Thursday, May 1, 2008

MERG ... and the lack of accountancy expertise

Dear Colleagues

A few months ago I wrote the following. It was addressed to Dr. Kochi at WHO and was copied to a number of people who have been associated with the WHO MERG initiative (MERG stands for Monitoring and Evaluation Reference Group) over the past several years.
From: "Peter Burgess"
Date: Sun, 16 Dec 2007 02:08:01 -0500
Subject: Performance Metrics in the International Health Malaria Sub-Sector

Dear Dr. Kochi

This is a rather belated follow up to some communication earlier in the year.

We are continuing to push forward a Tr-Ac-Net initiative to be of assistance in the global effort to have an effective integrated mosquito and malaria control program.

We are proud to be associated with the Integrated Malaria Management Consortium (IMMC) in our efforts to get good cost accounting and performance metrics to be an integral part of the malaria management approach that is used everywhere.

However, it is apparent that there are serious problems with the prevailing modus operandi. Notably, the expertise in cost accounting and performance metrics is almost totally absent.

While the Tr-Ac-Net contribution into the malaria sector is our expertise in cost accounting and the metrics of performance, it seems that (1) this functional expertise is being ignored, and worse (2) there is an active effort to ensure that good accounting and accountability is not deployed in this segment of the international relief and development sector

I offer as an an example of the problem the information below. This is a list of people charged with developing the MERG methodology (albeit back in 2004, but what has really changed?) ... but I find there is nobody (that I recognise) as being an expert in either cost accounting or in performance metrics. Tr-Ac-Net would argue that without this, the exercise is doomed to failure. We recognise that scientific and medical professionals do not like to be challenged by mere accountants ... but the fact is that while scientific and medical professionals are good at what they do ... they are not very good at mere accounting, and especially cost accounting and performance analysis.

In due course we will offer critiques of work that is currently going on based on the MERG methodology that totally fails to address the key issues.

With a substantial increase in funding now flowing into the malaria subsector ... it would be great if this translated into a sustainable reduction in the burden of malaria in the beneficiary countries and communities. Up to now, we have been able to locate a lot of information about the "coverage" of various anti-malarial interventions ... but is this really of much importance? Surely we should be looking for the maximum of reduction of the burden of malaria in the society at the least cost BOTH in the reduction phase and in the ongoing sustainable phase. I would refer you to the experience in Darwin, Australia where the last case of local malaria was in 1962, but their surveillance (in 2007) is still ongoing and their interventions are rapid and comprehensive in order to keep malaria out of their society.

Tr-Ac-Net and the IMMC are interested in helping ... the question is simply HOW?

Peter Burgess
Peter Burgess
The Transparency and Accountability Network:
Tr-Ac-Net in New York
IMMC - The Integrated Malaria Management Consortium Inc.
917 432 1191 or 212 772 6918

Washington, USA 8-9 MAY 2003
Dr Bernard NAHLEN, Coordinator, M&E, WHO/HQ - Geneva
Tel: 004 1 22 791 2869; Fax: 004 1 2 791 4824; e-mail:
Dr Claudia STEIN, Edipemiology & Burden of Disease, WHO/HQ - Geneva
Tel: 004 1 22 791 3234; Fax: 004 1 2 791 e-mail:
Dr Magda ROBALO, Regional Malaria Adviser, WHO/AFRO - Harare
Tel: 47 241 38 167; Fax: 47 241 38006; e-mail:
Dr Alisalad ABDIKAMAL; Malaria M& E, WHO/AFRO - Harare
Tel: 47 241 38 167; Fax: 47 241 38006; e-mail:
Dr Thomas TEUSCHER, WHO/HQ - Geneva
Tel: 004 1 22 791 3741; Fax: 004 1 2 791 4824; e-mail:
Dr Tessa WARDLAW, Senior Project Mofficer, Monitorning & Evaluation
Tel:+1 212 824 6727; e-mail:
Dr Mark YOUNG, Senior Health Adviser RBM Health Section Programme Division
Tel: +1 212 303 7966; Fax: +1 212 824 6460; e-mail:
Dr Abdoulaye SADIO, Regional Monitoring & Evaluation Officer, West and Central Africa; e-mail:
Dr Lawrence BARAT, Technical Specialist on Malaria
Tel: +1 202 458 9123; Fax: +1 202 473 8107; e-mail:
Dr Matt LYNCH, Malaria Advisor, USAID, Office of Health, Infectious Diseases and Nutrition, 1300 Pennsylvania Ave, Washington DC 20523-3700.
Tel: +1 202 712 0644; Fax: +1 202 216 3702; e-mail:
Dr Alastair ROBB, Senior Public Health Adviser, Health & Population Department
Tel: +44 207 023 0112/733; Fax: 44 207 023 0428/0174; e-mail:
Dr Vinand NANTULYA, Director, Strategy & Evaluation
Tel: +41 22 791 1700; Fax: 41 22 791 1701; e-mail:
Dr Fred BINKA, School of Public Health, University of Ghana
Tel: +233 21 401 550/27 581 828; Fax: +233 21 254 752;
Dr Graham ROOT, Malaria Consortium East Africa Office, Uganda
Tel: +256 41 344 038; Fax: +256 41 344 059;
e-mail: or
Dr Don de SAVIGNY, IDRC/TEHIP Research Manager, Swiss Tropical Institute
Tel: +41 61 284 8221, Fax: +41 61 271 7951; e-mail:
Dr Bob SNOW, Centre for International Development, Harvard University
Tel: +1 617 495 4112; Fax: +1 617 496 875; e-mail:
Dr Richard STEKETEE, Chief, Malaria epidemiology Branch, Division of
Parasitic Diseases, Centres for Diseases Control (CDC), United States of America
Tel: +1 770 488 7755; Fax: +1 770 488 4206; e-mail:
Dr Erin ECKERT, Principal Investigator, ORC/Macro - Measure Evaluation, USA
Tel: +301 572 0397; Fax: +301 572 0999; e-mail:
The people involved have a lot of expertise, but, I think it is fair to say that none of them have much, if any, experience of cost accounting and the best way to make use of cost and performance information.

Cost accounting and performance metrics are not well served by the use of advanced statistical methods ... cost accounting is different from doing clinical trials.

In most cases it is very easy to get a good idea of costs simply by knowing some of the cost elements and knowing how the operations are carried out ... and by focusing on the "material" items. For example, there is a vast difference in the cost of doing something using local staff paid at local wage rates and doing similar work with expatriate staff at international rates, together with all the other cost adders associated with expatriates (travel, accommodation, per diems, etc.).

Tr-Ac-Net is developing the Community Impact Accountancy (CIA) system as a framework for analysis of program impact. CIA draws on experience with accounting systems and with development activities around the world ... many of which had elements of excellence, and some which were expensive and disastrous. CIA type management information would have helped then, and will soon be available so as to help in some of the much larger programs now being initiated.


Peter Burgess

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