Re-Designing International Health Partnerships

Role: Global Health Lead, Scottish Government

Scope: £3m Flagship Programme (within £7m Portfolio) | Rwanda, Malawi, Zambia

Redesigned a £3m flagship international health programme to shift funding power toward country-led priorities while preserving accountability under heightened political and media scrutiny.

Context

Scotland’s Health Partnerships Programme had historically delivered small grants against predefined objectives with annual reporting. This model prioritised predictability and central control, but limited flexibility and local ownership.

The redesign took place during a period of global instability in international development funding, including the withdrawal of USAID from key institutions. Ministerial sensitivity to reputational risk was high, and scrutiny of all international spend intensified. Any perceived risk could have affected confidence in the wider International Development portfolio.

Structural Problem

The strategic ambition was to embed decolonisation in practice: shifting programme design authority closer to in-country partners. However, a country-led, adaptive approach introduced perceived risk.

Finance and risk colleagues questioned whether flexibility could coexist with robust accountability and whether this model would withstand political scrutiny. The core challenge was clear: how do you redistribute capital decision-making without weakening accountability or political confidence?

Strategic Intervention

As Global Health Lead, I designed and secured approval for a new capital distribution and governance model that balanced flexibility with oversight. The redesign included:

• Procuring an independent third-sector delivery partner to manage implementation

• Embedding country-led scoping in Rwanda, Malawi, and Zambia before interventions were defined

• Introducing milestone-based funding tranches tied to outcomes rather than fixed activities

• Establishing strengthened governance, reporting cadence, and escalation mechanisms to maintain ministerial assurance

Cabinet Secretary Angus Robertson speaking at the Health Partnership Programme Launch Event

Impact & Outcomes

• Secured ministerial approval and funding for a £3m programme under heightened scrutiny

• Shifted programme design authority to country-led scoping across Malawi, Rwanda and Zambia

• Replaced rigid annual grants with milestone-based, outcome-driven funding architecture

• Embedded decolonisation principles within formal governance structures

• Maintained political confidence and protected the wider portfolio from reputational exposure

What This Taught Me

Capital architecture shapes power, incentives, and behaviour. Values-led reform must be operationalised through disciplined governance and clear risk design.

I learned that balancing ambition with institutional confidence requires transparency, structured oversight, and careful stakeholder alignment. Sustainable reform is not about reducing risk to zero - it is about designing systems that can absorb and manage risk responsibly.