Shapes in the Fog

World Bank offices in Kathmandu

On very foggy days - and this does not pertain to Nepal - it's interesting to note how as the fog lifts you begin to observe shapes that become more clear with time.  That's very much how International Development projects work.  When you begin to plow through the mountain of reports that have been written over time - months, years and sometimes a decade or so, it's easy to become bewildered.  And then, when you can't take it anymore, something magical happens - the World Bank (or another significant party) invites you to a meeting.  In this case, I was invited to a meeting with the 'pooled donor' organizations at the offices of the WB in Kathmandu shown here.

I entered the meeting not knowing who would be in attendance or what the focus of the meeting would be - in fact I did not know that this was even a meeting with the donors.  Pooled donors are those donor organizations who give money dedicated to a cause with no particular strings attached - it must be used in healthcare, but they do not, for example specify the HIV/AIDS program, TB drugs, medical infrastructure, etc...and so, recipients really like this kind of money because it gives them the flexibility to do with it what they wish (and I wish I could say .... within reason, but I do not think I can make that qualifier).  One such donor is familiar to most of you reading this - USAID - and the organization was well represented.

At any rate, it seems that one of the major frustrations with this healthcare reform initiative at this point is that the government has been under such turmoil and change that it is a moving target of policy, personnel and accountability.  This has attracted the attention of the donor organizations who recognize that accountability will be key to ensuring that their investments (aka OUR investments) are used to make a difference to the people of Nepal.  I am impressed with the resolute intent of the donor organizations to wield their collective might to seek a greater degree of accountability from the government of Nepal.

Schedule for Procurement Planning in Nepali

Unfortunately, the government is not the only moving target - so too are the regional and district healthcare leaders responsible for the implementation of many of the programs that are being created to improve access, cost and quality of healthcare services throughout the country.  In fact, because of the constant revolving door of personnel in key positions, I am beginning to consider a new kind of training program for district and regional healthcare leaders within the pharmaceutical procurement and distribution sector - potentially a day-to-day, week-to-week and month-to-month guide as to how to operate in their given position.

As the human resources program manager acclimates to his new role on this assignment, I suspect there will be many discussions around how to create and distribute training materials that will address the needs of those who manage regional and district healthcare operations throughout the country given a broad range of communications channels and technical competencies.  We will need to ensure that we capture the attention of the educated healthcare administrator with access to power, a computer and the Internet as well as the district administrator in the village who cycles or walks to work where electricity and computers are found only in the imaginations of his or her unborn children who will (if extremely fortunate) become educated and emigrate to the developed world in search of a better life.  I hope you will stay with me as the fog begins to lift and the ideas that are developed to address these seemingly daunting challenges take shape.