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.

PIP: This paper examines the need for better coordination of external resources through a discourse on the effectiveness of aid and good government. The review of key issues, allowing increased attention to aid coordination in the health sector, presents the first section. The second section describes, assesses, and compares the strengths and weaknesses of the dominant mechanisms found to be utilized, to coordinate health sector aid in the case studies. The case studies include the low-income, high aid-dependent countries of Bangladesh, Cambodia, Mozambique, and Zambia. Four factors were clear in the analysis. First, coordination mechanisms in many countries have been introduced as a part of an incremental process after trying out several approaches. Second, some instruments function largely for consultation, predominantly coordinating inputs; while, others are more directive and operational. Third, many of the mechanisms have not excelled, although judging the effectiveness or impact of aid coordination was difficult. Finally, the paper ends by suggesting that experience and analysis of different coordination mechanisms has shifted the effect of the policy environment on coordination of aid inputs per se to the management of processes, through which domestic and external resources are deployed.