Time for the results?

Results is the buzzword of the moment in development and especially here at the World Bank and IMF Spring meetings. On Friday I participated in a day discussing Results Based Financing for Health and today a consultation on a new Bank instrument called Program[me] for Results (P4R).

Of course, the idea that we want to see good outcomes from development activities is hardly revolutionary. Actually achieving real change is the aim of all of us and always has been. At Friday’s meeting, we covered some wide topics that are being put together under the results heading, perhaps with only a loose connection between them.

We discussed how a state can prompt its citzens to make healthier choices. There is much enthusiasm for “conditional cash transfers“, tying welfare payments to behaviours, such as girls attending school or women giving birth in health centres. Save the Children has helped show that unconditional cash transfers, simply giving cash to the poor, actually leads to better outcomes for their children.

We discussed how health managers can get their staff to work harder by paying them for outcomes instead of simply paying a salary. Civil society participants pointed out that it would be a good start if we ever had ensured staff were always paid a reliable, living wage. It was acknowledged that paying per output may work for poorly paid staff doing low-level tasks but actually reduces performance in staff who are expected to use their initiative.

Finally, how aid is delivered by donors and their need to get recipient countries to report results is clearly becoming an important debate. For the UK, the need to justify aid spending to a hostile media means a strong desire to talk about results (lives British aid has helped to save and not just the amounts spent). This is understandable and I have blogged before that the UK government’s reproductive, maternal and newborn health strategy has the right balance because it looks for national level impact without trying to tie UK funding to counting outputs.

Do the poor need to be pushed to do good things?

However, while there are important debates under each topic, all of these have something potentially quite dangerous in common. They seem to start from the premise that the poor need to be pushed to do good things.

If we take a rights-based approach to development, we should be talking about empowering poor communities, low-level staff and developing countries to achieve what they want for their families and people.

If we believe in aid effectiveness, we should stop assuming that rich countries know what’s best and instead make sure that the aid they are morally obliged to give supports nationally-owned plans. In all cases, we should be working to remove the obstacles and barrers that prevent those without economic power from acting in the interests of their communities. Those barriers are usually put there and reinforced by those with economic power.