Localization and the Goal of Universal Health Coverage
Many are championing localization — the process of shifting funding and power to organizations and leaders from the countries requesting technical assistance right now, but questions remain about how to do it. One program — the USAID-funded African Collaborative for Health Financing Solution (ACS) — has been an exemplar on the localization front. ACS partnered with five African organizations that came together to advance the universal health coverage (UHC) agenda in sub-Saharan Africa while also shifting the nexus and modality of technical support to African organizations. The ACS experience provides rich learning on how to go beyond simply working with individual local partners, but instead building collective engagement to strengthen the fabric of local and continent-wide ecosystems.
Key Lessons in Locally Led Development from ACS
Effective local partnerships are built on trust, shared vision and continuous engagement, not one-off transactional activities.
Co-creation of international development initiatives
Co-creation of international development initiatives facilitates strong commitment and engagement amongst partners by building collective purpose.
Clear communications and expectations
Prerequisites for effective collaboration and successful implementation of development activities are understanding respective expectations and clear communication, both of which take time.
It is essential to break down and properly estimate the finances, time, human and technological resources required for a successful partnership. It helps ensure the successful completion of the activities each partner leads, and builds strategic, equitable partnerships that go beyond any one project or set of activities.
Understanding each partner's organization
Each partner’s vision, size, organizational culture, internal processes or internal decision-making processes must be analyzed and factored in at the outset of collaborative partnerships in order to effectively allocate resources and to set expectations on setting up and managing the partnership.
Facilitation between partners
Convener/connector and facilitator roles are critical for coordination and cross-learning of partnerships, especially among a network of multiple, complementary partner institutions.
Tools and Resources to Support Locally Led Development Goals
ACS co-developed resources and tools on each of the following topic with its African institutional partners. These resources can be used by civil society organizations, governments and global development implementers to support locally led development to achieve ambitious goals like universal health coverage.
1. Supporting local organizations and strengthening the ecosystem
A principal focus of ACS was to engage local organizations and strengthen country wide and regional UHC ecosystems in Sub-Saharan Africa. Strong ecosystems made up of different types of institutions with a mix of skills are essential for countries to advance a collective goal like universal health coverage. Strengthening the overall ecosystem helps to engage more local institutions and shift power dynamics to countries. ACS collected three key resources available in both English and French as well as contact information for ACS team and partner members.
2. Supporting country level learning
Continuous learning at the country level is essential in the pursuit of a goal like universal health coverage. Stakeholders must capture information about what works and what doesn’t, how to navigate complex processes, and effective monitoring, measurement and dissemination of health system changes. ACS developed tools and resources to facilitate continuous context-based evidence generation and use.
3. Strengthening accountability
A well-functioning accountability system helps to clarify responsibilities, reduce information asymmetries, identify and fill gaps in resources, improve performance and facilitate progress toward development goals. ACS developed practical tools and strategies to deepen understanding of how accountability works and to enhance the accountability of all stakeholders in the pursuit of UHC.
4. Supporting inclusive policy dialogue
Inclusive policy dialogue that brings together a wide range of stakeholders makes for a richer conversation aligned around common goals. It also helps to foster homegrown solutions that are politically feasible, technically valid and socially acceptable in the local context. ACS and its African Institutional Partners codeveloped resources to design, implement and access inclusive policy dialogue that can be adapted and used in other countries and contexts.
5. Harmonizing resource tracking for better health financing decision making
Effectively tracking resources is critical for planning, policymaking and measuring whether spending is leading to desired outcomes. However, using multiple resource tracking methodologies, some of which are required by donors, creates challenges. ACS piloted a program in Namibia and Botswana that harmonized resource tracking by combining various methodologies into one system. ACS developed resources to support other countries facing similar challenges.
ACS African institutional partners include: