by Enrico Materia, Head of Human Development

• Over the last 25 years, the global increase in life expectancy – due to improvements in nutrition and hygiene, to vaccination programmes and to improved control of infectious diseases – has been accompanied by a rise in the number of people suffering from chronic non-infectious diseases, obesity and substance abuse. The health effects of globalisation and demographic and social transition have been highlighted in particular by a new study involving 195 nations – “Global Burden of Diseases 2000-2015” – published by The Lancet magazine in November 2016.

The study also underlined how much progress has been overshadowed by the consequences of permanent warfare, fragile state structures and increasing inequalities between nations and within nations. Various Sub-Saharan African countries have achieved notable reductions in maternal and infant mortality rates and deaths caused by HIV/AIDS and malaria, but 24 nations still have maternal mortality rates of over 400 for every 100,000 pregnancies, with particularly high percentages in the Central African Republic, Afghanistan and Sierra Leone.

The famine now widespread in Yemen, the Horn of Africa and South Sudan, and in other African countries, is threatening the lives of 20 million men, women and children. This is a highly complex emergency where natural causes – above all such a prolonged drought – interact with man-made factors. Refugee camps shelter multitudes of displaced people, while migratory movement inside many nations and towards Europe continues to increase due to the insecurity caused by wars, ecosystem degradation and the impoverishment of natural resources.

In low and medium income countries, the rapid transformation of lifestyle induced by the globalisation of trade is producing new forms of malnutrition caused by the use of industrial foods and drinks. These contribute to the spread of heart diseases, diabetes and obesity: an “imminent disaster”, warns the Director General of the World Health Organisation Margaret Chan, for the health of whole populations and for national health systems that must respond to a swelling demand for new services. A “double burden” of infectious and non-infectious diseases is weighing down on poor nations.

Development aid for the health sector continues to grow (in the three-year period 2013-2015, according to OECD-DAC figures, it reached a total of 28.8 billion dollars, an increase of 22% on the previous triennial), but the challenges ahead remains formidable, such as achieving the target of UN Sustainable Development Goal number three: “Ensure healthy lives and promote well-being for all, at all ages.” An increase of between 70 and 90 billion dollars a year would be needed to provide universally accessible health services, a figure corresponding to one third of the total annual health expenditure of the world’s low and medium income nations. In 27 countries out of 34, annual per capita health expenditure is still below 86 dollars, the minimum level necessary for providing basic services. In many poor countries, people have to pay for many medical treatments out of their own pockets, and the WHO estimates that every year 100 million people become poor due to health costs. In order to avoid the poverty-disease trap, the Abuja Declaration signed in 2001 by African Union nations aimed at an increase in domestic health expenses of up to 15% of government budgets, but 16 years later only one of those countries has achieved that goal.

Italy’s traditional Cooperation initiatives are today accompanied by innovative projects for the prevention and control of chronic diseases. The Italian health cooperation, in other words, must confront old and new challenges in priority countries for its aid operations. Italy’s commitments are enshrined in the 2030 Agenda for Sustainable Development, which aims to integrate in one shared framework a series of interdependent goals concerning personal dignity, prosperity, the environment and social justice, as parts of one path to integral human development. AICS has adopted – in its organisational structure too – an approach to human development focused on the richness of human life, i.e. centred on people, opportunities, rights and choices. According to the thinking of the economist Amartya Sen, development does not involve only the economy in itself and the overall resources available in a given society, but also the way that these are distributed and the ways they are used to guarantee fundamental services such as education and health, and to improve everyday living conditions.

For the Italian Cooperation sector, health – understood as a right and at the same time as a condition and opportunity for development – continues to be a priority intervention area that is increasingly integrated with gender equality and women’s empowerment, the rights of minors and people with disabilities, and the struggle against poverty and malnutrition. The guiding principles of Italian health cooperation projects aimed at global health adopt this approach: recommending initiatives involving social protection and countering social, economic and gender inequalities, giving priority to low and medium income countries and to the most disadvantaged groups of their populations. The same principles focus on universal health coverage with fair access to services and financial support, and also on reinforcing health systems on a universal basis via reforms orientated towards fairness, solidarity and social inclusion. Emphasis is also placed on self-determination and community involvement, on vocational training, research and knowledge sharing, on health provision during natural or man-made disasters and on the link between emergencies and development.

Within the perspective of this range of priorities, Italian health cooperation operates in 30 countries through initiatives that use both bilateral and multilateral channels, aid credits, and support from international partnerships such The Global Fund and the GAVI Vaccine Alliance.

Traditional commitments – against infective diseases such as AIDS, tuberculosis, malaria and neglected tropical diseases (in Burkina Faso, Ethiopia and Mozambique), and in support of mother-and-child health, plus in the struggle against malnutrition (as in Niger and Sudan) – are now accompanied by innovative initiatives aimed at preventing and controlling chronic diseases (Palestine, Bolivia) which, as seen above, are a major source of illness and mortality in low and medium income countries.

Always essential is the reinforcement of national health systems and their resilience (in Sudan, Ethiopia, Afghanistan, Iraqi Kurdistan, Lebanon, Bolivia and Peru). Here, primary treatment services are increasingly being orientated towards a family medicine approach (e.g. in Sudan and Palestine), with particular attention focused on maternal and infant assistance and on combating gender violence.

There is a long list of initiatives for which a growing use of resources is foreseen in the coming years, often including multilateral strategies and the actions of civil society organisations: these include supporting reforms that introduce health expenditure financing in order to sustain universal health coverage and improve social protection; the prevention of chronic diseases through technical assistance for partner governments in countering the main risk factors, in part through increased excise duties on harmful products; the reinforcement of services for sexual and reproductive health and rights; the promotion of integrated multi-sector initiatives to improve physical, cognitive and emotional development in the first one thousand days of infancy; the response of health systems to violence against women and girls, in the context of multi-agency intervention; the strengthening of community mental health services and their integration with primary treatment services.

Aid must increasingly be channelled through state-systems, supporting the budgets of national Ministries of Health in order to contribute in a sustainable way to funding for health expenses and to reducing transaction costs. Initiatives must be integrated with programmes capable of favouring the complementary nature and the coherence of the Italian Cooperation system, as indicated in law 125/2014 and by the 2014 OECD-DAC Peer Review. It is therefore important that forms of subsidiarity and task division between cooperation partners are implemented. In other words, it is vital to overcome project fragmentation in the shared reference frameworks provided by nation-programmes, and to aim for greater predictability of financial flow by creating multi-year project funding and by concentrating resources on programmes with greater financial commitment, timespan, impact and sustainability.

Foto: S. Di Lorenzo / Green Cross Italia

Turning the challenge of migrations into an opportunity. But how? A study by the Italian Centre for International Development of the University of Tor Vergata, published in February 2017 with the cooperation of the Agency, seeks for possible answers. Below is the introduction.

• The large migratory flows towards Europe that have dominated recent headlines and generated heated political debate are likely to be a long term phenomenon due to the entrenched nature of many of the factors driving persons to move across borders. If left unchecked, the migration challenge will seriously jeopardise the fundamental pillars of European integration and solidarity both within and between Member States. But at the same time, if proactively and effectively managed, the migration challenge can be transformed into an opportunity for both an aging Europe and for partner (origin) countries, in terms of economic growth, development and the sustainability of social security systems.

Notwithstanding the tensions generated by the recent spike of migratory flows, migration is a phenomenon determined primarily by long-term structural factors and any migration strategy must be designed accordingly. Crises can exacerbate outward migratory flows, but even emergency responses are more effective if framed within a long run strategy. A long-term perspective does not imply that results will be only realised in the long-run; on the contrary, actions framed in a consistent strategy are also more likely to be effective in the short-run.

More specifically, since international labour migration is increasingly flowing from developing to developed countries, migration policies should be conceived in a manner consistent with development policies and in partnership with countries of origin. Such policies should set out to encourage the positive effects migration can have in both origin and destination countries (or to contain the potential unfavourable effects it may entail in the short-run) in order to generate mutual benefits, i.e. a win-win situation.

Some of the mutual long term benefits of migration can be spoiled if migration is characterised by unregulated migration spikes and by the use of irregular channels for crossing borders. For this reason, the interventions should be designed in such a way to control flows and to discourage irregular migration. In practice, this means that the internal measures that have been the focus of much of the EU policy debate on migration to date need to be complemented by stronger joint external actions, within the framework of long-run development policies targeting countries of origin.

Indeed, the countries of origin are where the migration challenge must ultimately be addressed, and the centre of gravity of EU action should therefore shift to supporting countries of origin in this regard. The process of turning challenge to opportunity and of maximising the benefits of migration for all parties concerned must start by addressing the factors determining the extent and composition of migrant flows in the countries where they originate. Only by considering the forces making people move across the borders will it be possible to manage migrant flows in a sustainable way.

The Migration Compact, the recent non-paper of the Government of Italy moves in this strategic direction. The Migration Compact, consistent with recent EU Declarations (e.g., the Valletta Action Plan), calls for systematic and significantly scaled-up efforts involving close partnership with countries of origin aimed at controlling and improving the quality of migration flows and at reducing incentives to migrate through irregular channels.

The current Report is set within the framework of the Migration Compact and supports its broad call for an enlargement of the space of intervention from within the borders of the destination countries to the countries of origin, as part of a systematic and long-term response to migration and the development factors driving it.

The Report presents and discusses an array of policies that can be implemented in the countries of origin to help turn the challenge of migration into an opportunity for origin and destination countries alike. Taken together, the policies aim at bringing about the desired migration scenario, i.e. controlled migration flows, reduced incentives for irregular migration and a two-way flow of migration benefits.

It is important to note at the outset that, notwithstanding the high sensitivity of the issues and the repeated calls for coherent and effective interventions in the countries of origin, there is very little programme experience and even less solid evidence about their effectiveness. Moreover, with the exception of a few origin countries, integrated strategies of intervention are completely absent. This reinforces the potential role of Italy not only in implementing appropriate and effective strategies, but also in providing the necessary intellectual leadership in this regard within the EU and multilateral institutions and banks.

The remainder of the Report is organised as follows. Chapter 1 sets the scene by reviewing the evolution and characteristics of international migration flows towards Europe and Italy and the factors driving them. Chapter 2 then reviews policy options and experiences in countries of origin for achieving sustainable migration. These include active labour market policies aimed at making migration a choice not a necessity; education and training aimed at increasing the employability of prospective migrants; pre-migration preparatory programmes aimed at equipping prospective migrants with “migration knowledge and skills”; circular migration policies aimed at facilitating two-way movements of both migrants and their accumulated knowledge, skills and capital; diaspora engagement policies aimed at mobilising diaspora communities as agents of development in their countries of origin; return migration policies aimed at making migration a reversible choice; and protection policies aimed at safeguarding children left behind by migrant parents. Chapter 3 discusses next steps towards an integrated strategy for sustainable migration.

• Towards sustainable migration

• Verso una migrazione sostenibile

• Presentation in Milan, 13/03/2017

We publish the speech delivered by Director Laura Frigenti at the VI International Forum on Migration and Peace, held in Rome on 21-22 February 2017. 

• The ‘common future’ in the title of this session - Migration and Development: Building a Better Common Future - has been part of the Italian Cooperation and Development perspective for some time. The law which established the Agency I direct expressed this perspective strongly when it referred to “protecting and promoting human rights, the dignity of individuals, gender equality, equal opportunity and the principles of democracy and the rule of law; preventing conflicts and supporting peace processes, reconciliation, post-conflict stabilisation, and the consolidation and reinforcement of institutions.”

We are facing great challenges to peace and security: endemic wars, rising tensions, terrorism, organised crime, as in South America. Conflicts and violence stifle development. Endemic wars and protracted humanitarian emergencies are debilitating threats. In the same way, climate and environment represent titanic challenges, and also create their refugees. On this subject, I’d like to point out that most displacements caused by climate change take place within the same country, involving moves from rural areas to cities, but also between different rural areas.

This is the framework for unprecedented migratory movements: what we are seeing is mass migration. This new phenomenon also constrains the aid community to reshape its traditional aid instruments towards new and more effective methods. But to do so requires a deeper comprehension of these phenomena. We have to reinforce our analytical capacity. We have to invest in statistics. We simply cannot manage our relations with developing countries using categories and paradigms from the last century. The report that I will present shortly is part of this effort.

Allow me to concentrate on the economic dimensions of this challenge. The economic gap between a European and an African is 70:1. At current growth rates, it will take 118 years to correct this imbalance. And creating jobs in Africa is only part of the solution: it is also necessary to confront the problem of the restrictions and the malfunctioning of markets and lack of regional integration.

We also need to improve our understanding of what is happening. In Africa, for example, an anthropological revolution is underway, affecting young people above all: they are far more independent than their parents, more ready to take initiatives, more connected and informed. This is globalisation: free movement of goods, money and people. But it’s also urbanisation. People move to cities in order to have more opportunities. And cities are frequently the first step towards the adventure of emigration. Today, African families have far less social cohesion. In many cases, individuals decide their own destinies, and are ready to take the risk of travelling to the unknown.

People in Europe – with much younger populations knocking at their doors, masses who in their own countries find personal fulfilment practically impossible – can easily be tempted by fear, by easy short-cuts and irrational proposals fed by the insane narratives of politicians. Our programmes for educating people on global citizenship are one response to these ‘shouted’ threats: we try to bring to our youth a culture based on awareness of others and comprehension of their choices – including their migratory choices – and to explain the collective benefits derived immigration. A new initiative being launched in 2017 will focus specifically on this. We also have to explain that three quarters of African migration does not involve leaving the African continent, and that this necessitates providing special support for transit countries: the flow of vertical aid provided by international organisations in, for example, an area in Ethiopia, to help Eritrean or Sudanese refugees, should be accompanied by measures designed to support the resilience of local communities.

We talk a lot about “migration and development” nowadays. But we have to distinguish between one-way migration and migrations that end by generating a return flux, not only economic (exile remittances) but also human (repatriation, willing or not, exiles who participate in the development of their native land, return entrepreneurs). Here, I’d like to emphasise the fact that circular or two-way migration is a potential growth factor (in a process defined by sector specialists as “co-development”) and that it can also contribute to improving conditions in the migrants’ home country. Here I’m referring to the role played by communities of exiles, which need to be listened to, understood and assisted to carry out the role that history assigns them, in a free but structured way.

In the final analysis, from an economic and development perspective, emigration should not be simply reduced and controlled, but also guided and organised. From a strictly economic point of view, all international studies highlight the positive effects that migration brings to development: each brain drain corresponds with a short term brain gain that in the long term can work to the advantage of migrants’ home countries: through earnings sent home, exchanges of experience and know how, plus cultural interaction, are all “mass effects” which are far more significant than our restricted micro-sector initiatives.

We have to equip ourselves to confront complexities, which are often frightening. Simplified approaches are not helpful: for example, creating jobs that produce goods and services is a necessary condition that is not sufficient on its own. While the creation of jobs and therefore of business enterprise, through the leverage of profit on development, can contribute to the reduction, organisation or containment of migratory fluxes, a parallel effort is needed to amplify and reinforce market demand for the goods and services produced. In certain contexts, the creation of jobs requires an accompanying boost of demand that can consolidate and improve the ability to supply. And this may not be sufficient. Private consumption or investment is not effective in stimulating signs of recovery in depressed economies. What is also needed is an intervention encouraging the development of regional markets, reinforcing them, abolishing tariff barriers and boosting broader circulation of goods and services.

And generally speaking, we should reason more in terms of innovation. In order to achieve the massive gains in efficiency that have been produced by mobile phone technology, there was no need to pass through land-line technology. That was a technological leap. And the results are there before us. Mobile banking was invented in Kenya (M-Pesa), not in Europe. Other technological leaps are possible. Tablets are being distributed in primary schools in Ethiopia, along with immediate demonstrations on how to use them. The smart city model need not be that far away, and its application to medium-sized cities in the developing world – reducing emigration to the bidonville slums of capital cities – is an option to be considered. Innovation in the service of development – such as single-dose syringes which are unusable after one injection – is a rarely explored territory which should discussed more often with partner nations. An example of authentic ownership.

To conclude, I’d like to focus briefly on one field with great potential, where Italy can make a major contribution: social enterprise initiatives. Thinking of the cooperative model, or of social impact financing. We have recently launched a small 5 million Euro pilot project supporting these new players, particularly aimed to involve young people. This kind of model is frequently requested from us in many countries. In this context, I’d like to emphasise the renewed focus on the private sector, a key player which has to conform with a series of principles and special conditions: measurable impact on development, additionality, neutrality and transparency, shared interests and goals, co-financing, stimulus effect, conformity with labour, social, environmental and fiscal regulations, and respect for human rights. Nevertheless, it has great potential. It is vital that we attract private sector involvement in developing countries. It can make major contributions, beyond the usual rhetoric on MSEs, for example in extending an entrepreneurial mentality.
In this context, the Agency is called upon to promote innovative forms of partnership with private subjects for implementing specific initiatives that benefit developing nations, with particular focus on initiatives in countries with high migration rates or migratory transit rates.

At the same time, we need to compensate for market failures and intervene directly in transit countries to protect the most vulnerable migrants, the voiceless people, in order not to lose entire generations through lack of education, guaranteeing adequate nourishment or civil registration. We need both old and new forms of intervention, such as the Canadian sponsorship system or humanitarian corridors to protect vulnerable groups.

As was emphasised in the New York Declaration of September 19th 2016, migration must be a choice and not a necessity.
But we have to be far-sighted in order to confront our long-term challenges, including that of governance and that of demography. In Africa, estimates forecast 450 million new job-seekers entering the employment market between 2010 and 2035. A massive opportunity (particularly in terms of demographic dividends), but also a titanic challenge in terms of job creation. There are no easy answers, but there are various pilot initiatives which help us to see our horizon.

Let’s get back to work. Thank you.

by Emilio Ciarlo, manager of Institutional relations and Communication

• More transparency in cooperation, through quicker and clearer communication of information and data. Motivated by this ambitious goal, the Italian Agency for Cooperation and Development has joined the International Aid Transparency Initiative (IATI), a voluntary initiative that unites 450 organisations from various countries around the world, including OECD-DAC and UNDP. In order to improve the transparency of data concerning development aid and boost the adoption of shared international standards, IATI has evolved a standard format for communicating data (IATI 2.02) which contains all information deemed necessary for electronic publication – of a rapid, complete and long-term nature – of data on the cooperation activities of single donors.

Adhering to this standard was an extremely important decision for AICS, but doing so was challenging indeed, since the adoption of such a high quality technical standard required a major updating of our Agency’s computer and management systems. We had to rethink and reinforce our entire internal management system (from SIC to SICONTA) and redefine our personal classification fields for inserting data in the light of the latest OECD-DAC indications and new sustainable development goals.

This major commitment to transparency was formally undertaken by the Agency on January 20th 2016, when it signed article 3 of the convention between AICS and the Ministry of Foreign Affairs and International Cooperation. Compared to the past, when Italy was limited to an observer role in the assembly, AICS then postponed its formal adhesion to IATI from December 2016, to gain time to be able to implement both the preparatory procedures for full formal adhesion and the modification of its internal management systems, work-flows and organisation.

“These are all complex operations, which affect the organisational structure and the flow of information between different Agency offices, as well as requiring economic investment and retraining of our human resources – explains AICS Director Laura Frigenti – and they also need time to be fine-tuned during a phase of organisational start-up. We are in the middle of an operation which will conclude in the coming months: our long-term goal is to render the Agency’s activities more transparent and more participatory. The first stage of this process took place in Nairobi last November, when AICS took part in the Global Partnership Initiative and the date for our official adhesion was fixed for March 1st 2017. There are four main goals which the Agency must pursue in adhering to the AITI organisation: the sharing and promotion of the AITI vision and mission; the implementation of its standards, or the commitment to implement them within one year, and submitting this to monitoring by the Annual Report; the payment of the annual membership fee, as established by the Members’ Assembly; and making its operative skills available to the various work groups.

With formal adhesion in place, members will be able to access the IATI data register plus other correlated databases, receive support in implementing IATI standards, receive regular news and updates, share experiences in data use and other innovations in the field, as well as taking part in spending review events. And finally, the Open Aid platform will participate in the third OGP (Open Government Partnership) National Action Plan, with its Open Aid 2.0 project.”