Roundtable Topic 8: Sectoral Application

This page comprises information on background resources for Roundtable 8, compiled by the United Nations Development Programme. It does not necesserily represent the views of the Third High Level Forum organizers.

To access detailed information on the background resources for Health listed below, please visit the UNDP Aid Effectiveness Portal.

Background Resources: Health

World Health Organization, Effective Aid: Better Health, Report prepared for the Accra High Level Forum on Aid Effectiveness, September 2008    
Aid has made a significant contribution to health gains achieved so far. This report argues that greater adherence to the Paris Declaration would accelerate progress still further. As such, health is a litmus test for broader aid effectiveness efforts. Improvements in the effectiveness of health aid are already happening: increased predictability of aid, more harmonization of the efforts of various donors, better alignment of health aid with countries priorities, and greater accountability - from both donors and recipients - for the results aid achieves. However these achievements need to be extended to more countries and broadened to include a wider group of aid actors.

World Bank and World Health Organization, “Aid effectiveness in health”, Paper for the Global Forum on Development Pre-Meeting on Aid Effectiveness in Health, December 2006
This is a report of a meeting between the World Bank and the WHO on aid effectiveness in the health sector. The challenge is to balance vertical financing (money raised for specific communicable diseases) with horizontal spending to improve health systems. The new global health funds have been effective at mobilising finance and at partnerships with the private sector, but have tended to overshadow sectoral coordination. There is a tension between the global funds’ focus on results on particular health issues, with the need for sustainable development of health systems. To balance these pressures, the two organisations have developed new Good Practice Guidance, and will be carrying out further analysis with a view to presenting recommendations at Accra. 

World Bank, “Integrating global partnership programs with country-led national programs: synthesis of findings and recommendations”, December 2006
This study looks at the ability of global programmes – e.g., Global Fund to Fight Aids, TB and Malaria (GFAMT), Global Environment Facility (GEF), Global Alliance for Vaccines and Immunization (GAVI), Education for All Fast Track Initiative (EFA FTI) and the Consultative Group on International Agricultural Research (CGIAR) – to align with country priorities and systems. It finds large variations depending on the characteristics of individual funds. EFA FTI is an example of a well-aligned mechanism, while the global health funds are struggling to fit within country-level coordination mechanisms. The challenge is greater in ODA-dependent, low-capacity countries, where recurrent funding for health systems is more difficult to secure. The report concludes that the proliferation of new global programmes needs to be controlled, and where they are necessary they should be designed with a view to fitting better within the overall development landscape.

Denis Dreschler & Felix Zimmerman, “New actors in health financing: implications for a donor darling”, OECD Development Centre Policy Brief No. 33, 2006
This paper is based on a study of the health sector in Ghana, which has seen a rapid increase in financing not just from donors, but also global programmes, NGOs, private foundations, the pharmaceutical industry and FDI.  Despite this, both the volume and quality of health services have declined, while the MDG health indicators have stagnated or deteriorated. The authors attribute this to weaknesses in policy making and planning in the face of increasingly complexity in the sector. They single out three factors: (i) a lack of information systems to forecast flows and design more effective policies; (ii) a lack of coordination mechanism encompassing both traditional donors and new actors; and (iii) weaknesses in country ownership and leadership capacity, in particular higher-level management skills in the health administration. 

WHO, “Aid effectiveness and health: making health systems work”, Working Paper No. 9, 2007
Aid effectiveness is particularly challenging in health, not just because of the complexity of the aid architecture, but because of the large numbers of donors, the extent of unmet needs, cross-sectoral implementation challenges, private sector involvement in health services, and the long-term recurrent nature of most health needs. Progress towards the MDGs has been slow, despite scaled-up assistance. Health often receives insufficient priority in PRSPs, with little attention to equity and financial sustainability.  Global funds have led to distortions in health financing – for example, funding for HIV-AIDS doubled between 2000 and 2004, while funding for primary health care dropped by half.  Some global issues like SARS and avian flu have attracted a great deal of attention, while developing vaccines needed by poor countries has not. With more than half of aid off-budget and earmarked for specific projects, recipients find it difficult to secure sustained funding for health systems. General budget support has not necessarily led to increased health sector spending. 

WHO, “Poverty Reduction Strategy Papers: their significance for health – second synthesis report”, 2004
This paper is somewhat dated, but looks at how first-generation PRSPs dealt with the link between health outcomes and poverty. PRSPs recognise poor health as one of the elements of poverty, but few provide comprehensive information on the health needs of poor people. Few examine the specific difficulties of deliver health services to poor people. “In the main, PRSPs do not systematically identify those health issues which are the biggest contributors to poverty or the greatest brake on economic growth, and then set out to tackle them. Nor do they look systematically at the health situation of the poor – beyond noting that they tend to have the worst health outcomes and are unable to afford health care fees." 

Global Health Policy Research Network (GHPRN)
The Central for Global Development runs the GHPRN, which brings together academic, policy and implementation experts to tackle a range of policy issues on health. The site contains a range of publications on health financing.

Global Fund to fight AIDS, Tuberculosis and Malaria
The Global Fund site contains information on its governance arrangements and programming, including its policies on country coordination mechanisms.

Health Systems Action Network
This is a global network of health professionals. The site contains a useful guide to new financing mechanisms in the health sector.