An epidemic of childhood blindness due to retinopathy of prematurity (ROP) in Argentina: A mixed-methods study on policy, legislation, and international collaboration

Abstract

Background: A persistent challenge in international development is the lack of coordination both between recipient governments and donors, and implementing partners with the same donor. Coordination or cooperation is a conclusion of countless aid summits, but remains trapped in the theoretical-tangible methods of coordination are rarely offered. Here, we present a USAID-developed coordination mechanism, the District Operational Plan (DOP), implemented in 34 districts across Uganda by the Strengthening Decentralization for Sustainability (SDS) Programme. Structure/Method/Design: The objectives of the DOP are to ensure that USAID projects are aligned with district development plans, eliminate duplication and strengthen the district and USAID's joint coordination, implementation, monitoring, and evaluation of activities within the district. The DOP mechanism is threefold and includes a signed memorandum of understanding between district local government, USAID, and implementing partners (IPs); commitment to quarterly District Management Committee (DMC) meetings integrated into already-existing district planning meetings; and a sharing of quarterly workplans and reports with district heads of departments (HoDs). Prior to the quarterly meetings, the HoDs consolidate and analyze submitted work plans for duplication of activities or coinciding of scheduled activity dates. Results (Scientific Abstract)/Collaborative Partners (Programmatic Abstract): The DOP is a collaboration between district local government, USAID-Uganda, and USAID-funded IPs. SDS acts as a secretariat to USAID-Uganda and thus plays a key role in working with local governments to ensure the DOP is enacted. Non-USAID IPs also participate in this collaborative effort via DMC meetings if invited by the district leadership. Summary/Conclusion: The DOP initiative began in February 2012. To date, 78 DMC meetings have been held across 34 districts with an average of 69% USAID IPs present at each meeting. Technical assistance to district leaders in meeting facilitation, leadership, and integrated budgeting and planning has been delivered. So far, 13 districts have incorporated or invited non-USAID development partners into the coordination meetings. As a result of DOP implementation, some districts have reported improved understanding of IP activities, an improved leveraging of resources, and IPs have collaborated with one another on similar activities. Challenges include insufficient commitment by high-level officials in some districts, poor IP participation in DMC meetings due to "meeting fatigue," and late submission of work plans by some IPs.This innovative initiative is being studied by USAID missions outside Uganda for potential replication. Addressing the lack of applied government project-donor feedback and coordination mechanisms is a critical step toward recipient country-driven development and empowerment.