Abstract
The international community holds high expectations for aid producing demonstrable results in the health sector, at the global and developing country levels. Yet, measuring the effectiveness of aid presents methodological challenges. Existing evaluation frameworks are not sufficiently geared toward learning whether and how practices have changed. We present a framework for measuring the results of implementing aid effectiveness principles at three levels: implementation process, health system strengthening, and outcomes/impact. We developed this framework in the context of monitoring results on the effectiveness of the aid agenda in the health sector in Mali. Despite some changes in behavior that resulted in increased aid effectiveness and improved results at system and outcome levels, overall, the aid effectiveness principles have not been fully implemented. Thus expectations in terms of health outcomes should be realistic.
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References
World Bank. (1998) Assessing Aid: What Works, What Doesn’t, and Why? New York: Oxford University Press. Policy Research Report.
World Health Organization. (2007) Everybody’s Business: Strengthening Health Systems to Improve Health Outcomes: WHO’s Framework for Action. Geneva: WHO.
Piva, P. and Dodd, R. (2009) Where did all the aid go? An in-depth analysis of increased health aid flows over the past 10 years. Bulletin of the World Health Organization 87 (12): 930–939.
Institute for Health Metrics and Evaluation. (2012) Financing Global Health 2011: Continued Growth as MDG Deadline Approaches. Seattle, WA: Institute for Health Metrics and Evaluation, University of Washington.
Ravishankar, N., et al (2009) Financing of global health: Tracking development assistance for health from 1990 to 2007. The Lancet 373 (9681): 2113–2124.
Esser, D. and Keating Bench, K. (2011) Does global health funding respond to recipients’ needs? Comparing public and private donors’ allocations in 2005–2007. World Development 39 (8): 1271–1280.
Duran, D. and Glassman, A. (2012) An Index of the Quality of Official Development Assistance in Health. Washington: Center for Global Development. CGD Working Paper 287.
Cassels, A. (1997) A Guide to Sector-wide Approaches for Health Development: Concepts, Issues and Working Arrangements. Geneva: World Health Organization.
Paul, E., Laokri, S., Robert, A., Zinnen, V. and Dujardin, B. (2009) SWAPs in motion: Lessons from case studies in six African countries. Tropical Medicine & International Health 14 (Supplement 2): 18.
Vaillancourt, D. (2009) Do Health Sector-wide Approaches Achieve Results? Emerging Evidence and Lessons from Six Countries – Bangladesh, Ghana, Kyrgyz Republic, Malawi, Nepal, Tanzania. Washington DC: The World Bank. IEG Working Paper 2009/4.
Organization for Economic Coordination and Development, Working Party on Aid Effectiveness, Task Team on Health as a Tracer Sector. (2011) Progress and Challenges in Aid Effectiveness. What Can We Learn from the Health Sector? Paris: OECD/WP EFF/TT-HATS.
World Health Organization, World Bank, GAVI, and Global Fund. (2010) Monitoring and Evaluation of Health System Strengthening: An Operational Framework. Geneva: WHO.
Lu, C., Schneider, M.T., Gubbins, P., Leach–Kemon, K., Jamison, D. and Murray, C.J. (2010) Public financing of health in developing countries: A crossnational systematic analysis. The Lancet 375 (9723): 1375–1387.
Peters, D.H., El-Saharty, S., Siadat, B., Janovsky, K. and Vujicic, M. (eds.) (2009) Improving Health Service Delivery in Developing Countries. From Evidence to Action. Washington DC: The World Bank.
Pawson, R., Greenhalgh, T., Harvey, G. and Walshe, K. (2005) Realist review. A new method of systematic review designed for complex policy interventions. Journal of Health Services Research and Policy Supplement 1 (July): 21–34.
De Savigny, D. and Adam, T. (eds.) (2009) Systems Thinking for Health Systems Strengthening. Geneva: Alliance for Health Policy and Systems Research and WHO.
Victora, C.G., Black, R.E., Boerma, J.T. and Bryce, J. (2010) Measuring impact in the millennium development goal era and beyond: A new approach to large-scale effectiveness evaluations. The Lancet 377 (9759): 85–95.
Contandriopoulos, A.P., Champagne, F., Denis, J.L. and Avargues, M.C. (2000) Evaluation in the health sector: A conceptual framework. Revue d’Epidémiologie et de Santé Publique 48 (6): 517–539.
Ritchie, J. and Lewis, J. (2003) Qualitative Research Practice. A Guide for Social Students and Researchers, 1st edn. London: Sage Publications.
World Health Organization Maximizing Positive Synergies Collaborative Group. (2009) An assessment of interactions between global health initiatives and country health systems. The Lancet 373 (9681): 2137–2169.
World Health Organization. (2008) Measuring Health Systems Strengthening and Trends: A Toolkit for Countries. Toolkit on monitoring health systems strengthening. Geneva: WHO.
Note that some global health initiatives have extrapolated the number of lives saved from their interventions. Transposed to aid effectiveness and HSS, a similar practice would mean extrapolating, for example, that if an 80 per cent reduction in mortality rates can be attributed to HSS, and 75 per cent of HSS can be attributed to aid, then 60 per cent of lives saved are attributable to aid; this, however, is not credible from a scientific point of view.
Dujardin, B., Paul, E., Laokri, S. and Samaké, S. (2007) Analysis of the Health Sector-wide Approach (SWAp) dynamics in Mali. Tropical Medicine & International Health 12 (S1): 116–117.
Samaké, S. (ed.) (2009) L’approche sectorielle dans le domaine de la santé au Mali. Bamako, Mali: Coopération Technique Belge and Ministère de la Santé du Mali.
Samaké, S., Berthé, I., Cissé, S.Y. and Paul, E. (2011) The Results Achieved through Implementing the Paris Declaration in the Health Sector in Mali. Paper for the OECD/WP EFF/TT-HATS final report.
Paul, E. (2011) Documenting results of efforts to improve health aid effectiveness: Mali case study. GRAP-PA Santé on behalf of WHO and IHP+, October.
Lawson, A., Habas, J., Keita, M., Paul, E., Versailles, B. and Murray-Zmijewski, et A. (2011) Joint Evaluation of Budget Support Operations in Mali, 2003–2009. Eco-consult and Consorts for the European Commission of the European Union, Belgium, and Canada. Pilot exercise of the Development Assistance Committee/OECD et Alexandra Murray–Zmijewski Published in Brussels.
République du Mali, Cellule de Planification et de Statistique du secteur santé, développement social, promotion de la famille. (2011) Evaluation du Plan de Développement Sanitaire et Social, Bamako.
World Health Organization. (2012) Trends in Maternal Mortality 1990–2010. Geneva: WHO.
UNICEF, WHO, WB, UN DESA Population division. (2011) Levels & Trends in Child Mortality Report. New York: Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation.
République du Mali, CPS secteur santé, développement social et promotion de la famille, Institut national de la statistique. (2010) Mali. Enquête par grappe à indicateurs multiples.
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With a focus on learning whether and how practices have changed, the authors present a framework for measuring the results of implementing aid effectiveness principles at three levels: the implementation process, health system strengthening, and outcomes and impact.
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Paul, E., Ireland, M., Martini, J. et al. Results from implementation of aid effectiveness principles in the health sector in Mali. J Public Health Pol 34, 140–152 (2013). https://doi.org/10.1057/jphp.2012.64
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DOI: https://doi.org/10.1057/jphp.2012.64