55 - Government-to-Government Direct Funding: A Tool to Foster Locally Led Development

Abstract Information: 
Background
The United States Government, through the United States Agency for International Development (USAID/Liberia), co-created a $55 million Government-to-Government (G2G) Partnership for Improved Health Outcomes Activity with the Government of Liberia. The G2G uses a Fixed Amount Reimbursement Agreement (FARA) mechanism, a performance-based financing approach to enable the Ministry of Health (MOH) to deliver critical health services through sub-national levels via the County Health Teams.
Purpose
USAID/Liberia intends that local organizations conduct the G2G verification as a strategy to strengthen local capacity and foster accountability to health service users. The counter-verification also assures USAID/Liberia of the quality of data the MoH reports, which informs reimbursement decisions. USAID/Liberia engaged the Data, Evaluation, Learning, and Technical Assistance (DELTA) activity to counter-verify the MoH reports. 
Method
DELTA subcontracted a local firm to lead data collection. In addition to overall management support, we fielded a national consultant to provide technical assistance to the firm to develop electronic data collection tools, train enumerators (largely comprising healthcare workers), manage data platforms, conduct data quality assurance during field work, analyze data and prepare reports. The MoH plays a central role in designing and implementing the field activities and providing feedback to validate findings.  The G2G is unique due to its focus on elements of power sharing, capacity-building, context-specific interventions, direct government participation, mutual learning, policy dialogue, and South-South collaboration. Through utilization of these distinctive features, G2G initiatives possess the capability to cultivate sustainable growth, strengthen governing frameworks, and encourage cooperation amongst governments across the globe.
Result
This locally led, iterative process leveraged the central role of national government and was supported by local professionals throughout design and implementation. Institutional capacity strengthening support ensured a technically robust approach that was ethically sound, culturally responsive, and efficient. USAID/Liberia received high quality report that measures data accuracy and ascertains milestone achievements. The MoH uses lessons learned to foster adaptive management in decentralizing health services delivery.  Data verification enhances accountability within the health system and the learning is largely focused on decentralization of decision making.
Significance
The G2G demonstrates USAID’s commitment to Liberian-led sustainable development. The mechanism empowers local institutions and gives visibility to Liberian professionals as important contributors to national development. The MoH uses lessons to improvement and strengthens its management, administrative, and governance structures. Meanwhile, USAID learns from the G2G experience to develop strategies and design new activities in the health sector as well as other sectors. The G2G engenders a reciprocal partnership of mutual learning and benefits. Session participants will also learn about the strategies that the Data, Evaluation, Learning and Technical Assistance (DELTA) activity used to identify a local data collection firm and support the firm to develop and implement the counter-verification methodology. 
Statement of Relevance
The relevance of locally led development for long-term, sustainable community progress is becoming increasingly acknowledged on a global scale. Giving local actors—citizens, leaders, and organizations—the supportive environment they need to take the lead in choosing the precise policies and initiatives that best meet their needs is a top focus for this strategy. This strategy is critical for several reasons.

First, locally led development encourages accountability and ownership. Communities that actively participate in the processes of decision-making and execution get invested in the outcomes, which can result in longer-lasting solutions. This grassroots involvement ensures that local traditions, values, and goals are considered, which increases the effectiveness and acceptance of initiatives.

Additionally, it is essential to acknowledge and value indigenous knowledge to address the intricate development context of local communities. This provides information on their social dynamics, environmental issues, and economic prospects. Making use of this abundance of local expertise promotes innovative, customized solutions that deal with fundamental problems rather than depending on presumptions. Initiatives for development that are driven locally are more effective because they acknowledge and utilize indigenous cultures and traditional knowledge, promoting reciprocal benefits and shared values.  This promotes inclusion and equity, addressing the needs and interests of every community groups. Apart from its efficacy and efficiency, this approach fosters collective resilience and social cohesiveness by empowering underprivileged and marginalized groups, including women, youth, and indigenous people.  

Session participants will learn how USAID/Liberia has forged a strong partnership with the Government of Liberia to enable the Ministry of Health to provide much needed health services to remote communities. The G2G direct funding mechanism empowers the government to co-create the funding mechanism. Owing to risks associated with direct government funding, USAID employed a third-party verification approach to measure the accuracy of data report by the Ministry as well as ascertain the achievement of milestones. The findings from this initiative informs reimbursement decision that USAID/Liberia makes.  Session participants will also learn about the strategies that the Data, Evaluation, Learning and Technical Assistance (DELTA) activity used to identify a local data collection firm and support the firm to develop and implement the complex verification methodology.  

Under this mechanism, USAID has strengthened the leadership and technical skills of the Ministry of Health. Also, DELTA has provided institutional capacity building for the local firm and several young and emerging Monitoring and Learning professionals in Liberia. This strategy challenges the conventional top-down system that has dominated the development ecosystem and calls for a shift in the balance of power.

The potential for locally led development to increase community capacity, capitalize on local knowledge and experience, promote diversity and social inclusion, and produce more effective, efficient, and long-lasting outcomes makes it relevant. Through fostering locally led strategies, partnerships, and sustainable progress, this strategy has the potential to improve lives and enhance prosperity.