New norms and forms of development: brokerage in maternal and child health service development and delivery in Nepal and Malawi

1. In t r o d u c t Io n
T isresearch brief presentsf ndingsof thestudy
on outsourcing of external development assistance
in maternal and child health (MCH) in Nepal. It
outlinestheinstitutional modalitiesand norms
guiding thef nancing and delivery of MCH
projectsand programmes. First, our mapping of
thesocial and political organisation of external
development assistancerevealsamessy assemblage
of actors, institutional arrangementsand activities
informed by thenorms: ‘valuefor money’ and
‘measurableresults’. Second, wefound that for
development assistanceto function ef ectively it is
not just about thef ow of f nancial resourcesto a
project or aprogrammebut also about networks
and key personal and institutional relationships.
T ird, wefound that thereisincreasing political
pressureto show that thedisbursement of resources
New Normsand Formsof Development
Brokeragein Maternal and Child Health Service
Development and Delivery in Nepal
R e s e a R c h B R i e f
thesenew institutional modalitiesand norms
for health outcomesand Statecapacity to deliver
ef ectiveMCH services.
Br Ief d esc r Ipt Io n o f t h e st u d y
Our research ispart of atwo-year project funded
by theUK’sEconomic and Social Research Council
(ESRC) and theDepartment for International
Development (DFID) to beundertaken between
May 2014 and October 2016. T eresearch isbeing
carried out by theSchool of Social and Political
Scienceand theSchool of Health in Social Science
at theUniversity of Edinburgh in collaboration
with Social ScienceBaha, Nepal, and Kamuzu
Collegeof Nursing, Malawi. Ethical clearance
wasobtained from theEthicsCommitteeof the
School of Social and Political Science, Nepal Health
Research Council and theMalawi Collegeof
New Norms and Forms of Development
Brokerage of Foreign aid in Maternal and Child Health Service Development and Delivery in Nepal and Malawi
A Collaborative project of University of Edinburgh (UK), Social Science Baha (Nepal) and University of Malawi (Malawi)
May 2014 - August 2016
Research Problematic
Implications of changing modality of foreign aid (i.e.
shift towards outsourcing, effectiveness,
coordination, value for money and achievement of
measurable results) for health outcomes and the State
capacity
Research Method
• mapping institutional terrain around external development
assistance in Maternal and Child Health (MCH)
• ethnographic study of four selected projects
Findings
• development assistance in MCH is a messy assemblage of actors, institutional arrangements and activities
involving ‘providing’, ‘managing’ and ‘spending’ arranged through chains of outsourcing and sub-contracting
• preoccupation with metrics and results-based frameworks has reduced the impact to measurable results only;
and marginalised and rendered invisible politico-economic and sociocultural dimensions
• personal relationships significantly shape the sub-contracting and accountability systems
• impact on State capacity in terms of coordination; demoralisation of government staff and aid patronage
Outcome
Dissemination and publication of research results led to increased debate on the unintended consequences of
sub-contracting and result-framework on state capacity and morale of government staff