Nursing Studies, School of Health in Social Science, University of Edinburgh, Doorway 6, Teviot Place, Edinburgh, EH8 9AG, UK.
School of Social and Political Science, University of Edinburgh, Crystal Macmillan Building, 15a, George Square, Edinburgh, EH8 9LD, UK.
Global Health. 2018 Mar 27;14(1):33. doi: 10.1186/s12992-018-0350-0.
Nepal has been receiving foreign aid since the early 1950s. Currently, the country's health care system is heavily dependent on aid, even for the provision of basic health services to its people. Globally, the mechanism for the dispersal of foreign aid is becoming increasingly complex. Numerous stakeholders are involved at various levels: donors, intermediary organisations, project-implementing partners and the beneficiaries, engaging not only in Nepal but also globally. To illustrate how branding and bidding occurs, and to discuss how this process has become increasingly vital in securing foreign aid to run MCH activities in Nepal.
This paper is based on a qualitative study. The data collection method includes Key Informant Interviews, the review of relevant policy documents and secondary data, and finally field observation visits to four maternal and child health (MCH) projects, currently funded by foreign aid. Through these methods we planned to gain a comprehensive understanding of the aid dispersing mechanism, and the aid-securing strategies, used by organisations seeking funds to provide MCH services in Nepal.
Study findings suggest that foreign aid for the provision of MCH services in Nepal is channeled increasingly to its beneficiaries, not through the Government system, but rather via various intermediary organisations, employing branding and bidding processes. These organisations adapt commercial models, seeking to justify their 'cost-effectiveness'. They argue that they are 'yielding good value for money', with short-term target oriented projects. This ethos is evident throughout the aid dispersing chain. Organisations use innovative ideas and intervention packages, branded internationally and nationally, and employ the appropriate language of commerce in their bid to secure funds. The paper raises an important question as to whether the current mechanisms of channeling foreign aid in the MCH sector, via intermediary organisations, can actually be cost-effective, given the complex bureaucratic processes involved.
The study findings are very important, for Nepal's development in particular, and for international development in general. The paper concludes by recommending strongly that foreign aid should concentrate on supporting and strengthening the national government system. Complex bureaucratic process must be minimised and streamlined in order to provide quality care to the beneficiaries.
自 20 世纪 50 年代初以来,尼泊尔一直接受外国援助。目前,尼泊尔的医疗保健系统严重依赖援助,甚至向其人民提供基本的医疗服务也依赖援助。在全球范围内,外国援助的分配机制变得越来越复杂。众多利益相关者在不同层面上参与其中:捐助者、中间组织、项目实施伙伴和受益者,不仅在尼泊尔,而且在全球范围内都参与其中。为了说明品牌塑造和竞标是如何进行的,并讨论这一过程如何在确保外国援助方面变得越来越重要,以在尼泊尔开展妇幼保健活动。
本文基于定性研究。数据收集方法包括关键知情人访谈、相关政策文件和二手数据的审查,最后是对四个当前由外国援助供资的妇幼保健 (MCH) 项目的实地考察。通过这些方法,我们计划全面了解组织为在尼泊尔提供妇幼保健服务而寻求资金的援助分配机制和援助保障策略。
研究结果表明,尼泊尔提供妇幼保健服务的外国援助越来越多地通过各种中间组织而不是通过政府系统直接提供给受益者,这些中间组织采用品牌塑造和竞标过程。这些组织采用商业模型,试图证明其“成本效益”。他们认为,他们通过短期目标导向的项目“物有所值”。这种精神在整个援助分配链中都很明显。组织使用创新理念和干预措施包,进行国际和国内品牌塑造,并在竞标中使用适当的商业语言来争取资金。该文件提出了一个重要问题,即通过中间组织为妇幼保健部门分配外国援助的当前机制是否实际上具有成本效益,考虑到所涉及的复杂官僚程序。
研究结果对尼泊尔的发展,特别是对国际发展都非常重要。该文件最后强烈建议,外国援助应集中支持和加强国家政府系统。为了向受益者提供优质护理,必须尽量减少和简化复杂的官僚程序。