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

U.S. Agency for International Development. March 1994. Strategies for Sustainable Development. Washington, D.C.: U.S. Agency for International Development The Foreword to this document notes that these papers reflect a great deal of work and wide consultation with members of U.S. Congress and congressional staff, representatives of other U.S. government agencies, members of the development community, and the U.S. Agency for International Development's (USAID's) own experts, in the United States and abroad. It presents an integrated approach that defines long-term objectives, specifies their relevance to U.S. interests, describes the ways in which those objectives are to be pursued, and identifies mechanisms that can be used to implement the approach and standards for measuring success. This document was distributed in March 1994 and the policies and programs of USAID could be expected to change over the time that has elapsed. Nonetheless, the document is included as a thoughtful piece of analysis feeding into a rapidly changing policy environment.

• To cope with threats to peace, stability, and the well-being of Americans and people throughout the world.

• To constructively address the pollution of the seas and the air, overburdened cities, rural poverty, economic migration, oppression of minorities and women, and ethnic and religious hostilities.

• To articulate a strategy for sustainable development in partnership with those whom USAID assists.

• Threats to development come from many sources: continuing

poverty; population growth and rapid urbanization; inability to read, write, and acquire technical skills; new diseases and endemic ailments; environmental damage; and absence of democracy.

• Americans cannot isolate themselves from these conditions, which, in one way or another, sooner or later pose a perhaps costly strategic challenge to the United States.

• Effectively delivered, development assistance is a powerful means of addressing, ameliorating, and even eliminating the problems of rapid population growth, environmental degradation, endemic poverty, debilitating hunger, mass migration, and anarchy.

• This work is both altruistic and self-interested. Successful development creates new markets for exports and promotes economic growth in the United States, and America's poor increasingly benefit from development methods that have been pioneered abroad.

1. Operational approaches

   • Sustainable development. Sustainable development is economic and social growth that does not exhaust the resources of a host country; respects and safeguards its economic, cultural, and natural environments; creates incomes and chains of enterprises; and builds indigenous institutions that involve and empower the citizenry.

   • Partnerships. Sustainable development is built on a sense of ownership and participation. It will be increasingly implemented by nongovernmental organizations, whose effectiveness depends in large measure on their institutional autonomy and protection from USAID micromanagement. The active participation of private enterprise will also be encouraged.

   • Integrated approaches and methods. The fundamental building block of USAID's programs will be integrated country strategies that take into account the totality of the development problems confronting a society, developed in close cooperation with host governments, local communities, and other donors.

   • Areas of concentration. USAID programs will focus on three kinds of countries: (1) sustainable development countries, where assistance is based on an integrated country strategy with clearly defined program objectives; (2) transitional countries, which have recently experienced a national crisis or a significant political transition, where timely assistance is needed to reinforce institutions and national order; and (3) countries where aid to nongovernmental sectors

may facilitate emergence of a civic society, alleviate repression, and meet basic humanitarian needs.

2. Programmatic areas fundamental to sustainable development

   • Protecting the environment by reducing long-term threats to the global environment, particularly climatic change and loss of biodiversity, and promoting sustainable economic growth locally and regionally by addressing environmental, economic, and developmental practices that impede development or that are unsustainable.

   • Building democracy by focusing on problems such as human rights abuses, lack of experience of democratic institutions, and disenfranchisement of women and minorities, and by concentrating on building local democratic capacities and on appropriate technologies that can be maintained locally.

   • Stabilizing world population growth and protecting human health by concentrating population and health programs in two types of countries: those that contribute the most to the global population and health problems and those where population and health conditions impede sustainable development.

   • Encouraging broad-based economic growth by emphasizing (1) strengthening markets, including improved governance and local empowerment; (2) expanding access and opportunity, including small business development and microenterprises; and (3) investing in people, including enhancing education for the poor, women, girls, and minorities, and providing market-oriented technical and vocational training.

   • Aiding in postcrisis transitions by providing humanitarian assistance that saves lives; reduces suffering; helps victims return to self-sufficiency; reinforces democracy; and includes disaster preparedness and mitigation, timely delivery of disaster relief, preservation of basic institutions, and building and reinforcing local capacity to anticipate and deal with disasters and their aftermaths.

   • Measuring results. Inputs are meaningless without reference to effects, so that the success of foreign assistance is measured by its impact on nations. USAID will measure results by asking how programs achieve discrete, agreed objectives. This forces all involved to focus on how projects actually affect how people live and to distinguish between self-sustaining and ephemeral accomplishments.

Strategies for Sustainable Development begins by acknowledging the profound changes under waya social, political, and economic metamorphosis throughout the world and states that USAID has redefined its mission and charted a plan to achieve it.

The key shift in emphasis is to sustainable development, defined as development that permanently enhances a society's capacity to improve its quality of life and enlarges the range of freedom and opportunity, day to day and generation to generation. When sustainable development is the goal, the focus moves from projects to the web of human relationships affected by those projects.

Given its commitment to sustainable development, USAID sees the fundamental building block as integrated country strategies that account for the totality of development problems confronting the society. These strategies are to be formulated in partnership with host governments, communities, and other donors and are to consider how social, economic, political, and cultural factors combine to impede development.

In short, the focus is not on discrete problems but on development, recognizing that the mix of factors that impede or support development will differ from country to country and can be effectively addressed only in the context of each country and in partnership with the people of that country. The emphasis is on three types of countries and four types of programs, in each instance proceeding to where help is most needed and where it can make the most difference. This “ matrix” of countries and programs provides considerable flexibility, as well as opportunities for targeting by need. The fundamental thrust is toward building indigenous capacities; enhancing participation; and encouraging accountability, transparency, decentralization, and the empowerment of communities and individuals.