A blueprint for country-driven development.

The Obama administration in the USA, the Cameron government in the UK, and other donors talk almost daily about developing countries owning and directing their health programmes. But are donors ready to do so? And what would that look like? In most cases, donors control exactly how their money will be spent. The donor defi nes the priorities. We have some ideas to change the dynamic, from the basis of our experience in working closely with ministries of health in six countries. At the Global Health Council annual conference on June 13–17, in Washington, DC, fi ve of those ministries—Ethiopia, Mali, Nepal, Senegal, and Sierra Leone—will issue a call to action that gives practical steps for how to rapidly push forward country ownership of health programmes. For the past 2 years, two programmes, the Ministerial Leadership Initiative for Global Health and the African Public Health Leadership and Systems Innovation Initiative, with support from the Bill & Melinda Gates Foundation, have supported country-led development. The Ministerial Leadership Initiative has worked with the fi ve countries named above; the African Public Health Leadership has worked in Namibia. These programmes have built on past eff orts, such as the Paris Declaration, the International Health Partnership Compact, and the Accra Agenda for Action. They have directly tackled the need to strengthen governance and leadership in ministries of health to make country ownership a reality, not just an empty promise. Our observations of the powerful successes of these intensive programmes have led to a set of seven essential elements to advance country-driven development. Here are the seven. First, articulate a vision. To be eff ective, both vision on the part of country leaders and responsiveness by development partners are needed. Leaders at the highest level of government, with input from civilsociety organisations, must clearly communicate their priorities. Similarly, donors need to do a better job in 11 Anon. Afghanistan civilian compensation. Guardian (London) March 28, 2011. http://www.guardian.co.uk/world/datablog/2011/ mar/28/afghanistan-civilian-compensation (accessed April 15, 2011). 12 Boer R, Vandenbroucke E. Worldwide investments in cluster munitions: a shared responsibility. April, 2010: 29–30. http://www. netwerkvlaanderen.be/en/fi les/documenten/campaigns/ banksandweapons/Full%20Report.pdf (accessed Jan 9, 2011). 13 Cluster Munitions (Prohibitions) Act 2010. http://www.bailii.org/uk/legis/ num_act/2010/ukpga_20100011_en_1.html (accessed Jan 9, 2011). 14 International Coalition to Ban Uranium Weapons. The problem: producers—General Dynamics. http://www.bandepleteduranium.org/ en/a/72.html#4 (accessed Jan 10, 2011). 15 Aitken M. Gulf war leaves legacy of cancer. BMJ 1999; 319: 401. 16 Bertell R. Depleted uranium: all the questions about DU and Gulf War syndrome are not yet answered. Int J Health Serv 2006; 36: 503–20. 17 Fetter S, von Hippel FN. The hazard posed by depleted uranium munitions. Science Global Security 2000; 8: 125–61. 18 Miller AC, Brooks K, Stewart M, et al. Genomic instability in human osteoblast cells after exposure to depleted uranium: delayed lethality and micronuclei formation. J Environ Radioact 2003; 63: 246–59. 19 Hong X, LaCerte C, Thompson WD, Wise JP Sr. Depleted uranium induces neoplastic transformation in human lung epithelial cells. Chem Res Toxicol 2010; 23: 373–78. 20 Busby C, Hamdan M, Ariabi E. Cancer, infant mortality and birth sex-ratio in Fallujah, Iraq 2005–2009. Int J Environ Res Public Health 2010; 7: 2828–37. 21 Alaani S, Savabieasfahani M, Tafash M, Manduca P. Four polygamous families with congenital birth defects from Fallujah, Iraq. Int J Environ Res Public Health 2011; 8: 89–96. 22 UN General Assembly, 65th Session. Eff ects of the use of armaments and ammunitions containing depleted uranium (A/RES/65/55). Dec 8, 2010. http://www.un.org/en/ga/65/resolutions.shtml (accessed Jan 10, 2011). 23 Socially Responsible Investment Review Committee. Recommendation to Council on divestment from arms manufacturing companies. February, 2010. http://www.admin.ox.ac.uk/media/global/wwwadminoxacuk/ localsites/councilsecretariat/documents/srirc/C1032.pdf (accessed May 23, 2011). 24 Extract from the Vice-Chancellor’s report on the meeting of Council held on 21 June 2010. February, 2011. http://www.admin.ox.ac.uk/councilsec/ committees/srirc/report_march_2010 (accessed May 23, 2011). 25 Mankelow N. OUEM says it cannot take in college funds. FT Mandate May, 2010. http://www.ftmandate.com/news/fullstory.php/aid/2439/ OUEM_says_it_cannot_take_in_college_funds.html (accessed Jan 9, 2011).