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Lessons From Africa: The Leadership Spark

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The world has poured billions of dollars into Africa in recent decades trying to address poverty, disease and malnutrition. We know that progress has been too slow, and too uneven.

Last week, many eyes were turned toward Tanzania, where some of the world's brightest minds gathered at the World Economic Forum on Africa. African leaders, and individual, corporate and government donors, are reassessing the effectiveness and sustainability of past spending and looking for new ideas in this fragile global economy.

At Population Services International (PSI), our experience shows that donor funds are most effective when they support a locally led, results-based and integrated approach. Of these, most important is local leadership, although all partners - businesses, NGOs, community leaders, donors - ideally are equally involved in implementing and evaluating a development strategy.

This sounds basic, but it's been exceptionally difficult to achieve. The approach may work well at smaller community levels, but when brought to scale across a region or a country, top-down solutions often wind up being imposed to fill gaps that emerge from flawed bottom-up approaches, with neither achieving success.

There are genuine success stories, though. One great example of a locally-led and integrated strategy that has been done right, to scale, and that serves as a prime example of just how effective donor funds can be when spent wisely is in Rwanda.

Just over five years ago, malaria was Rwanda's number one killer. But working closely with international donors and partners, Rwanda's National Malaria Control Program put together a multifaceted approach that, in a mere 18 months, cut the number of malaria deaths across the country by more than half. The project's two main tools - long-lasting insecticide-treated nets and WHO-recommended anti-malarial drugs - did not differ significantly from approaches used in other malaria-endemic countries. What did differ was the strong leadership of the Rwandan government that paved the way for success.

For me, it is the overall thrust of that too rare effort - rather than the details - that can provide lessons for development aid beyond public health. Three years ago, Rwanda intensely scaled up its malaria interventions by aligning international partners to its aggressive, comprehensive and country-specific national strategy. In effect, they threw the most effective malaria interventions available at the disease and reshaped the government's health care and financing focus to achieve superior results.

With new resources from the Global Fund to Fight AIDS, Tuberculosis and Malaria, Rwanda initiated an aggressive campaign and managed to deliver an unprecedented number of mosquito nets to vulnerable communities across the country. But they knew that prevention was only part of their very specific battle against malaria, so Rwandan leaders worked to strengthen their health care system through innovative financing strategies and increased access to the most effective malaria treatment drugs where they were needed most: in the community. Ultimately, what allowed for the success of these strategies was the collaboration of partners fostered by the local leadership - a host of international and national NGOs including PSI, United Nations agencies, and funders such as the U.S. President's Malaria Initiative and the Global Fund. While the partners provided resources and expertise, Rwandan leadership ensured efficient use of funds.

Clearly, success is achievable, for we have the tools to prevent and treat diseases such as malaria. And partnerships are vital; without implementing partners and funders, Rwanda would not have been able to achieve success at this scale. But the cornerstone is leadership at the country level.

As good partners, we must do a better job of listening to the people who are most affected by the problems we want to solve. If we cultivate knowledge and experience, the most vulnerable African communities can teach us how to help tackle their problems. It makes perfect sense that the answers to some of the most pressing issues of our time can be found where those problems are most keenly felt: on the ground.