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Cited by 16International Development and AidPublic health and occupational medicineHealthcare Systems and Reforms

Effects of donor proliferation in development aid for health on health program performance: A conceptual framework

Open access
Pallas, Sarah Wood, Ruger, Jennifer Prah·2017·Social Science & Medicine
DOI 10.1016/j.socscimed.2017.01.004
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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.

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  • Dependence on external development partners has been shown to jeopardize the sustainability of existing progress, undermine national and community ownership, and distort the national agenda in other contexts including Cambodia, Pakistan, and other countries in sub-Saharan Africa.

    “Dependence on external development partners has been shown to jeopardize the sustainability of existing progress, undermine national and community ownership, and distort the national agenda in other contexts including Cambodia, Pakistan, and other countries in sub-Saharan Africa [1, 14, 29].”

    From Health sector fragmentation: three examples from Sierra Leone (2019) · cites this paper as [29]

  • In other sub-Saharan African contexts, systems weaknesses, gaps in local capacity, and perceived lack of transparency have been found to contribute to the decision for external actors to implement parallel structures and vertical programmes that introduce health sector fragmentation.

    “It has been noted in other sub-Saharan African contexts that systems weaknesses, gaps in local capacity, and perceived lack of transparency have been found to contribute to the decision for external actors to implement parallel structures and vertical programmes that introduce health sector fragmentation [1, 4, 29, 32, 38, 42].”

    From Health sector fragmentation: three examples from Sierra Leone (2019) · cites this paper as [29]

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Authors
Pallas, S. W., & Ruger, J. P.
Affiliations
Yale University (US)
Corresponding author
Pallas, Sarah Wood
ORCID
Venue
Social Science & Medicine
Publisher
Elsevier BV
Published
2017-02
Volume
175
Pages
177-186
ISSN
0277-9536 (ISSN-L)
DOI
10.1016/j.socscimed.2017.01.004
OpenAlex
W2571276304
Cited by
16
References
63
Citations by year
2025: 2 · 2024: 3 · 2023: 2 · 2022: 1 · 2021: 3 · 2020: 1 · 2019: 2 · 2018: 2
FWCI
0.58
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Social Science & Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • SSRN Electronic Journal (submittedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
Funders
U.S. Agency (#5T32HS017589)
Topics
  • Social Sciences › Development › International Development and Aid
  • Social Sciences › Political Science and International Relations › Public health and occupational medicine
  • Social Sciences › Economics, Econometrics and Finance › Finance › Healthcare Systems and Reforms
Keywords
aid effectiveness, transaction costs, donor accountability, aid volume, information hoarding, health budget, health workforce capacity, corruption, conceptual framework
MeSH terms
Delivery of Health Care, Developing Countries, Financing, Organized, Health Promotion, Humans, International Cooperation, Global Health

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