While localisation of foreign aid has been a priority for the US government since former President Barack Obama’s time in office, the US Agency for International Development (USAID) has renewed this prioritisation, sparking conversation within the development community about the evolution of locally lead capacity-building to improve grassroots public health outcomes.

Using a webinar forum to discuss the topic, BroadReach hosted thought leaders spanning long-established local partners, newly constituted local partners, international implementers and international donors. The panel discussed strides made and work to be done to create greater local healthcare impact and health equity on the continent, in line with the 2030 Sustainable Development Goals (https://apo-opa.info/3DYSf7i). This discussion was also held within the context of PEPFAR’s 20-year anniversary and how their localised approach helped change the trajectory of the HIV epidemic.

Three key take-outs from the BroadReach ‘Lead with Localisation’ webinar (https://apo-opa.info/3ZXzOc4):

1. Effective localisation requires strategic local partnerships

“Strategic capacity building is based on effective and inclusive local partnerships. We’re not just coming to help people, we’re coming to partner with them,” said Dr Denis Mali, Senior Care and Support Advisor at USAID, Southern Africa.

USAID’s updated Acquisition and Assistance (A&A) Strategy (https://apo-opa.info/3TIqdUt), announced earlier this week, outlines tools and culture shifts needed to increase local engagement, reduce bureaucratic burdens for staff and partners, and enable sustainable, inclusive and locally led development results in the countries where it focuses its foreign aid.

Reacting to USAID’s renewed A&A strategy, BroadReach Health Development’s Dhirisha Naidoo said more formalised guidance from USAID on how it would be working with local partners going forward was “hugely welcome” and that "the updated framework to enable localisation makes it easier for those on the frontline in local communities to have a voice.” Naidoo runs the PEPFAR and USAID HIV treatment and care programme called APACE across four rural and peri-urban areas in KwaZulu-Natal and Mpumalanga, South Africa.

“Staying the course and engaging with local leadership, or power structures, or influencers – be they churches, tribal leadership, schools etc - has given us the ability to tailor services that meet the needs of communities,” says Naidoo.

“As USAID Administrator Samantha Power said in 2021 (https://apo-opa.info/3TqhtC5) when she announced a new vision for global development, we as international donors don’t have to bring all the resources, we must bring a bigger tent. We need to listen to the voices of the people we support, we must embark on real partnerships, and we must strengthen the voices of those who are marginalised,” said Dr Mali.

Naidoo said it was impossible to conduct meaningful health interventions on the ground “without the deep and meaningful collaborative partnerships”. This included partnerships with funders, the department of health, communities, smaller partner NGOs and traditional leaders, as well as local representatives of different government departments and international donor partners.

2. Localisation starts with local human resources

One highly effective local partnership that uses hyper local human resources within their overall strategy is Mothers2Mothers. The organisation has equipped mothers and healthcare professionals to achieve significant reductions in mother to child HIV transmissions in communities across 10 African countries. Mothers2Mothers was one of the first truly local organisations to receive prime USAID funding nearly twenty years ago.

Lesotho country director Mpolokeng Mohloai said: “We are testimony to the localisation call. Services need to be implemented by people with local context, knowledge and wisdom. Since our inception 21 years ago, we’ve capacitated 12 000 women to reach 15 million other women with vital health services. We have achieved a total reduction in mother to child HIV transmission for 8 years in a row in the areas where we work.”

Naidoo said it was critical to embrace “HR for health and human capital”. “In rural and peri-urban areas, it can be hard to find qualified staff such as professional nurses and doctors. So, it’s important to build local capacity, and through various partnerships there are many options to explore (for education and training). It’s about sustainability. We have staff who joined us 15 years ago as nurses or data capturers within their hometowns, who have gone on to become programme delivery managers, or senior provincial and national officials as a result of capacity building. There is value in those partnerships over time.” 

3. Localisation requires funding and decision-making autonomy

The USAID’s renewed A&A strategy was developed through consultation with hundreds of USAID staff and more than 15 partner engagements, with the goal to enable sustainable, inclusive, and locally led development results through acquisition and assistance.

Next USAID plans to improve local partners’ ability to enter into more equitable and sustainable financial partnerships to pursue their own capacity strengthening and development goals. This follows the 2021 announcement by USAID (https://apo-opa.info/3TwVFVl) that 25% of its funding would go to local partners by 2025.  

Batuke Walusiku-Mwewa, Country Director of Catholic Medical Mission Board (CMMB) Zambia (https://apo-opa.info/3n6As8N) has recently gone through a localisation process within CMMB transferring leadership from the ‘mother organisation’ in New York to a fully local entity within Zambia, applying an important principle called “subsidiarity”. “Subsidiarity means that nothing must happen at the higher level if it can happen on the local level. This includes strategic and operational decisions.” CMMB Zambia will rebrand and become its own autonomous entity called “Access to Health Zambia” on 1 April 2023.

Walusiku-Mwewa explained that “when local capacity is built, it lasts forever, unlike when an international organisation does all the work and then leaves.”

Amita Mehrotra, Senior Technical Advisor for Capacity Development with FHI360 (https://apo-opa.info/3loYw67), one of largest international health NGOs and implementing partners in the world, said the aim of localisation was the “decolonisation of aid, with a focus on diversity, equity and inclusion”. Mehrotra, who supports teams all around the world with expert capacity building, says: “We need to take a hard look at our own value propositions and ask ourselves if what is being delivered isn’t already available, or if not, how can we deliver locally.”

Naidoo concluded: “We should learn and leverage off each other instead of creating local competition. This is how we can achieve health equity at scale.”