out their approach as well as tools designed to help staff at
the operational level.12 Nonetheless, an increasing number
of donors are reforming their internal processes along the
lines agreed on at Accra. Although the impact of these
reforms has yet to be measured, anecdotal evidence suggests
that at least some partner countries are more systematically
involved in the management of technical cooperation funded
by external donors.
Two good examples are Rwanda and the Comprehensive
African Agriculture Development Program (CAADP).
Rwanda is one of the only countries in the world to expand
community health insurance to the national level. Rwanda’s
community-based health insurance, known locally as
Mutuelles, is just one example of health policies and strategies
that have succeeded because of the country’s broad-based
participatory approach. As part of Rwanda’s decentralization
policy, policymakers involve communities in identifying their
own problems. Most policies and strategies are evidencebased, often starting as pilot initiatives that are scaled up if
they show results. The rollout of the Mutuelles was prompted
by the successes of pilot projects, which were then adapted to
the demands of the national context.
The impressive expansion of health coverage,
decentralization of services, and performance-basedfinancing in Rwanda has had a number of positive results.
Since 1999 there has been a substantial reduction in
healthcare costs and user fees and an increase in the use
of healthcare services. In 2004, Mutuelle members were
three times as likely to visit a doctor as uninsured people. In
addition, since the beginning of the program, malaria and
tuberculosis infection rates have decreased.13
The Comprehensive African Agriculture Development
Program (CAADP) is another example of the effectiveness of
local ownership in making gains in sustainable development.
CAADP is a framework for coordinated, evidence-based
investments in the agricultural sector—with the goal of
significantly reducing chronic hunger, malnutrition, and
poverty by stimulating broad-based economic growth in
Africa. It is entirely African-led and African-owned. It
represents African leaders’ collective vision for agriculture
in Africa. This ambitious and comprehensive vision for
CAADP Pillars
Pillar 1: Extend the area under sustainable land
management
Pillar 2: Improve rural infrastructure and trade-related
capacities for market access
Pillar 3: Increase food supply and reduce hunger
Pillar 4: Support agricultural research, technology
dissemination and adoption
8 Briefing Paper, December 2011
agricultural reform in Africa aims for an average annual
growth rate of 6 percent in agriculture by 2015.14 To do so,
African governments have committed to increasing public
investments in agriculture to a minimum of 10 percent of
their national budgets. Since CAADP’s inception in 2003,
development partners have worked together closely to
support its processes and the development of its pillars. This
collaborative effort has resulted in a significant harmonization
of donor support for CAADP activities and investment
programs. The New Partnership for Africa’s Development
(NEPAD), the Regional Economic Communities (RECs),
and the African Union (AU), together with a number of
individual donor and African governments, have worked to
further harmonize support. The result is the formation of
the CAADP Multi-Donor Trust Fund, designed to channel
financial support to CAADP’s work. Hosted at the World
Bank, the Multi-Donor Trust Fund is a flexible yet systematic
and efficient way to harmonize priorities, enable economies
of scale, increase the efficiency and effectiveness of financial
resources, and target specific gaps in financing, capacity,
and technology. The fund complements other funding for
CAADP priorities and facilitates partnerships and coalitionbuilding among African institutions, partners, and donors.
As these examples illustrate, countries in Africa are already
investing in country-led frameworks to combat poverty and
hunger, and looking to the United States and the rest of the
international community to keep their promises to boost
agricultural productivity and security. The Fourth HighLevel Forum in Busan presents an excellent opportunity to
widen the aid effectiveness debate and prioritize questions
of ownership, participation, and power in the global
development agenda. Momentum is already being generated
for improving global food security. In spite of the currently
tight budget climate, the international community should
not back off—rather, it should press forward to support
country-led development initiatives.
5. Fragile States and Situations
Fragile and conflict-affected states present very specific
challenges to aid effectiveness efforts as well as to other
humanitarian and development needs. On July 29, 2011, the
United Nations declared a state of famine in two southern
regions of Somalia—meaning that at least 30 percent of the
population suffered from acute malnutrition, at least 20
percent of households faced extreme food shortages, and
there were at least two deaths per day for every 10,000 people.
Four other regions met the criteria by early September.
Among the worst affected in Somalia’s crisis are small
farmers and agro-pastoralist famili