What role should aid mechanisms play in the early recovery of weakened health sectors? This paper, published by KIT Development Policy and Practice, argues that flexible, experimental solutions are best suited to achieving the multiple objectives and delivery strategies of a developing health system. Aid effectiveness in this area has lagged because of an over-emphasis on gradually transitioning from ‘humanitarian’ mechanisms to ‘developmental’ ones, rather than a simultaneous approach. Although management concerns and design questions always influence aid delivery, they are even more central in early recovery situations. Progress will result from deeper coordination of the aid mechanisms deployed, and the use of key donor comparative advantages in technical and operational areas.
Agreed principles of aid effectiveness for the health sector were laid out by the International Health Partnership in 2007, with the aim of meeting Millennium Development Goals for health. Many different aid mechanisms have been deployed in fragile state contexts in recent years. The strengths and weaknesses of these mechanisms are evaluated based on case studies from the varied contexts of Sierra Leone, South Sudan, Liberia and Timor-Leste. The mechanisms have included general budget support, a multi-donor trust fund, extension of humanitarian aid in an NGO context and technical assistance. Interviews conducted with key informants and relevant secondary sources provide the evidence for the cases.
At the early recovery stage, health sectors in fragile states require both ongoing delivery of basic services and assistance in rebuilding. Relief and development objectives often differ, with the former generally more state-avoiding and the latter often tied to a relevant Ministry of Health.
A single aid mechanism may be inappropriate for this multi-faceted agenda. Other findings include the following:
- Overly complex aid mechanisms and capacity limitations in implementing them resulted in disruption of the delivery of health services.
- Interim or substitute aid mechanisms, while seeking to address projected or actual shortcomings in the health sector, were usually ad hoc or unplanned.
- Particular country contexts and weakened capacity levels must be factored in to efforts involving state partnership, such as budget support and multi-donor trust funds.
A paradigm shift is necessary to build an integrated mix of modalities to effectively accommodate state, non-state, system-building and service delivery objectives in early recovery contexts. The current approach of gradual movement from relief delivery to system building is not working.
- Integrating and sequencing different aid mechanisms requires close attention, especially with regard to local factors.
- The feasibility of attempts to bolster the health system should be supported by the provision of technical assistance and gauged in pilot projects at an early stage, including an evaluation of different implementation methods.
- Donor agencies operating at the country level need to coordinate their activities and focus on selecting appropriate and complementary aid mechanisms. They should also ensure that vulnerable groups continue to receive health service coverage during the transitional period.
- Donors operating at the country level should also consult each other about which agencies are best equipped to support which activities.
