CROSS-COUNTRY ANALYSIS ON DONOR PROLIFERATION
Median health aid volume and median number of donors by year and type of health aid, 1995–2010. Panel (A) shows the median volume of aid in millions of 2009 U.S. dollars per recipient country in each year for each of three subsectors of health aid: general and basic (120), population and reproductive (130), and water and sanitation (140). Panel (B) shows the median number of donors providing aid for each of the three subsectors of health aid in Panel (A).
Previous literature suggests that increasing numbers of development aid donors can reduce aid effectiveness but this has not been tested in the health sector, which has experienced substantial recent growth in aid volume and number of donors.
Accordingly, we tested if donor proliferation and fragmentation in health sector aid affect health service delivery and population health outcomes using data on 139 countries from the recent period of health donor scale-up from 1995 to 2010. We examined the applicability to the health sector of existing hypotheses about donor proliferation’s negative effects on development generally.
As the first empirical test of whether donor proliferation and donor fragmentation in health sector aid per se affect health service delivery and population health outcomes, we found no statistically significant relationship between donor proliferation in development aid for health and measures of health services and health outcomes in aid-recipient countries from 1995 to 2010.
Our results suggest that greater nuance is needed in designing policies to translate development aid into population health improvements, in particular through tailoring policies to specific country settings and health subsectors and distinguishing policy responses to donor proliferation versus donor fragmentation.
Future research and policy prescriptions to enhance the effectiveness of development aid for health should differentiate the potential challenges posed by donor proliferation from those of donor fragmentation and examine these within specific subsectors of health aid. Improving measurement of donor proliferation and fragmentation, as well as inclusion of other contextual are important directions for future cross-country research.
