New forms of development: branding innovative ideas and bidding for foreign aid in the maternal and child health service in Nepal

We term international development an industry, because of the volume of financial transactions and number of people involved in this field, and the scope of global networks and service provision. There has been a significant increase in total global development assistance in the health sector – from $7 Billion in 1990 to $35.4 billion in 2014. This sector has been frequently described as a foreign aid business and industry by a number of scholars for the same reasons.

Globally, the modern idea of foreign aid for international development seems to have emerged mainly after the Second World War. Before this, similar ideas and development activities, in the field of health, education, and overall infrastructure development and service provision existed, usually in countries with weaker economies in Africa and Asia. However, they were not organised in the way we see these today. Pre-WW2 foreign aid support for countries with weaker economies seems to have come from humanitarian and charity agencies, much of it conducted as much to support the existence of the colonial staff as anyone else. It tended to be operated in an opportunistic fashion, and was carried out by religious individuals, organisations and business entrepreneurs (Edwards 2014). Since then, and especially over the past seventy years, the modern idea of foreign aid for international development has evolved. Initially designed to reconstruct war-torn countries in Europe, it has come a long way since then. Currently this sector occupies a significant amount of international socio-political space. It has become one of the most important global industries of the twenty-first century, and one, which continues to evolve rapidly with modern day globalisation.

In our study the word ‘project’ refers to a particular activity or activities designed to achieve certain aims and is usually short term. A ‘programme’ denotes a longer-term process, with perhaps multiple stages and the possibility to continue for longer periods with additional funds. Six out of eight MCH case studies (in Nepal and Malawi) are projects and two are programmes. However, in this paper, when we use the term ‘project’, it will also include MCH programmes.

Intermediary organisations play key roles in providing funding sources and information to local implementing partners, and information about the local needs and context to the donors. All parties need funding to conduct their business, so become involved in bidding for it. Contracting and sub-contracting out intervention packages is common in the field of international development.

The multi-sectoral approach promoted by Suaahara phase-1 is not a new idea in health service development in Nepal. It was much discussed in the 1980s and 90s, and seen as one of the core principles of Primary Health care to achieve the Health for All by 2000 goal. CHECK IF “DOUBLE” QUOTATION MARKS SHOULD BE CHANGED TO ‘SINGLE’.

As health professionals in Nepal, we have witnessed the reappearance and recycling of some of these so-called ‘innovative ideas’ around MCH services in Nepal for several decades. However, because of a lack of written evidence, as they were not published, or even documented properly, they do not seem to have had any proven prior existence. In the current day MCH development sector we have noted with interest these same ideas suddenly acquire new names and become the latest innovations.

Although we use the term ‘competitive’, we also feel that the process may not be as competitive as it may sound. In practice, bidding and securing funds is often based on individual and institutional relationships.

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Kangaroo mothercare is also an innovative term, which encourages parents to keep newly born babies as close to their body; maintain skin-to-skin contact and exclusive breast-feeding. Details can be found at: http://​www.​kangaroomotherca​re.​com

Numerous interviews and conversations with Care Nepal field staff during field visits in their programme implementing districts and also in head office in Kathmandu.

Interview with the Suaahara Project Manager, August 2014

‘Hardware support’ means providing tangible structural support, such as a building construction and supply of necessary equipment. ‘Software support’ refers to the equipping of health professionals with appropriate knowledge, and supporting them their professional development and skills acquisition, so they are better prepared to provide quality MCH care.

Interview with Suaahara District Implementing Officer, 3rd January 2016.

Interview with the Suaahara Project Chief, Kathmandu, August 2014.

Interview with Suaahara District Implementing Officer, January 2016.

Interview with Suaahara District Implementing Officer, January 2016.

Thematic Officers are those who are responsible for a specific or themed role. For example, some officers are responsible for water and sanitation whilst others may be responsible for health education and nutrition, or project management, monitoring and evaluation.

Interview with the District Project Coordinator, January 2016.

Poor MCH statistics, records and numbers can also be seen to be useful while making a funding application. Currently, there is a major global focus on statistics and numbers. In order to be more transparent and accountable to the donors and the beneficiaries, international aid flow needs to be supported by statistics and numbers, as a means to measure aid effectiveness and overall progress. In relation to MCH projects, mortality and morbidity statistics are the basis for granting funds to set up a new project.