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Change-Management

It’s time to improve the ‘Value for Money’ toolkit, and not junk it

Suvojit Chattopadhyay's picture

 Julio Pantoja / World BankThe ‘results agenda’ of donor agencies have inspired several heated debates. Value for money is one of the main tools that helps further this agenda. There is significant pressure on donor development agencies to ‘demonstrate’ what they have achieved (results), and further, examine whether these results have been achieved in a cost-effective manner (‘value for money’). This pressure to demonstrate ‘value for money’ often leads to plenty of frustration, as those designing and implementing aid programmes struggle to strike a balance between what is easy to prove versus the complex nature of an intervention designed to tackle a real-world problem.

There are several problems with the results agenda – development interventions take place in a wide range of contexts, that lend themselves to comparisons on some counts and not, on others. These contexts change every day, and certainly over the lifetime of a development project, and attempting a grand theory or mathematical formulae to capture the entire process is nearly impossible.

Besides technical problems, there are valid fears that focusing too closely on ‘value for money’ will lead development workers to focus on ‘bean-counting’ and preferring interventions that can be easily measured and whose costs and benefits are easy to estimate. Some researchers have gone further and argued that an obsession with such metrics essentially forces development workers into lying about how their projects actually work.

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Hace más de 20 años, atendí a un joven llamado Melquíades Huaya Ore en Carabayllo, Perú, que tenía tuberculosis multirresistente. Según la concepción tradicional de ese momento, tratar a los pacientes pobres como él con los mismos medicamentos que se utilizaban en los países ricos era insostenible, demasiado caro y no valía la pena el esfuerzo.

En contra de todos los consejos, hallamos la manera de llevar los medicamentos y, con la ayuda de un grupo de trabajadores sanitarios comunitarios muy dedicados, pudimos tratar con éxito a Melquíades. Me alegra contar que hoy en día es contador en Perú y está prosperando.

La experiencia y las evidencias nos muestran que no hay receta mejor para la salud, la riqueza y la seguridad que un sistema de atención sanitaria que brinde a todas las personas la misma cobertura.