Global Health Initiatives and aid effectiveness: insights from a Ugandan case study

Valeria Oliveira Cruz,Barbara McPake

doi:10.1186/1744-8603-7-20

Abstract

BackgroundThe emergence of Global Health Initiatives (GHIs) has been a major feature of the aid environment of the last decade. This paper seeks to examine in depth the behaviour of two prominent GHIs in the early stages of their operation in Uganda as well as the responses of the government.MethodsThe study adopted a qualitative and case study approach to investigate the governance of aid transactions in Uganda. Data sources included documentary review, in-depth and semi-structured interviews and observation of meetings. Agency theory guided the conceptual framework of the study.ResultsThe Ugandan government had a stated preference for donor funding to be channelled through the general or sectoral budgets. Despite this preference, two large GHIs opted to allocate resources and deliver activities through projects with a disease-specific approach. The mixed motives of contributor country governments, recipient country governments and GHI executives produced incentive regimes in conflict between different aid mechanisms.ConclusionNotwithstanding attempts to align and harmonize donor activities, the interests and motives of the various actors (GHIs and different parts of the government) undermine such efforts.

Highlights

The emergence of Global Health Initiatives (GHIs) has been a major feature of the aid environment of the last decade
In spite of historical gains in health status, challenges still abounded: in 1998, the infant mortality rate (IMR) in Africa was still 91 per thousand, more than four times the rate for Europe [1]; in 2006, over 3.3 billion people worldwide were at risk of malaria transmission contributing to approximately 1 million deaths each year [2]; and the estimated number of individuals living with HIV/AIDS by 2001 in Sub-Saharan Africa was 28.5 million
Introduced in Uganda in 1998, budget support occurred in two different forms: general contributions to the budget of the government and earmarked contributions to the Poverty Action Fund (PAF)-equivalent to a Poverty Reduction Strategy Paper (PRSP)

Summary

Introduction

The emergence of Global Health Initiatives (GHIs) has been a major feature of the aid environment of the last decade. The international aid community sought for new “ways of doing business” that could tackle the high burden of disease in the low-income world by expanding access to interventions such as vaccines, insecticide treated bed nets, and anti-. Over this period the term Global Health Initiatives (GHIs) started to be used. A useful one for the purposes of this paper describes GHIs as a standard model for financing and implementing disease control programs in various countries and in different regions of the world; they can be part of a multilateral or a bilateral program as the case of PEPFAR (the United States President’s Emergency Plan for AIDS Relief); alternatively they can be established as a public private partnership like the Global Fund [8]. It is estimated that more than 100 such entities exist [9]

Methods

Results

Discussion

Conclusion