DONOR PROLIFERATION
Since 1990s, development aid for health and the number of donor organizations providing such aid have grown dramatically. It has been suggested that, as the numbers of donors increases, the transaction costs of aid-recipient countries increase, the performance incentives for donors and recipients diminish, the quantity and quality of human resources in the recipient government bureaucracy decrease and corruption within recipient countries increases.
To investigate how donors and government agencies responded to a proliferation of donors providing aid to Ghana’s health sector between 1995 and 2012, we interviewed 39 key informants from donor agencies, central government and nongovernmental organizations in Accra.
Our data suggested explanations as to why donors and government officials had adopted the aid effectiveness principles, highlighted the conditions that facilitated the adoption and maintenance of aid effectiveness principles, and revealed a potential paradox in the application of aid effectiveness principles.
Ghana’s response to donor proliferation included creation of a sector- wide approach, a shift to sector budget support, the institutionalization of a Health Sector Working Group and anticipation of donor withdrawal following the country’s change from low-income to middle-income. Key themes included the importance of leadership and political support, the internalization of norms for harmonization, alignment and ownership, tension between the different methods used to improve aid effectiveness, and a shift to a unidirectional accountability paradigm for health-sector performance.
Although Ghana’s response decreased the government’s transaction costs,. it also increased the donors’ coordination costs and reduced the government’s negotiation options. Harmonization and alignment measures may have prompted donors to return to stand-alone projects to increase accountability and identification with beneficial impacts of projects.
