Global Health in Transition: A Synthesis: Perspectives from International Organizations (1996)

Carnegie Commission on Science, Technology, and Government. 1992. Partnerships for Global Development: The Clearing Horizon. New York: Carnegie Corporation of New York. This report is one in a series of documents whose purpose is to strengthen the institutions and decision-making processes by which the use of science and technology is connected to world affairs. A number of workshops, research efforts, analyses, and consultancies involving leaders of industry, governmental and intergovernmental foreign assistance programs, major private voluntary organizations, workers in the field, and scholars of development furnished the underpinnings for the report.

• To define as the central goal of development the realization of the full potential of all individuals in all societies in a way that enlarges the range of people's choices and makes development more democratic and participatory without compromising options for future generations.

• To analyze the dissonance between changes in the world over the past three decades and the institutional and legal framework of the United States' approach to development cooperation, little changed since the 1960s.

• Beneath waves of political change have been sustained material growth and improved welfare in developing countries. Growth was spurred by fundamental changes in economic structure, so that those countries are no longer simply sites where natural resources are mined:

Now more than half of developing country exports are manufactured goods, up from 26 percent in 1965.

• Underlying economic and social advances are progress in science and technology. To capitalize on these opportunities for developing countries, much more widespread application of science and technology is needed in the manufacturing and service sectors and in the creation of an educated, skilled workforce.

• U.S. interests include a range of factors:

  • Moral interests. Generosity and humanitarian concerns are a hallmark of American values; global partnerships lead to learning and action, at home and abroad.

  • Economic interests. Global prosperity is crucial to continued prosperity in the United States. In 1950, exports and imports accounted for less than 5 percent of the U.S. gross national product; in 1990 they made up 28 percent. Between 1986 and 1990, exports accounted for 41 percent of growth in the gross domestic product; in 1990 alone, they accounted for 88 percent.

  • Security interests. These are linked to four core, interactive, and interdependent areas: advances in democracy; economic and social progress; reduction of conflicts within and between nations; and environmental security.

  • Scientific interests. The progress of science requires cooperation. Though science and technology have had limited roles in past cooperation for development, they will be necessary factors in the future.

1. Principles of balanced institutional development. The most fundamental principle of cooperation for development is to foster the balanced development of the public, private, and independent sectors; pluralism within these sectors; and creative interaction among them.

2. A balanced approach. For much of its history, development assistance has emphasized only one sector or approach, with predictable shortcomings in the results. Cooperation for development must encourage balanced evolution in societies of the knowledge, organizations, and decision-making processes used in each of the above sectors. In all of these, science and technology play essential roles.

3. Critical roles of science and technology. Science and technology are enabling tools in a responsive marketplace. They enhance flows of information that lower costs and guide entrepreneurial energy, underpin innovation, and facilitate the creation of new public services and products in response to individual choice and freedom. They are indispensable to a healthy independent sector, providing balance for what is retained by more powerful interests and fostering a culture that need not take received wisdom for granted.

4. Criteria for selection, design, and conduct of programs.

   • Favorable policy environment. Most important for development initiatives are fiscal and monetary policies that promote noninflationary, sustained economic growth; trade favoring competitive excellence in domestic industry; efficient use of resources; and protection of property rights.

   • Ecological and social sustainability. Today's choices about economic and social development expand, rather than restrict, the choices available to future generations.

   • Building capacity to solve future problems. An essential aim of cooperation in development must be to enable partners to make and act on their own choices.

   • Partnerships as the premise. Partnerships forged between countries should be such that the expectations of the partners are clear, each has something to gain, each has a clear responsibility, and each is accountable for progress toward goals in the program.

5. Determinants of current government program content. The report is sharply critical of three considerations that set the basis for U.S. government development assistance:

   • Earmarking. Congressional earmarks or “functional accounts” reserve monies for issues favored by particular domestic constituencies and interest groups. This process has created such de facto priorities as agriculture, child survival, and women's programs. About 85 percent of the current U.S. foreign assistance budget is locked by earmarking processes into specific sectoral programs or countries.

   • Dated definitions of needs. Since legislative action in 1973, the major U.S. foreign assistance priority has been “basic needs”: food and nutrition, population control and health, and basic education. This formulation has been applied globally to developing countries, and the definition of “basic needs” has not altered in 20 years, despite striking changes in the world and the status of many countries.

   • Obsolete geography. Most U.S. government development pro

grams group nations by geography alone rather than by economic or social criteria. For example, Thailand has more in common with Brazil and Mexico from a development perspective than it has with its neighbors, Laos and Cambodia.

6. Resulting mismatch. These determinants, in combination, limit the effectiveness of U.S. cooperation for development, most critically in the specification of expenditures for particular countries and sectors. This drives programs to respond to legislative requirements rather than to the conditions in the country. Thus, though the nature and level of U.S. development cooperation are, in that sense, largely predictable, the problems to be addressed often are not.

7. New approach. Entirely new approaches are needed. The critical international boundaries are not geographic, but economic and social. Development programs must be updated to recognize diversity among developing countries and their problems as their economies and societies evolve. This implies the following:

   • A full spectrum of partner countries. This includes the economically advanced, middle-tier, and poorest countries.

   • Adaptive programs. This means flexibility according to development needs as seen by the countries, rather than according to a few centrally chosen formulas.

   • No more “top-down” management. The blunt instrument of top-down management is antithetical to the concept of development cooperation based on partnerships.

8. Bottom line. Rapid and widespread change logically requires that the United States unbind its approaches to cooperation for development and adapt them to new landscapes of political, economic, and technologic opportunities. Cooperative development programs must effectively balance growth with equity, management with participation, large-scale with small-scale endeavors, and global campaigns with local needs.

The Carnegie report brings a clarifying perspective to the larger concepts of development. Although much of its content is devoted to concerns for the U.S. government's overall approach to development assistance (with which we do not deal here), the Commission's overall analysis of the development arena and its recommendations are rel

evant to broader international concerns about cooperation for development. It is on these issues that we will focus this commentary and later reflections.

The report's rationale for partnerships for global development is succinctly stated: “The most fundamental principle of cooperation for development is to foster the balanced development of the public, private, and independent sectors, pluralism within these sectors, and creative interaction among them.”

A central part of the report's analysis is its depiction of the ways in which patterns of development have been shifting away from bilateral and multilateral modes of development assistance that focus on yesterday's patterns whose relevance is diminished. Striking changes have been taking place in the global development environment, particularly in the increasing diversity among developing countries and the range of their needs as they move ahead in their development trajectories. Thus, a fully fresh conceptualization of development is requiredin objectives, components, participants, processes, and context, whether those are local, national, or global.

In keeping with its broad-spectrum view of diversity, the report urges the involvement of developing countries at all levelsadvanced, middle-tier, and poorestconsistent with the view that countries at different levels need different approaches that are tailored to the unique characteristics of each and encompassing the public, private, and independent sectors functioning interactively. The report underscores the value of science and technology as contributors to those sectors: science and technology are crucial enabling tools in a responsive marketplace and indispensable to a healthy independent sector.

The report confirms the strategic importance of a vigorous U.S. response to the challenges of underdevelopment. The social, economic, and humanitarian benefits to the United States are great; the cost of not addressing them could be tragically high.