Healthier Returns: Making Aid for Healthcare More Effective - Jessica Espey, Save the Children
A new report from Save the Children looks at progress and challenges in delivering effective aid to the health sector. Healthier Returns: Making Aid for Healthcare More Effective makes recommendations for participants in the Fourth High Level Forum on Aid Effectiveness, and the 2012 World Health Assembly.
The report highlights innovation to encourage effective delivery of health aid. For instance, use of tools that facilitate participatory strengthening of national plans, efforts to improve public financial management and promote transparency in some countries, and wider use of programme-based approaches. However, progress remains ad hoc and contingent on political will rather than on binding obligations.
Other challenges include slow progress in aligning national and donor priorities and plans; non-local procurement of health supplies and services; poor aid predictability; an increasing tendency to assess effectiveness according to short-term results; and weak accountability mechanisms at the national and international levels.
The health sector’s persistent challenges are not just technical and procedural. They are symptomatic of the need for greater clarity about how global health initiatives are governed. Good global health governance would involve a coherent framework with clearly defined roles for all actors in collective pursuit of common agendas. Priorities should be determined by the needs of people living in poverty, rather than by the donor community’s interests.
A step change in donor behaviour is required to realise a genuine partnership model, whereby aid is disbursed based on a country’s determination of its own needs. As the Paris Monitoring Survey makes plain, this has not yet happened.
Save the Children recommends reforms in six areas to make health aid more effective:
- donors must strengthen harmonisation and alignment for country ownership
- support for local capacity building
- all actors must manage for development results not by results
- institutionalise mutual accountability mechanisms
- address the challenge of delivering aid effectively in conflict affected and fragile states
- fill the funding gap.
Jessica Espey is a Research and Policy Adviser with Save the Children