A rethink on the use of aid mechanisms in health sector early recovery

A rethink on the use of aid mechanisms in health sector early recovery

How can aid mechanisms best support health sector early recovery?

States emerging from protracted crises struggle to provide basic services. This is no more crucial than in the health sector where vulnerable ‘post-conflict’ populations are frequently in dire need of care. However, development actors are frequently faced with difficult choices – particularly how much emphasis to place on ‘humanitarian’ emergency health relief in the face of a need for health systems building. Yet is it possible to simultaneously provide basic health services whilst also developing local health provision?

This paper considers how aid mechanisms can engender such a ‘twin approach’ and sustain a continuous flow of resources during the progression from humanitarian to development aid. Specifically the research focuses on four ‘post-conflict’ case studies and analyses how particular aid mechanisms have aided early recovery of their health sector. These are:

  • general budget support (GBS) in Sierra Leone
  • multi-donor trust fund (MDTF) in South Sudan
  • extension of humanitarian aid in Liberia as an example of project aid in a nongovernmental context
  • technical assistance (TA), as an example of project aid to build the capacity of Timor-Leste’s government.

The authors’ findings/recommendations include:

  • the use of GBS in Sierra Leone and the MDTF in South Sudan reveal their limitations in ensuring continued health service delivery and demonstrated in both contexts the need for associated aid mechanisms to boost more immediate health service objectives. Conversely the extension of
    humanitarian project aid in Liberia revealed it’s constraints in contributing to health system building
  • most post-conflict countries witness a major vacuum in human resource capacities at all levels of the state. This has direct consequences for the effectiveness of those aid modalities (e.g. GBS, MDTFs) which are conditioned upon a certain minimum level of government capacity
  • in Timor-Leste TA tended to be more ad hoc and fragmented due to reliance on diverse donor provision to vertical programs or duplication of support to specific areas of health systems strengthening
  • a paradigm shift is required which allows for an integrated mix of modalities used to balance
    the multiplicity of objectives (state, non-state, systems building, service delivery) in early
    recovery settings
  • better coordination of donor agencies at country level is needed to determine the choice of aid instruments and their complementarity, in order to ensure that health service coverage for vulnerable populations is maintained while simultaneously (re)building the health system.

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