Foreign aid for health and development

Yodi Mahendradhata

Funding malaria control in Indonesia

-

10,000,000

20,000,000

30,000,000

40,000,000

50,000,000

60,000,000

70,000,000

80,000,000

90,000,000

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Budget Gap Analysis by Source of Funding

GAP

Proposed TFM

GF R8

GF R6

GF R1

Unicef

WHO

Local Government

Central Government

Health improvements in the decade from 2000 to 2010 by total health aid quartile (Bendavid & Bhatyacharya 2014)

Foreign aid and economic growth in Africa?

FUNDING SOURCES

• National treasuries

• Debt repayments

• Private philanthropist

• Corporate donations

CHANNELS OF ASSISTANCE

• Bilateral development agencies

• European commission

• UN agencies• Development

banks• GFATM• GAVI• Foundations• International

NGOs

IMPLEMENTING INSTITUTIONS

• Ministries of health

• Health programs

• National NGOs• Private sector• Universities

and research bodies

Resource flow of foreign aid for health

Health aid by origins

Health aid as percentage of

national income

Health aid by channel

Funding of UN agencies

Health aid geo distribution

Health aid disease distribution

Mortality vs donor funding

DALYs vs donor funding

National health budget vs donor (US$ million)

Country HIV prevalence National health budget

Donor commitment

(HIV)

Ethiopia 1.4% 113 130

Rwanda 3.1% 37 47

Uganda 6.7% 112 167

US Foreign Aid top 10 request FY 2011

Afganistan

Pakistan

Israel

Egypt

Iraq

Kenya

Jordan

Nigeria

South Africa

Ethiopia

The emerging donors: BRICS

Foreign aid and economic growth in Africa?

World Bank: Indonesia HIV/AIDS and STDs prevention and management project

Relevance Substantial

Efficiency Negligible

Efficacy Negligible

Outcome Unsatisfactory

Institutional development impact

Negligible

Sustainability Unlikely

Bank performance Unsatisfactory

Borrower performance Unsatisfactory

The real value of aid? (Crisp 2010)

Real value

Value on paper

• Trade/mining concessions

• Debt repayment• Donor service

payment

Channeling aid back to donor country

Country recipient

External technicalassistance

US$200,000Typical annual cost for

international consultant (>1/3 for school fees and child allowance)

Hosting multiple donor missions…

Limited integration with country system…

Multiple donors, multiple requirements, multiple mechanisms….

The global financial crisis?

WHO 2 year budget*

0

1000

2000

3000

4000

5000

6000

2006/2007 2012/2013

*Figures in US$ million

The end of the golden era for global health?

Private donation*

0

500

1000

1500

2000

2500

2008 2011

NGO & FBO spending*

0

500

1000

1500

2000

2500

3000

3500

4000

2008 2010

*Figures presented in US$ Million

Conceptual framework of donor proliferation's hypothesized effects on health program performance: detailed view of individual effects*

*Pallas & Ruger (2017)

Conceptual framework of donor proliferation's hypothesized effects on health program performance: overview*

*Pallas & Ruger (2017)

7 deadly sins of donor agencies

Nr Sin Description

1 Impatience With institution building

2 Envy Collusion and coordination failure

3 Ignorance Failure to evaluate

4 Pride Failure to exit

5 Sloth Pretending participation = ownership

6 Greed Unreliable/stingy transfers

7 Foolishness Underfunding of global and regional public goods

The Paris Declaration

Principle Description

Ownership Developing countries exercise leadership over their development policies and plans

Alignment Donors base their support on countries’ development strategies and systems

Harmonisation Donors co-ordinate their activities and minimisethe cost of delivering aid

Managing for results Developing countries and donors orient their activities to achieve the desired results

Mutualaccountability

Donors and developing countries are accountable to each other for progress in managing aid better and in achieving development results