Bottom Up vs Top Down

There are two types of approaches to development. One is bottom up (grassroots movements), while the other is top down (government movements). Bottom up movements have shown great success in many cases. One such case, as you might have already heard about, is Grameen Bank, which is micro-finance banking. This initiative has exploded and is being emulated worldwide with a few modifications to it, such as Kiva, which is run not by a bank but regular people online.

But, I have always been intrigued by top down approach to development. Most people criticize the effectiveness of this approach. The main issue people bring up with this method is that if the government is corrupt, development will not go anywhere. Or that the top is disconnected from the people, so it will be hard to meet the needs of the people. Although, it is true that top down approach has failed is many cases, but there are some cases where the government has been successful.

One of the biggest success story is in Uganda, where the government has been fighting HIV/AIDS. Some of the methods they have used are:

  • In 1999 the Ugandan Ministry of Health started a voluntary door-to-door HIV screening program using HIV rapid tests in an effort to reduce the spread of HIV.
  • Uganda has also begun to implement routine or ‘opt-out’ testing (whereby anybody who enters a healthcare facility is tested for HIV unless they specifically ask not to be) in some healthcare settings.
  • In 2007, HIV testing and counseling was available in 554 health facilities in the country. By the end of 2008, this number had risen to 812 and increased further to 1,904 in 2010. Uganda delivered HIV testing and counseling to an estimated 2,654,683 people aged 15 years and older in 2010.
  • Uganda produces generic drugs to reduce cost for the public and increase the supply in the market.

Results so far:

  • Uganda continues to increase the number of people on treatment, from around 200,000 in 2009 to 248,222 in 2010, the sustainability of its HIV treatment program must be considered.
  • In fact, between 1991 and 2007, HIV prevalence rates declined dramatically. Various claims have been made on the extent of these declines, but mathematical models estimated falls from about 15% in 1991 to about 6% in 2007. Source

So, there is a good side to governments. Do you agree or disagree with top down approach? Do you know of any other success stories for top down approach?

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3 thoughts on “Bottom Up vs Top Down

  1. Darrelle says:

    Personally, I think you need a mix of top down and bottom up. Top down has a far better scope of results making its benefits much larger, yet bottom up empowers people to take control of their own livelihoods and improve them with definite results. I think they need to meet in the middle.

  2. Kevin says:

    You know, this reminds me of how important economies of scale are. (http://en.wikipedia.org/wiki/Economies_of_scale) Economies of scale seems like an esoteric concept that only matters in textbooks, but it’s an important factor in development organizations.

    Also, I agree that the whole “oh your idea is top down so it will never work” argument is totally bogus.

    • mludin says:

      Economies of scale is one of the central pillars of development, but the finance required to work in large scale is an important obstacle which needs to be solved.

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