[Sustainability College] At the Forefront of Sustainable Development Assistance to Foster Human Resources
Copyright JFS Lecturer: Yojiro Ishii, Deputy Director General, and Group Director for Health Systems and Reproductive Health, Human Development Department, Japan International Cooperation Agency
"Sustainable Development Assistance" does not mean that development assistance should be continued indefinitely. In fact, sustainable development assistance is considered to be successful when it ends. The most important aspect of this approach is the support of self-sustaining development in order to allow developing countries to continue social development by themselves. First, I would like to talk about the types of assistance that are necessary, focusing particularly on people.
Development Assistance to the Health Sector
Total development assistance funding for health-related fields is estimated to be about two trillion yen worldwide, as of 2007. This has ballooned about by four times when compared to 1990 levels. Assistance funds have thus increased substantially when compared with other fields. Where do those funds come from?
Bilateral assistance accounts for one third of the total funds, with the United States being the major contributor. Particularly since September 11, 2001, the Bush Administration substantially increased assistance funding in an effort to improve national security, spending massive amounts on measures against HIV/AIDS and Malaria.
Funding by NGOs has also grown, and such funding plays an increasingly large role. For example, the Bill and Melinda Gates Foundation has been expanding since around 2000, and this trend has sparked participation by private financial groups, with the health sector gaining additional funds from them.
In the 1990's, Japan was the largest Official Development Assistance (ODA) donor. However, ODA funds have continued to decrease since 1997 due to the country's economic situation, and Japan is now fifth in the world.
Through free financial aid or technical aid provided via bilateral cooperation, funding by Japan supports the building of hospitals and healthcare centers, and the creation of infrastructure to deliver vaccines using refrigerated vehicles in order to preserve quality. ODA can also be offered to international organizations, such as UNICEF. Japan has contributed to the Global Fund to Fight AIDS, Tuberculosis and Malaria, which was established for the G8 Kyushu-Okinawa Summit in 2000, and Japan is a major donor, accounting for 7 to 8 percent of the total fund of two trillion yen.
Looking at regional allocations for ODA, Asia was mostly targeted in 1970's. In 1981, when I joined the Japan International Cooperation Agency (JICA), three quarters of the funds were for Asia; however, the ratio has gradually decreased, reaching 28 percent in 2007. In contrast, the funding ratio for Africa has increased markedly since 2000. At the fourth Tokyo International Conference on African Development , which was held in Yokohama in 2008, Japan promised to double its support for Africa, and although the total amount of ODA is decreasing, the shift in spending ratios will continue.
Assistance to Target People instead of Countries
One of the necessary elements for us to conduct assistance is human security. This is a concept that Sadako Ogata, the president of JICA, developed at the United Nations with Amartya Sen, who won a Nobel Prize for Economics.
Under the East-West Cold War structure after World War II, the assistance system for developing countries was mainly used to bring countries onto the respective sides. However, when this structure fell apart, the meaning of assistance changed radically. People began studying the ways in which assistance could be use to create societies where people could live in safety. It is important to ensure that assistance is delivered to the people.
There are two approaches to ensuring human security: the idea of protection, in which we help people who are "lying down"; and the idea of empowerment, in which we support the efforts of people who are trying to "stand up." The concept of human security tries to support communities and individuals through these approaches. When building a business framework, this notion is at the forefront of our thinking.
I would now like to introduce concrete examples of this concept. Over a period of 15 years, JICA expanded a project in an illegal residency district around Lusaka, the capital city of Zambia, called the Primary Health Care Project, which involved community-based activities to improve maternal and child health.
Many cities in Africa have such illegal residency districts, which were created by population flowing in from the countryside. The general level of social awareness within the community tends to be very low. Together with a regional counterpart, we considered the ways in which we could improve the residents' environment, and the first thing we aimed to provide was safe water. We installed a water tower and set up a site for water collection for each small group, and then let the community residents manage them.
In order to manage the water facilities, fuel is needed to operate pumps and chemicals are necessary to keep the water clean. We required the residents to build a water management system incorporating a method to procure the necessary commodities. This encouraged organization among the residents, and they subsequently devised further means to improve various other elements of their living environment.
For example, the residents had long dumped their garbage anywhere, but they later organized garbage collections, and now discard their garbage at a community site, while other local people cooperate to keep the roadside ditches clean. They also built a clean public bathroom next to the market, for use by people who come to the market, while a shower room was built for people who travel from longer distances, and the fees collected for its use then support other community activities.
What the residents needed most, in addition to these activities, was an improvement in maternal and child health. This required governmental intervention. However, the government does not manage all aspects of community health; instead, health volunteers are recruited from among the residents, which further empowers the residents themselves. The combination of government support and resident activities create sustainable local health activities, and this can help to realize human security within the community.
Differences in Assistance between Africa and Asia
As illustrated in the example of JICA's health business in Zambia, we believe that the health of women and children is the key. You may wonder about the men, but experience has shown that when the health of women and children improves, the overall health of men improves later. At present in Africa and South Asia, improving the health of women and children, and prolonging their lives by preventing infectious diseases are necessary.
In contrast, in Southeast Asia and Oceania, no infectious diseases are responsible for major health problems, but adult onset diseases are a more serious problem. Particularly in China, the population is aging rapidly, in part because of the one-child policy. Thus, health measures unique to the needs of an aging country with a population of 1.3 billion are needed. We therefore need to change our goals and devise new ways to support populations depending on societal development.
Another issue is the fostering and securing of human health resources as an international health issue. More people are coming to Japan as nurses or care workers from Indonesia or the Philippines. Although many of the doctors or nurses in Africa have moved to Europe or America, and the Japanese have never considered this to be our problem. However, this movement is now happening between Japan and other Asian countries.
If Japan benefits through these cross-border movements of the human health resources, other countries need to have such resources replaced. More and more people are obtaining medical care in developing countries at lower costs and medical tourism, in which patients go to developed countries to obtain higher levels of healthcare, is increasing. In Asia, where there are stronger ties between countries, new solutions that differ from those used in Africa are necessary. We are currently exploring such solutions, and as this issue is directly related to our health, we are also working to raise awareness among Japanese.
Five S's in Development Assistance
One of our tools to improve companies is the "Five S's", which are concepts of comprehensive quality management, including office environmental improvements: "Seiri" (Sort out), "Seiton" (Set/Organize), "Seisou" (Shine/Cleanliness), "Seiketsu" (Standardize), and "Shitsuke" (Sustain/Discipline). This idea has been introduced to domestic car manufacturers, such as Toyota, and is now achieving the desired effects. To enhance safety and efficiency, the five S's were introduced to the Japanese medical sector in the 1990's. Because the five S's were devised in both Japanese and English, they are now being used in fields related to development assistance.
For example, management of patient medical records is often poor in developing countries, and in many cases, medical staff simply write records and store them without a clear organization system. If such records are properly organized, the quality of medical care increases dramatically, as repeated examinations of the same patients are prevented when different doctors can consult well-kept patient records. In addition, when pharmacies are properly organized, the staff can keep track of which medicines are out of stock and need to be refilled. Although such organization is often taken for granted in the developed world, nations lacking this basic level of infrastructure cannot efficiently make use of the trillions of yen in funding. Our staff is currently traveling around 15 countries in Africa to teach the five S's concept.
Japanese Assistance Called Catalytic Support
Methods of assistance vary among countries. For example, the US does not apparently trust governments in developing countries, and as a result, they typically set up cooperative structures through local NGOs. On the other hand, European countries tend to provide greater support to the financial sectors of the central government, conducting top-level assistance to provide funding, and leaving the operational management to the recipient countries.
Japanese assistance focuses on cooperation from the top (central government) to the grassroots (community) level. We call this "catalytic support" and we provide support specific to the target field.
As support for the central government, the creation of systems or improving the capabilities of people who formulate national policies is very important. However, the people who deliver support to residents are field administrators and medical staff. Therefore, we also have to improve the capabilities of these people. Providing assistance unique to local needs in the field, such as the project in Zambia or promotion of the five S's, is the strong point of the Japanese approach. In this way, working with various support systems at both the national and community levels is the Japanese approach to global cooperation.
When students who are concerned about such activities ask about what they should do now, I like to ask them to look at what is happening in society, starting with Japan. It is also a good idea to go out to the field, and to take advantage of opportunities for fieldwork with international organizations, including JICA. I hope that I am able to encourage the development of human resources who will be active in the international community. Development assistance can therefore lead to Japanese people making greater contributions to the world.
After graduating from university, Yojiro Ishii began working at JICA. He engaged in project implementation of ODA businesses centering on the healthcare field over a period of about 30 years. He transferred to Pakistan and Bangladesh for a total of seven years and participated in business management of the assistance fields, negotiating with other countries and assistance planning. He is now aiming to expand cooperation among global health businesses by working with international organizations. In addition, he continues to work hard to secure and to cultivate domestic assistance resources.