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Resource allocation processes at multilateral organizations working in global health.
1International Decision Support Initiative, Imperial College London, St Marys Hospital, 10th Floor QEQM Wing, South Wharf Road, W2 1NY, London, UK.
Health Policy and Planning
|February 8, 2018
Summary
International institutions allocate over $10 billion in health development assistance annually. Allocation processes are complex but lack flexibility, transparency, and recipient country input, despite stated goals of aid effectiveness.
Area of Science:
- Global Health Policy
- International Development Assistance
- Health Economics
Background:
- International institutions disburse over US$10 billion annually in development assistance for health (DAH).
- DAH disbursements totaled $458 billion between 1990 and 2014.
- Understanding the allocation decision-making process for global health funding is crucial.
Purpose of the Study:
- To explore and describe the resource allocation decision-making processes of nine convening agencies of the Equitable Access Initiative.
- To provide plain language descriptions of the complete DAH allocation process for prominent multilateral global health agencies.
- To comparatively analyze the choices and strategies employed by these nine international institutions.
Main Methods:
- Comparative analysis of resource allocation processes across nine multilateral health agencies.
- Categorization of allocation into a five-step framework: strategy definition, resource mobilization, country eligibility, support type, and funds allocation.
- Examination of technical, political, and ethical aspects of the allocation procedures.
Main Results:
- All reviewed institutions follow a similar five-step resource allocation pattern.
- Processes are well-structured and complex, reflecting institutional principles and goals.
- Significant shortcomings identified: technical inflexibility, lack of performance/impact criteria, limited consideration of incentives, non-transparent donor/bureaucrat influence, earmarked funds, low accountability, and limited recipient country influence.
Conclusions:
- While DAH allocation processes are structured, they exhibit critical technical, political, and ethical deficiencies.
- Aid effectiveness and value for money are not primary drivers in resource allocation.
- Improvements in transparency, accountability, flexibility, and recipient country participation are needed for more equitable and effective global health funding.
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