Better Aid

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This series of books examines strategies for making aid more effective.
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Aid Effectiveness in the Health Sector

Aid Effectiveness in the Health Sector

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13 Aug 2012
9789264178014 (PDF) ;9789264130685(print)

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Aid plays an important role in reducing poverty and inequality, stimulating growth, building capacity, promoting human development and accelerating the achievement of the Millennium Development Goals. Effective aid is critical both to maximise the impact of aid and to achieve long-term, sustainable development.

Aid to the health sector has increased substantially over the last 20 years from USD 5 billion in 1990 to USD 21.8 billion in 2007. Consisting of a growing and diverse range of actors, aid to the health sector faces complex governance and management challenges: for example, donors inadvertedly invest in duplicate and fragmented efforts, while partners are unable to take full responsibility and leadership. By reviewing these challenges against the aid effectiveness principles outlined in the landmark 2005 Paris Declaration and 2008 Accra Agenda for Action, this report provides insight and expounds lessons from the health sector to the broader challenges of aid effectiveness. Health, then, is used as a "tracer" sector to help assess the risks and benefits of the diverse range of actors, and promote co-ordination and coherence among development programmes.

This work is the result of a collaboration between the Working Party on Aid Effectiveness – an inclusive, international forum with the aim of improving aid delivery – through its Task Team on Health as a Tracer Sector and the World Trade Organization.

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  • Foreword

    The Fourth High-Level Forum on Aid Effectiveness (HLF4), held in Busan, Republic of Korea from 29 November to 1 December 2011, presented a critical opportunity for all development partners to work together on a new global compact to broaden and deepen the global development partnership. It was an opportunity to re-energise the development agenda, so that developing countries supported by their development partners can achieve better results and reach the Millennium Development Goals (MDGs). The work on aid effectiveness and health, which has been developed and regularly reported on for the past four years in the context of the Working Party on Aid Effectiveness, has been the most tangible effort to bridge the debate on the quality of development co-operation partnerships and the one on development results, including the MDGs.

  • Acknowledgements

    This report was prepared by the Working Party on Aid Effectiveness’s Task Team on Health as a Tracer Sector (TT-HATS) as a contribution to the Fourth High-Level Forum on Aid Effectiveness, Republic of Korea, 29 November-1 December 2011. The report was produced under the management of Elisabeth Sandor (OECD).

  • Abbreviations
  • Executive Summary

    Aid plays an important role in reducing poverty and inequality, increasing growth, building capacity, achieving human development and accelerating achievement of the Millennium Development Goals (MDGs). Aid effectiveness is critical, both to maximise the impact of aid and to achieve the necessary changes for long-term, sustainable development.

  • Introduction

    The 2005 Paris Declaration on Aid Effectiveness outlines donor and partner country commitments to reforming the way in which aid is delivered and managed in order to maximise development results. Action required to improve the effectiveness of aid is reflected in the principles set out in the Paris Declaration...

  • Strengthening Country Ownership and National Plans

    The Paris Declaration on Aid Effectiveness places partner countries’ ownership of policies and programmes at the centre of the international agenda to make aid more effective. The Accra Agenda for Action deepens and broadens these commitments by calling for greater inclusion of development actors beyond the state. Strong country ownership in health has been shown to improve health service delivery. This chapter draws on a range of country case studies, tools and aid modalities that are aimed at improving country ownership over health policies. In particular, it reviews the evidence for increased involvement of non-state actors in the health sector, particularly civil society organisations, and assesses the impact of their involvement on health delivery and outcomes.

  • Using and Strengthening Country Systems in the Health Sector

    Aligning aid to partner countries’ development priorities, and supporting and using partner countries’ own systems and institutions builds countries’ capacity to manage their own development processes. This chapter outlines the progress made in using and strengthening these systems in the health sector. The chapter further outlines the advances and remaining challenges in increasing the amount of aid that is channelled through the country’s own systems, and the impact on the health sector of these reforms, or lack thereof.

  • Further Harmonising Aid to the Health Sector

    The impact of aid is reduced when donors decide separately which programmes to fund based on their own criteria and impose their own planning and reporting arrangements on recipient countries, making aid distribution uncoordinated. The results are duplication of development efforts, high transaction costs and excessive burdens placed on partner countries. The challenges of harmonisation are particularly pertinent to the health sector where there is a large and increasing number of donors. This chapter draws on evidence from initiatives to reduce donor proliferation to outlines some of the key blockages to achieving more progress towards harmonisation of donor approaches.

  • Improving Predictability and Transparency of Aid to the Health Sector

    The Paris Declaration recognises that predictability is vital to the effective use of aid by partner countries. The Accra Agenda for Action committed donors to improve the availability of information on aid flows. This chapter examines the success of initiatives to improve the predictability of aid to the health sector, particularly looking at the reasons for the mixed progress in improving predictability. This chapter looks at the contribution of innovative financing as a means of reducing the financing gap in the health sector and the impact it has had on predictability and increasing the effectiveness of aid to the sector. This chapter reviews evidence for improvements in transparency in the health sector.

  • Strengthening Mutual and Domestic Accountability for more Sustainable Development Results

    The Paris Declaration calls for managing for development results to enhance country decision making, alongside efforts to improve donorpartner country accountability. This chapter highlights lessons learned from the health sector that contribute to the understanding of the impact of aid on domestic accountability. This chapter also looks at the extent to which donors are defining and using results as a basis for decision making and evidence of the impact of results-oriented decision making in countries.

  • Aid Effectiveness and the Impact on Health Results

    This chapter examines the relationship between the effectiveness of aid and progress in health results. This chapter brings together a wide range of evidence from various sources and examines correlations and causalities between impacts in health and the improved delivery of aid.

  • Bibliography
  • Annex A: Definitions
  • Annex B: Emerging Donors and Aid Effectiveness in the Health Sector

    Non-traditional donors play an increasingly important role in development aid. According to the 2010 MDG Gap Task Force report on MDG 8, aid from non-DAC countries is growing, with significant contributions made by countries that do and do not report to OECD DAC. These include OPEC members (Kuwait, Saudi Arabia, Venezuela and the United Arab Emirates), middle-income, emerging donor countries (Brazil, China, India, South Africa, Thailand, Turkey and the Russian Federation) and others such as Iran, Korea and Chinese Taipei....

  • Annex C: IHP+Results Scorecard Summary of Development Partner and Country Government Performance
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