Responses to donor proliferation in Ghana’s health sector

Since the 1990s, development aid for health and the number of donor organizations providing such aid have grown dramatically. It has been suggested that, as the number 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. Between 2002 and 2012, such potential negative impacts provided motivation for international policy agreements on aid effectiveness notably the 2005 Paris Declaration on Aid Effectiveness and the 2008 Accra Agenda for Action. The agreements promoted donor harmonization, donor alignment with recipient-country systems, country ownership, managing for results, and mutual accountability; the so-called aid effectiveness principles. 

A case study from the health sector in Ghana investigates how donors and government agencies responded to a proliferation of donors providing aid to Ghana’s health sector between 1995-2012. 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 lower-middle income status. 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.

In 1995–2012, the country’s central government and donors responded to donor proliferation in health-sector aid by promoting harmonization and alignment. This response was motivated by Ghana’s need for foreign aid, constraints on the capacity of governmental human resources and inefficiencies created by donor proliferation. Although this 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.

Read the full article here: Responses to donor proliferation in Ghana’s health sector: a qualitative case study 
Sarah Wood Pallas, Justice Nonvignon, Moses Aikins & Jennifer Prah Ruger. (2015)

Bulletin of the World Health Organization 2015;93:11–18| doi: dx.doi.org/10.2471/BLT.14.141614