.3–7.8). Conclusion: The majority of the respondents were willing to participate and finance their participation in CBHI. The vulnerable subgroups (females, unmarried, self-employed, poorly educated and those with large family size) had higher odds of WTP. To reduce CHE, there is a need to harness this high WTP among PLHIV in the design of subsidized and sustainable CBHI programs with special focus on the socially disadvantaged.

Leveraging blockchain technology for innovative climate finance under the Green Climate Fund

The rapid development of digital technologies such as blockchain and distributed ledger-based systems holds transformative potential for the financial sector. Promising applications include asset management as well as peer-to-peer networks for the transparent exchange of data and information. International climate finance stands to benefit in particular ways from these new opportunities in financial technology. Distributed ledger technologies could be leveraged to support climate action, for example by facilitating transparent and standardized transactions, or by enabling more efficient monitoring and accreditation processes. In view of these promising opportunities, we focus our inquiry on the case of the Green Climate Fund to explore how distributed ledger technologies can be used for innovative climate finance. Based on our analysis of different digital system models and potential use cases, we then discuss some of the technical and political challenges that may arise, for example with regard to standards and safeguards, governance processes, country ownership, and further capitalization. Our findings show that distributed ledger-based systems could benefit the work of the fund in key areas such as multi-stakeholder coordination and impact assessment. However, our analysis also points to the concrete limitations of technology driven solutions. Digital technologies are not a standalone solution to persistent resource allocation and governance challenges in international climate finance, especially because the design and deployment of these digital systems is inherently political.

Politics of success stories in the path towards Universal Health Coverage: The case of Turkey

AbstractMotivationTurkey has been acknowledged as a “successful” example of Universal Health Coverage (UHC) reforms and has recently gained donor “darling status.” While the literature on UHC and health reforms in various countries has increased significantly in recent years, there is still little research on the political dynamics of the rise of UHC in national and global development agendas.PurposeThis study examines the politics of UHC in Turkey’s Health Transformation Program (HTP). It investigates how various policy actors, such as international organizations, policy experts and national political leaders, use UHC framing for different purposes.Approach &amp; MethodsThe article develops an interdisciplinary conceptual framework that combines elements of ideational scholarship and critical policy analysis. The analysis is based on a review of the secondary literature and primary sources. Qualitative content analysis is used to identify major themes and analyse patterns of interactions across the various policy levels.FindingsThe article’s main findings demonstrate the ways in which international actors and national policy‐makers engage in policy work and use their relationships, global policy ideas and experiences to build legitimacy and support for their respective agendas. Reforms in Turkey were proposed and implemented before the rise of UHC in the global agenda, suggesting an ex post facto rebranding of its reforms as UHC. For Turkey’s policy‐makers, rebranding worked to tie their policy solutions, summarized in the HTP, to UHC as a widely accepted cultural symbol. The Ministry of Health’s deliberate strategy to encourage data collection and monitoring was also a key part of its efforts to construct a success narrative in collaboration with global policy actors. For the global‐level advocates of UHC, Turkey provided evidence that UHC works. Before it became a target under the health‐related Social Development Goals (SDGs), advocates needed to demonstrate that they had the right framing and metrics for a UHC agenda. After 2015, successful examples have served as strategic tools for building support and political momentum as the agenda was diffused, and as these diverse agendas and interests overlapped.Policy ImplicationsThis article contributes to the current debates on policy diffusion, translation and implementation of the UHC agenda. It unpacks the use of success stories to navigate the political dynamics among national governments and global policy communities. Success stories, alongside an emphasis on country ownership, may serve to encourage the co‐production of policy across local, national and global levels.

Donor reliance and the impact on neglected tropical disease programme delivery: reflections and solutions for change from programme management perspectives.

Health systems within many developing countries are reliant on donor funding and non-governmental development organisations (NGDOs); this has had positive results but also presents challenges to sustainability and national ownership, with national programmes needing to respond to changing donor priorities. Simultaneously, the WHO neglected tropical disease (NTD) roadmap 2021–2030 calls for increased country ownership and domestically financed NTD programmes. Focusing on Liberia and blending primary research from the COUNTDOWN consortium and personal programmatic experience, this commentary reflects on the sustainability and financing of NTD programme delivery within the current context. We explore the successes and challenges of current models of collaboration and opportunities to improve country ownership and sustainability.

Partnership and Participation—A Social Network Analysis of the 2017 Global Fund Application Process in the Democratic Republic of the Congo and Uganda

Background:The Global Fund to Fight AIDS, Tuberculosis and Malaria was founded in 2002 as a public-private partnership between governments, the private sector, civil society, and populations affected by the three diseases. A key principle of the Global Fund is country ownership in accessing funding through “engagement of in-country stakeholders, including key and vulnerable populations, communities, and civil society.” Research documenting whether diverse stakeholders are actually engaged and on how stakeholder engagement affects processes and outcomes of grant applications is limited.Objective:To examine representation during the 2017 Global Fund application process in the Democratic Republic of the Congo (DRC) and Uganda and the benefits and drawbacks of partnership to the process.Methods:We developed a mixed-methods social network survey to measure network structure and assess perceptions of how working together in partnership with other individuals/organizations affected perceived effectiveness, efficiency, and country ownership of the application process. Surveys were administered from December 2017–May 2018, initially to a set of central actors, followed by any individuals named during the surveys (up to 10) as collaborators. Network analyses were conducted using R.Findings:Collaborators spanning many organizations and expertise areas contributed to the 2017 applications (DRC: 152 nodes, 237 ties; Uganda: 118 nodes, 241 ties). Participation from NGOs and civil society representatives was relatively strong, with most of their ties being to different organization types, Uganda (63%), and DRC (67%), highlighting their collaborative efforts across the network. Overall, the perceived benefits of partnership were high, including very strong ratings for effectiveness in both countries. Perceived drawbacks of partnership were minimal; however, less than half of respondents thought partnership helped reduce transaction costs or financial costs, suggesting an inclusive and participatory process may come with short-term efficiency tradeoffs.Conclusions:Social network analysis can be useful for identifying who is included and excluded from the process, which can support efforts to ensure stronger, more meaningful engagement in future Global Fund application processes.

Institutional Innovations and Their Challenges in the Green Climate Fund: Country Ownership, Civil Society Participation and Private Sector Engagement

This article investigates the institutional innovations within the Green Climate Fund (GCF), a new international organization that finances climate mitigation and adaptation in developing countries. In particular, donor–recipient parity in decision making, civil society participation and private sector involvement are explored. The aim of this study is to lay the institutional groundwork for a larger study that will be analyzing the effect of these institutional innovations on the design and result of the fund’s projects. An exploratory qualitative case study approach is used that includes the review of the secondary literature, official sources from the GCF, participant observation and semi-structured interviews. This article concludes that the GCF indeed implemented important institutional innovations that are unique for a major international organization. At the same time, this article reveals that these innovations have created some important challenges for the functioning of the fund. For example, donor–recipient parity, in combination with consensus orientation, initially led to gridlock. It is also difficult for the GCF to balance the goal of transparency and civil society participation with the need for secrecy of private contracts and a speedy process demanded by the private sector.

Building a tuberculosis-free world while responding to the COVID-19 pandemic

Building a tuberculosis-free world while responding to the COVID-19 pandemic

Urban Environmental Design, Guidelines in Creating a Balanced Singapore: Lessons for the Urban Communities in Thailand

Singapore has many limited resources. But at the same time can develop the country and preserve the environment of the city in a balanced and sustainable way. Therefore, the design of the city on this issue of Singapore is being taken to study the guidelines, as well as bringing the ideas to be presented to the urban communities that are experiencing environmental problems. Thailand has considered applying, and from the study found that Singapore’s urban development is consistent with universal theory, sustainable development, Smart City, compact city and livable city. And when analyzing these theories together with Singapore’s urban environment design, can summarize the guidelines into 4 main issues which are the Guidelines for balancing the city, the Guidelines for linking areas and activities within the city, the Guidelines for land using and urban planning, and the Guidelines for designing landscape elements that promote the good environment in the city. Moreover, building confidence by creating a sense of the country ownership together, as well as the state and the people participation in the development process is an important factor that makes Singapore a fast urban development among the “Good urban environment”.

Country Ownership as the Means for Paradigm Shift: The Case of the Green Climate Fund

Country ownership echoes from the aid effectiveness agenda in climate finance, becoming a means to ensure that (1) projects are aligned with national climate policies and strategies, (2) national systems are used to increase recipients’ accountability in the use of resources, and (3) national public and private stakeholders are engaged in the process. The concept is a key objective of the Green Climate Fund (GCF), considered in light of the GCF’s goal of promoting the paradigm shift towards low emission and climate-resilient development. In the interplay between international commitments and the progress of its in-country activities, the GCF relies on the agency of National Designated Authorities (NDAs). Based on documental sources, GCF data, and a survey, this article first analyzes whether the GCF’s institutional design creates appropriate responsibilities so NDAs can effectively enhance country ownership. As a second level of effectiveness, the article analyzes whether such an institutional design is currently capable of promoting the desired paradigm shift. In the context of the GCF being a young fund, we found that NDAs have the potential to enhance country ownership, but need more tailored capacity building to ensure that in-country activities are effectively equipped to deliver the paradigm shift.

Role of Intermediaries in Shaping Climate Finance in Developing Countries—Lessons from the Green Climate Fund

Social scientists are increasingly interested in the processes that give shape to global policy solutions. I investigate the issues of intermediation and the role of intermediaries in climate finance. I use the case of the Green Climate Fund (GCF), a new consortium for dedicated funding set up under the United Nations Framework Convention on Climate Change (UNFCCC) to assist developing countries in responding to climate threats, to ask a fundamental question: What role do intermediaries (GCF-accredited and related entities) play in catalysing climate action through climate finance in these countries? This paper offers three propositions focused on the role of intermediaries in the GCF, and tests these using data from the GCF and the wider literature. The results show a growing dominance of international intermediaries in GCF project development and implementation, the low capacity of national intermediaries to conceive and scale projects, and the mismatch between planned and actual funding allocations. Collectively, these outcomes derail the GCF from its core objectives of promoting country ownership of projects, building capacity of local intermediaries, and equitable allocation of funding between mitigation and adaptation. I offer three learning models to help the GCF and intermediaries capitalise on the early lessons from GCF activities and to scale climate finance effectively in developing countries.

Capacity building, local ownership and implementation of a multi-level HIV/AIDS positive health, dignity, and prevention initiative in Mozambique: approach, challenges and lessons learned

ABSTRACT Mozambique has for many years suffered from a high burden of HIV with an estimated prevalence of 11.1% among adults age 15–49 years. In response, Positive Health, Dignity, and Prevention (or Positive Prevention as it is known in Mozambique), was developed as a method of integrating HIV care and prevention via capacity building. Through comprehensive holistic care, HIV transmission is prevented while simultaneously promoting the health of people living with HIV/AIDS. Our initiative used a three-tiered approach, and included activities at national, provincial, and community levels. In order to change patient behavior and successfully train health-care workers in Positive Prevention, it was therefore considered necessary to work at multiple levels of influence. This ensured that the individual-level behavior change of PLHIV and health-care providers was maximized through supportive environments and policies. Related national-level achievements included the establishment of a Positive Prevention technical working group; the development of a Positive Prevention policy document; training national policy-makers on Positive Prevention; the development and distribution of a nationally approved Positive Prevention training package; the integration of Positive Prevention into existing Ministry of Health curricula; the development and approval of national data collection forms; and the drafting of a related national strategy. The framework and key activities of the Mozambique Positive Prevention Program may help to inform and assist others involved in similar work, as well as advancing country or local ownership of HIV/AIDS treatment, care and prevention efforts. By using a three-tiered approach, a supportive system was created. This was critical to both optimizing Positive Prevention provision and building long-term capacity. In order for related efforts to be successful in other settings, we encourage implementing partners to also work at multiple levels, with local ownership principles in mind, in order that Positive Prevention programs may have the greatest possible effect.