MFA Norway hosted the webinar Development assistance for health: What is the level of proliferation and fragmentation in channels and implementers? on June 28th 2023. IHME, World Bank and OECD provided invited presentations followed by invited comments by Africa CDC, Ministry of Health in Malawi, Wellcome Trust and WHO. This summary points to the key trends discussed during the webinar and was prepared by MFA Norway. Please follow the links below to view the three presentations.

  • Development assistance for health (DAH) has increased substantially since the early 2000s, with some stagnation from 2011. DAH rose sharply in 2020 and 2021, driven by COVID-19 related assistance. COVID-19-related assistance accounted for 44% of DAH in 2020-2021. DAH is being channelled through international NGOs/private foundations, the UN system, multilateral development banks, global health initiatives and bilaterally. Many new actors have emerged in DAH the last two decades. The health sector is among the largest recipients of total official support for sustainable development (TOSSD). Only a small share of private development finance target social sectors, such as SDG 3 (good health and wellbeing, 2%).
  • Health spending per capita varies greatly across income groups. DAH remains a major part of health financing of many low- and middle-income countries (LMICs), in particular in LICs (more than 40% of health financing in some countries). External development finance is an important financing source, but it is replaced by other sources as countries become richer. Government expenditures (domestic finance) tend to grow enough to cover the fall out in external assistance, but the transition is not automatic nor necessarily smooth.
  • The majority of DAH focus on HIV/AIDS and infectious diseases, reproductive, maternal, newborn and child health and health system strengthening. A large share of ODA is channelled through multilateral organisations. The major sources DAH have changed over time, with increased contributions to international NGOs / private foundations (31%) and global health initiatives (14%) (2019). Bilaterals (30%), UN (17%) and multilateral development banks (8%) also provide DAH. The share of ODA channelled through IDA and IBRD has declined.
  • The overall DAH landscape is becoming more crowded and complex, with an increase in number of donor agencies (proliferation) and lower financial size of transactions (fragmentation). The proliferation and fragmentation trends have been accompanied by the verticalization of aid and increasing circumvention of government systems. The median number of DAH channels in sub-Saharan Africa per country was 12 in 1990, and increased to 28 in 2020. Verticalization is particularly prominent within health: donors increasingly channel funds to โ€˜priorityโ€™ programs. Increased funding to vertical funds or specific GHIs helps scale up multilateral development finance, but risks exacerbating the pressures on the system. Most vertical funds rely on the implementing capacity of other multilateral organisations. While vertical programs have advantages, they have not contributed to an aid architecture that is โ€˜fit for purposeโ€™ in addressing the challenges of tomorrow, e.g., aging, climate, pandemics, etc.
  • DAH is increasingly provided to NGOs. For a large proportion of DAH, it is not reported who the implementer is (i.e. it is unallocable when differentiating between governmental and non-governmental implementation). Circumvention of government systems is a concern as little progress has been made to channel development assistance through government systems (despite the Aid Effectiveness agenda from Paris and Accra). The fragmentation and duplication also undermines efficiency and sustainability and increases transaction costs for countries. The increasingly more complex aid architecture makes development more challenging for poor countries, which are struggling to deal with the overlapping crises.

Please follow the links below to view the three presentations: