Effects of donor proliferation in development aid for health on health program performance: A conceptual framework. (February 2017)

• Record Type: Journal Article
• Authors: Pallas, Sarah Wood; Ruger, Jennifer Prah
• Is Part Of: Social science & medicine. Volume 175(2017)
• Page Start: 177
• Page End: 186
• Publication Date: 2017-02
• Subjects: Aid effectiveness -- Development aid -- Development assistance for health (DAH) -- Donor fragmentation -- Global health; Social medicine -- Periodicals; Medical anthropology -- Periodicals; Public health -- Periodicals; Psychology -- Periodicals; Medicine -- Periodicals; Medicine -- Periodicals; Médecine sociale -- Périodiques; Anthropologie médicale -- Périodiques; Santé publique -- Périodiques; Psychologie -- Périodiques; Médecine -- Périodiques; Electronic journals; 362.105
• DOI: 10.1016/j.socscimed.2017.01.004
• Languages: English
• ISSNs: 0277-9536

Abstract

Abstract: Development aid for health increased dramatically during the past two decades, raising concerns about inefficiency and lack of coherence among the growing number of global health donors. However, we lack a framework for how donor proliferation affects health program performance to inform theory-based evaluation of aid effectiveness policies. A review of academic and gray literature was conducted. Data were extracted from the literature sample on study design and evidence for hypothesized effects of donor proliferation on health program performance, which were iteratively grouped into categories and mapped into a new conceptual framework. In the framework, increases in the number of donors are hypothesized to increase inter-donor competition, transaction costs, donor poaching of recipient staff, recipient control over aid, and donor fragmentation, and to decrease donors' sense of accountability for overall development outcomes. There is mixed evidence on whether donor proliferation increases or decreases aid volume. These primary effects in turn affect donor innovation, information hoarding, and aid disbursement volatility, as well as recipient country health budget levels, human resource capacity, and corruption, and the determinants of health program performance. The net effect of donor proliferation on health will vary depending on the magnitude of the framework's competing effects in specific country settings. The conceptual framework provides a foundation for improving design of aid effectiveness practices to mitigate negative effects from donor proliferation while preserving its potential benefits. Highlights: Donor proliferation affects health program performance through multiple pathways. Donor proliferation may bring both costs and benefits to aid-recipient countries. Aid effectiveness practices modify donor proliferation's effects on health programs. Many of donor proliferation's effects remain unquantified. A framework of donor proliferation's effects can inform aid effectiveness efforts.