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Fourth
quarter 2007
Adviser
calls for more spending on health and education
Donors must change the way
they provide money, argues report
Donors are moving towards providing aid in the form of direct support to
the budgets of developing countries, but experts are calling for more
spending on health and education because there are not enough teachers,
nurses and doctors. "Current aid is failing poor people - only eight cents in the
aid dollar are channelled into government plans that include the training
and salaries of teachers and health workers," said Tom Noel,
a policy advisor at Oxfam, the UK-based development agency, and author of
Paying for People: Financing the skilled workers needed to deliver health
and education services for all,
a briefing paper for the organisation.
"Aid donors must change the way they provide money, making
long-term commitments and supporting national plans," he
wrote. Over four million health professionals and support
staff are needed, one-quarter of them in Africa. If things carry on as
they are now, these gaps are not going to be filled. A major proportion of donor aid is often devoured by administration and
personnel costs, said Jack Jones Zulu, a programme manager at the Southern
Africa Regional Poverty Network, which focuses on sustainable reduction of
poverty.
The trend is that donors are moving away from project
funding to general budget support (GBS): it saves the high transaction
cost and time [spent] meeting with donors, preparing reports, hiring
personnel to monitor projects, costs of consultants," he
said.
He pointed out that Zambia at one time held 1,300 accounts with various
donors. "The government had to prepare that many reports ...
With GBS, the government can utilise the money directly and according to
its priorities. Aid is also more effective when it is aligned with the
country's priorities." GBS is still a relatively unexplored area, but
evaluations
show that it delivers good results in social spending where donors and
governments have built mutual trust and transparency," Noel
commented. Developing countries have increased their investment in health
and education in the last decade, employing thousands more workers, the
Oxfam paper acknowledged, but doing more to meet the United Nations (UN)
Millennium Development Goals (MDGs) on education and health was beyond
their reach.
Andy Berg, of the International Monetary Fund, and Zia Qureshi, of the
World Bank, note in their paper,
The MDGs: Building Momentum
, that, In sub-Saharan Africa, budget allocations are, on
average, short of the benchmark of 20 per cent of the recurrent budget for
education agreed to under the Education for All Fast Track Initiative, and
the benchmark of 15 per cent of the recurrent budget for health adopted by
African governments in 2000. According to Berg and Qureshi, Africa will need to triple its health
workforce by 2015, adding more than a million workers. The
scaling-up of human development services will require a substantial
increase in financing, which will need to come from both improved domestic
resource management and larger aid inflows. The Commission for Africa, set up by British Prime Minister Tony Blair in
2004 to take a fresh look at the continent and the international
community's role in its development, put the direct cost to
Africa of health-worker migration at US$500 million each year.
The World Health Organisation (WHO) estimated that countries with severe
health-worker shortages would need to increase their level of spending by
about US$1.60
per capita
to meet the cost of training new health personnel. To pay
the salaries of the scaled-up workforce as they finish training, a further
increase of US$8.30
per capita
would be required ... This implies extra investment of a minimum US$7
billion each year," Noel said.
In the education sector, Oxfam has calculated a global shortage of 1.9
million primary school teachers, the number needed to ensure
that every school-age child can be taught by a qualified teacher in a
class of no more than 40 children, which is the maximum recommended by
institutions such as the World Bank and UNESCO."
Noel said sub-Saharan Africa would need to increase its current stock of
2.4 million teachers by 68 percent in ten years to reach the UNESCO
target.
According to UNESCO and the United Kingdom's Department for
International Development, it would take approximately US$10 billion in
external financing annually to achieve the goal of ensuring that every
child completed a quality primary education by 2015, while Noel put the
minimum at US$6.7 billion, based on World Bank analysis of the funding
requirements to meet this goal in low-income countries, but which included
only the salaries of teachers. Donors have reached out to support the
training, recruitment and retention of teachers and health workers with
debt cancellation, sector budget support, and general budget support.
Other sector-specific aid has also been successful such as the Education
for All Fast Track Initiative. Meanwhile, debt cancellation has resulted
in more funds being channelled into health and education. "Immediate increases have been seen in Benin, Burkina Faso,
Madagascar, Malawi, Mozambique, Tanzania, Uganda and Zambia," Noel said.
At present, GBS constitutes a very small proportion of overall aid: based
on disbursements by Organisation for Economic Co-operation and Development
(OECD) donors, in 2004 it accounted for just three percent.
"There is very little research done on GBS, but the potential
is tremendous," said Zulu, who has written a paper proposing
more GBS for Zambia.
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