Towards reimagined technical assistance Thinking beyond the current policy options

Towards reimagined technical assistance: thinking beyond the current policy options

Reda SadkiGlobal health, Leadership

In the article “Towards reimagined technical assistance: the current policy options and opportunities for change”, Alexandra Nastase and her colleagues argues that technical assistance should be framed as a policy option for governments. It outlines different models of technical assistance:

  1. Capacity substitution: Technical advisers perform government functions due to urgent needs or lack of in-house expertise. This can fill gaps but has “clear limitations in building state capability.”
  2. Capacity supplementation: Technical advisers provide specific expertise to complement government efforts in challenging areas. This can “fill essential gaps at critical moments” but has limitations for building sustainable capacity.  
  3. Capacity development: Technical advisers play a facilitator role focused on enabling change and strengthening government capacity over the long term. This takes time but “there is a higher chance that these [results] will be sustainable.”

Governments may choose from this spectrum of roles for technical advisers in designing assistance programs based on the objectives, limitations, and tradeoffs involved with each approach: “The most common fallacy is to expect every type of technical assistance to lead to capacity development. We do not believe that is the case. Suppose governments choose to use externals to do the work and replace government functions. In that case, it is not realistic to expect that it will build a capability to do the work independently of consultants.”

Furthermore, technical assistance should be designed through “meaningful and equal dialogue between governments and funders” to ensure it focuses on core issues and builds sustainable capacity. Considerations that need to be highlighted include balancing short-term needs with long-term capacity building and shifting power to local experts.

However, this requires reframing technical assistance as a policy option through transparent dialogue between government and funders.

What key assumptions about technical assistance does this challenge?

The article challenges some key assumptions and orthodox views about technical assistance in global health:

  1. It frames technical assistance not as aid provided by donors, but as a policy option and domestic choice that governments make to meet their objectives. This contrasts with the common donor-centric view.
  2. It critiques the assumption that all technical assistance inherently builds sustainable government capacity and questions this expected linear relationship. The article argues different types of technical assistance have fundamentally different aims – gap-filling versus long-term capacity building.
  3. The article challenges the idealistic principles often promoted for technical assistance, like localization, government ownership, and adaptability. It suggests the evidence is lacking on if these principles effectively lead to better development outcomes on the ground.  
  4. The article argues that technical assistance decisions involve real dilemmas, tradeoffs and tensions in practice rather than being clear cut. It challenges the notion of win-win solutions and highlights risks like unintended consequences.
  5. By outlining limitations of different technical assistance approaches, the article pushes back against a one-size-fits-all mindset. The appropriate approach depends on contextual factors and clarity of purpose.
  6. The article questions typical measures of success for technical assistance based on fast results and output delivery. It advocates for greater focus on processes that enable long-term capacity development even if slower.

How does The Geneva Learning Foundation’s work fit into such a model?

At The Geneva Learning Foundation (TGLF), we realized that our own model to support locally-led leadership to drive change could be described as a new type of technical assistance that does not fit into any of the existing three categories, because:

  1. TGLF’s model is grounded in principles of localization and decolonization that shift power dynamics by empowering government health workers from all levels of the health system – not only the national authorities – to recognize what change is needed, to lead this change where they work. We have observed that, even in fragile contexts, this accelerates progress toward country goals, and strengthens or can help rebuild civil society fabric.
  2. It focuses on nurturing intrinsic motivation and peer accountability rather than imposing top-down directives or extrinsic incentives. 
  3. It utilizes lateral feedback loops and informal, self-organized networks that cut across hierarchies and geographic boundaries.
  4. It emphasizes flexibility, adaptation to local contexts, and problem-driven iteration rather than pre-defined solutions.
  5. It builds sustainable capacity and self-organized learning cultures that reduce dependency on external support.

Reference: Nastase, A., Rajan, A., French, B., Bhattacharya, D., 2020. Towards reimagined technical assistance: the current policy options and opportunities for change. Gates Open Res 4, 180.

Illustration: The Geneva Learning Foundation Collection © 2024