European aid and health system strengthening: an analysis of donor approaches in the DRC, Ethiopia, Uganda, Mozambique and the global fund

Abstract

Background: In the field of international health assistance (IHA), there is a growing consensus on the limits of disease-specific interventions and the need for more health system strengthening (HSS). European donors are considered to be strong supporters of HSS. Nevertheless, little is known about how their support for HSS translates into concrete policies at partner country level. Furthermore, as development cooperation is a shared policy between the EU and its Member States, it remains unclear to what extent European donors share a similar approach. Objective: This article reviews a PhD thesis on European aid and HSS. The thesis investigated (1) the approaches of European donors towards IHA, and (2) the extent to which there are similarities or differences between them. An original analytical framework was developed to make a fine-grained analysis of European donors' approaches in the DRC, Ethiopia, Uganda and Mozambique. In addition, the relation of European donors with the Global Fund was investigated. Methods: An abductive research approach was used during which literature review, data generation, analysis and research design mutually influenced each other. The research built on a wide range of empirical data, including semi-structured interviews with 123 respondents, policy documents and descriptive statistical analysis. Results and conclusion: Four 'types' of European donors were identified, which vary in their focus (issue-specific versus comprehensive) and their level of support to and involvement of recipient states. Despite this heterogeneity at a specific level, there is still a general degree of 'unity' among European donors, especially compared with the US. Yet, there are signs that the 'transatlantic' divide on HSS may be converging, as European donors tend to focus more explicitly on result-oriented approaches traditionally associated with the US and Global Health Initiatives. Consequently, European donors play a limited role in bringing HSS more to the forefront in IHA.

Health Coverage and Financial Protection in Uganda: A Political Economy Perspective

“…Considering the position of development partners with respect to health financing, poor accountability for large sums of money involving the Ministry of Health has led to important changes in the form of support for health initiatives. 56 During the late 2000s, a shift occurred from budget support to vertical programs with poor coordination and weak system strengthening. 42 Nonetheless, programmes and initiatives driven by development partners continue to play a central role for healthcare financing and services provision.…”

<b><i>Helicobacter pylori</i></b> Infection in Africa: Update of the Current Situation and Challenges

“…A survey initiated by the European Society of Gastrointestinal Endoscopy (ESGE) revealed a general shortage of medical and nonmedical personnel in African countries. While in Europe, 1,286–6,645 physicians per million inhabitants are available, in Africa, 14–1,192 medical doctors support the medical system [113]. In parallel, academic and nonacademic training centers for basic or advanced endoscopy exist in only half of African countries [113].…”

“…While in Europe, 1,286–6,645 physicians per million inhabitants are available, in Africa, 14–1,192 medical doctors support the medical system [113]. In parallel, academic and nonacademic training centers for basic or advanced endoscopy exist in only half of African countries [113]. National endoscopy societies are only known to exist in South Africa, Nigeria, Morocco, Ivory Coast, and Burkina Faso.…”

Rethinking the donor's role in strengthening health systems through sexual and reproductive health and rights partnerships: A qualitative analysis of Ugandan case studies

“…Thus, while the NMFA's policies primarily focus on dedicating multilateral funding channels to HSS, SRHR partnerships bring their unique health system focus and localised approach to HSS and UHC. Earlier studies have indicated that if European donors like the NMFA want to ‘walk their talk’ on HSS, they will have to adjust their health development programmes and adopt innovative ways of supporting HSS (Steurs, 2019, p. 10). HSS will likely have a prominent place on the global health policy agenda until at least 2030 (Naimoli et al, 2018).…”