Posts tagged ‘NGOs’

November, 2013

“Thinking politically” Part III:

2: Not ‘the problem’:

Another way in which ‘politics’ has often been understood by donor officials has been as a ‘problem’ – as Laura Routley and David Hulme have recently pointed out (Routley and Hulme 2013: 15-16). The introduction of ‘political economy analyses’ (see tomorrow’s blog) of development programmes and interventions in recent years has – for many donors – simply flagged-up all the obstacles ‘politics’ poses to the successful implementation of an otherwise well-designed project. ‘Politics’ is the corrupt official embezzling part of the budget. ‘Politics’ is the inter-agency rivalry between local government bureaucracies standing in the way of smooth implementation of policy. ‘Politics’ is a nuisance and an enemy of development and something which policy-makers and practitioners must find a way to neutralize in order for their work to make the difference it is meant to make.

“Thinking politically”, however, means getting out of this mindset – particularly difficult in the ‘project cycle’ environment within many donor agencies and NGOs. Apart from anything else, ‘politics’ is not something one can avoid – it is everywhere and exists in every relationship and organization. There are few more politicized situations than those which are commonplace in development interventions: foreigners delivering services because a government can – or will – not, local elites losing resources (or gaining them) at the expense of others etc. Seeing this reality as a ‘problem’ is counterproductive at best.

Supporters of political thinking would also argue that this reality opens up opportunities for development actors. If we as outsiders can understand and appreciate the dynamics of power relationships within societies we can also work with – or through – them to deliver development projects and objectives. This is something increasingly advocated by leading public policy scholars such as Merilee Grindle and even by donors themselves – see, for example, the World Bank Institute’s Leadership for Development programme. This may mean making awkward choices – working through patronage networks instead of government ministries or with warlords instead of NGOs – but ultimately politics can be a solution and not just a problem.

3: About relationships

Building on this a range of commentators and organizations – including the Development Leadership Programme, led initially by Adrian Leftwich and now by the University of Birmingham International Development Department’s Heather Marquette – advocate focusing on relationships as the core of ‘thinking politically’. Emphasizing human agency rather than (or, at least, within) the formal and informal structures that govern a society, these thinkers stress that positive change happens through building coalitions between different groups and that, therefore, donors should focus on organizing ‘coalitions for change’ – bringing actors and organizations together around common goals. This involves understanding incentives – why people do the things they do – and appreciating the fact that incentives change and relationships evolve; politics is dynamic, complex and messy.

4: ‘How things really are’

My own favourite definition of ‘thinking politically’ is perhaps summarized as ‘seeing things for how they really are’. This means trying to avoid applying too many general frameworks or models to societies, or processes occurring within them, for fear of missing important issues and developments that don’t fit into those models.

Astute readers may have noticed that I have not yet even attempted to define ‘politics’ itself…..perhaps I will try and do this before the week is out!

Dr Jonathan Fisher is a Lecturer in International Development at the University of Birmingham.

Sources:

Laura Routley and David Hulme (2013): Donors, Development Agencies and the use of Political Economic Analysis: Getting to grips with the politics of development, Effective States and Inclusive Development (ESID) Research Centre Working Paper No 19, University of Manchester.

Development Leadership Programme 

Further links:

What are some of the ways in which donors have tried to get their staff to ‘think politically’ in recent years?

How to think and work politically in development

Discussion paper

Second paper

November, 2013

‘Don’t throw the baby out with the bath water’ – the importance of training in a low resource setting, by Miss Sadia Malick, Consultant Obstetrician and Gynaecologist & ammalife trustee

Training in the management of Obstetric emergencies is essential to prevent unnecessary disability and death in women. It is very important that all training is tailored and targeted for the group of healthcare workers being trained. All skilled birth attendants in the UK received skills updates every year.

In Pakistan, this is often not the case. There are three main groups of maternity healthcare providers. Firstly the trained doctors who are not working in hospital settings and do not take part in mandatory Clinical professional development programmes. These doctors remain on front line duties facing Obstetric emergencies all the time but unfortunately do not initiate or are part of programmes where they have to keep their knowledge up to date. Some NGO’s are involved with this cadre to improve and update skills with an aim to reduce maternal mortality and morbidity.

The second group are the trained nurses or midwives who provide midwifery care to women. These health care professionals usually work in district general hospital or smaller hospitals where they do not have the support of trained doctors’ majority of time. They have their experience and knowledge of working in obstetrics for many years but unfortunately have no formal training programmes to either update their skills or to learn new skills which would help them improve their care for the women they deliver. Some NGO’s are also involved with improving skills of this cadre.

The third group is that of the traditional birth attendants. This group is largely controversial and due to their lack of regulated training is blamed by the above mentioned group for the majority of the complicated cases that arrive too late in the hospitals, and present in a moribund state. The reality is that the services offered by TBAs are the most commonly used healthcare provider used by women, particularly in rural areas. This is due to many reasons, such as social (many women are not permitted to attend hospital to give birth for fear of exposure), financial (expensive, unaffordable healthcare, financial bribes by staff, or costly transportation to hospital) and a lack of any other service available (an absence of healthcare staff at the facility, as there is a global shortage of nurses, midwives and doctors).

Published research (Wilson et al, 2011, BMJ) suggests that engaging more with this group, by training and supporting them to detect and refer women experiencing signs of obstetric complications can improve outcomes for women and their babies.

Until societies decide that saving women is an absolute priority (economically and socially) and increase the numbers of skilled birth attendants to allow every pregnant woman to have a skilled birth attendant, like here in the UK. We should look to TBAs to fill the gaps. Evidence has shown that they can be effective, we should not ignore this. If there are interventions that work then we should use them. We cannot not ignore evidence; we should support TBAs until we have the optimal intervention to reduce maternal death – a skilled birth attendant such as a midwife or a doctor.

Useful links:

WHO maternal death

MME org

http://tinyurl.com/onm5qvy

Pakistan maternal mortality

Maternal info world bank

Perinatal deaths

Obstetric care Pakistan

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