Aid instruments and health systems development: an analysis of current practice

Area of Science:

• Health policy and systems research
• International development aid
• Global health financing

Background:

• Many donors are transitioning from project-specific health aid to broader sectoral support.
• This shift necessitates an examination of whether aid instruments have evolved accordingly.

Purpose of the Study:

• To explore the alignment between donor policy shifts towards sectoral support and the actual forms of aid instruments used.
• To develop a framework for analyzing current aid practices against donor objectives.
• To compare budgetary support with traditional project assistance in the health sector.

Main Methods:

• Qualitative research based on interviews with officials from bilateral and multilateral health agencies.
• Development of an analytical framework to assess aid instruments against donor objectives.
• Comparative analysis of budgetary support versus project assistance.

Main Results:

• Donor policy has shifted towards broad-based sectoral support in health.
• The range and form of aid instruments have not always kept pace with this policy shift.
• Budgetary support offers distinct advantages and disadvantages compared to project assistance.

Conclusions:

• The debate should focus on complementarity between different aid forms, not superiority of one over another.
• Effective health aid requires assessing instruments, channels, and management systems against country-specific development objectives.
• Achieving an effective balance in aid delivery is complex and challenging.