Alignment of aid with recipient country priorities

Further problems are created when the priorities of donors do not match the needs of recipient countries. Overall HIV/AIDS has been prioritised for official development assistance and is allocated a share of resources that is proportionally greater than its share in the total burden of disease. In Rwanda in 2005, donors earmarked US$1 million for integrated management of childhood illnesses, US$18 million for malaria and US$47 million for HIV and AIDS, even though malaria is the biggest cause of morbidity and mortality in the country.

When aid is earmarked for specific activities or is channelled outside of national policies, plans and systems, it can distort funds away from government priorities and population needs and lead to the misallocation of resources. In many low income countries, pro-poor health intervention sub-sectors including basic nutrition, infectious disease control, reproductive health and family planning, have actually seen their share of health assistance fall.

Small and poor countries that are dependent on aid do not have the power or capacity to influence bilateral policies or system wide issues such as where to allocate aid. Presently, there are no credible structures pursuing these issues.