Health sector development: from aid coordination to resource management

Abstract

Aid coordination has assumed a prominent place on health policy agendas. This paper synthesizes the findings of research undertaken to explore the changing practices of aid coordination across a number of countries. It begins by reviewing the key issues giving rise to increased attention to aid coordination in the health sector. The second section describes, assesses and compares the strengths and weaknesses of the dominant mechanisms or instruments which were found to be employed to coordinate health sector aid in the case studies. From this analysis, four factors become clear. First, in many countries, coordination mechanisms have been introduced as a part of an incremental process of trying out different approaches--there is no one model that stands out at any one time. Secondly, some instruments function largely for consultation, predominantly coordinating inputs, while others are more directive and operational, and are used to manage inputs, processes and outputs. Third, many of the mechanisms have not excelled, although, fourth, it is difficult to judge the effectiveness or impact of aid coordination. It is therefore argued that concern with the effectiveness of aid coordination arrangements must give way to a broader analysis of the processes, outputs and outcomes governing the use of both external and domestic resources, focusing on institutional characteristics, the distribution and nature of influence among the actors, and the interests which they pursue through the aid regime. These factors varied considerably across the countries indicating that aid management is context dependent and subject to continuing changes. Finally, the paper looks at the findings in the light of the introduction of sector-wide approaches.

Rehabilitating Health Systems in Post-Conflict Situations

“…Coordination of donors' inputs can occur in different formats-sharing information; seeking outside expertise as to appropriate inputs; or jointly managing inputs and processes (Walt et al 1999). Moving from project-based assistance-characterized by the quick disbursement of large amounts of money to a particular project-to sectorbased aid is an important step to maximize external assistance without jeopardizing an evolving national health system strategy.…”

An Overview of Changing Agendas in Health Sector Reforms

“…Bilateral aid budgets continued to decline as a total proportion of international transfers to poorer countries. There was, however, an increase in the proportion of loans from multilateral agencies, particularly for sectoral expenditure such as health [19], partly as a response to increasing concern over the impact of structural adjustment programmes on the social sectors of poor countries. In countries with significant donor support to the health sector, there was a move away from donor-specific project funding to what became known as sector investment programmes and sector-wide approaches (SWAps).…”

Between Intent and Achievement in Sector-Wide Approaches: Staking a Claim for Reproductive Health

“…Buse and Walt [17] describe ''an unruly me elange of external ideas and initiatives'' that confronts health planners, and list eight coordination mechanisms employed by donors to rationalize project support. The shift from aid coordination to resource management, which is integral to the concept of SWAps, marks a radical development [18]. Making government ownership the sine qua non of SWAps [6] provides a new mechanism of control and discipline over donors through deference to national leadership and the constraints of peer-donor pressure [11,18].…”

“…The shift from aid coordination to resource management, which is integral to the concept of SWAps, marks a radical development [18]. Making government ownership the sine qua non of SWAps [6] provides a new mechanism of control and discipline over donors through deference to national leadership and the constraints of peer-donor pressure [11,18].…”

“…Donor leverage is linked strongly to financial contributions, though ironically, smaller donors may secure positions of influence as a result of a history of developed trust, or by direct channelling of funding through government processes [7,18]. Priority setting to date has largely been determined by donor rather than government agendas, and with limited ''pooled'' resources, identified funds for specific programmes are relatively well quarantined.…”