I’m just back from a trip to the far north west of Bangladesh, near the Indian border. It was a very welcome, cool and quiet change from Dhaka. I first took part in a review of joint donor support to the health sector with colleagues from DFID, the World Health Organisation and the Government of Bangladesh. After finishing the review, I travelled further north to make a presentation on poverty levels in Bangladesh at a regional workshop. This was organised by the Chars Livelihoods Programme (CLP), which works with rural households living on the fragile sand islands in the mighty Jamuna River and which DFID funds.
Both programmes are producing great results. Our health review team visited a District hospital where mothers who would never normally have access to safe delivery facilities had very recently given birth thanks to a voucher scheme funded by DFID and a number of other donors. Fifty miles away in the Chars I and the other workshop participants visited a village and met a number of women - some of the most vulnerable people on the planet - who had been given assets of their choice (typically a pair of cows) and had their homes raised on clay plinths above the seasonal flood level, as well as a range of other support to enable them to become self-sufficient. Some have since rented land to grow crops for sale and others have started small businesses; almost all now have substantially higher incomes, more to eat and better protection from the river. Both of these programmes contribute to the Millennium Development Goals, and produce results that few people interested in the welfare of the poorest would argue with.
And yet there are also great differences. The health programme works largely through Government systems, aiming to build capacity and achieve long term systemic reform so that services can continue once our support has gone. This brings with it greater uncertainties, a much slower process and less control over the use of our money compared with the CLP, which gets resources into the hands of the poor very quickly but channels most of its support outside Government systems and would be unlikely to continue to operate were it not for ongoing funding. The Government of Bangladesh has approved and formally sponsors the outsourced CLP model, but it remains to be seen whether they will expand such approaches to public services and safety net delivery using their own funds.
The question of which model is more appropriate lies at the heart of the development debate. Owen Barder has recently written an article arguing that commitment to long-term sustainability should not blind us to the need to provide welfare to the poorest people in the world while their countries’ economies and governments develop, a complex and gradual process upon which aid can only have effects at the margin. And the CLP aims to build sustainability in a different way by connecting people to local markets and helping them build the independence to assert their rights and demand government services. At the same time, a successful country-wide Government health programme will reach millions of people and has the potential to produce direct results many years after our support ends.
Donors have come a long way in recent years in thinking through and balancing these issues. It is clearer than ever that there is no one-size-fits-all approach to development. Sustained engagement with the local context, a variety of approaches and rigorous, transparent evaluation are the only way to produce results that British taxpayers can consider worthwhile and that are maintained well into the future.