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Hennessy J, Mortimer D, Sweeney R, Woode ME. Donor versus recipient preferences for aid allocation: A systematic review of stated-preference studies. Soc Sci Med 2023; 334:116184. [PMID: 37639858 DOI: 10.1016/j.socscimed.2023.116184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/08/2023] [Accepted: 08/15/2023] [Indexed: 08/31/2023]
Abstract
As Official Development Assistance (ODA) tops 180 billion USD per year, there is a need to understand the mechanisms underlying aid effectiveness. Over the past decade we have seen some low- and middle-income countries become developed nations with record economic growth. Others remain in development purgatory, unable to provide their citizens with access to essential services. In an effort to improve aid effectiveness, the prescriptive nature of aid, where (typically) Western countries allocate funds based on perceived need or the strategic priorities of donors is being reconsidered in favour of locally-led development, whereby recipient governments and sometimes citizens are involved in the allocation and delivery of development aid. Meeting the preferences of donors (both governments and citizens) has been a longstanding priority for international development organisations and democratically governed societies. Understanding how these donor preferences relate to recipient preferences is a more recent consideration. This systematic review analysed 58 stated preference studies to summarise the evidence around donor and recipient preferences for aid and, to the extent possible, draw conclusions on where donor and recipient preferences diverge. While the different approaches, methods, and attributes specified by included studies led to difficulties drawing comparisons, we found that donors had a stronger preference than recipients for aid to the health sector, and that aid effectiveness could be more important to donors than recipients when deciding how to allocate aid. Importantly, our review identifies a paucity of literature assessing recipient perspectives for aid using stated preference methods. The dearth of studies conducted from the recipient perspective is perplexing after more than 30 years of 'alignment with recipient preferences', 'local ownership of aid', 'locally-led development' and 'decolonisation of aid'. Our work points to a need for further research describing preferences for aid across a consistent set of attributes in both donor and recipient populations.
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Affiliation(s)
- Jack Hennessy
- Centre for Health Economics, Monash Business School, Monash University, Australia.
| | - Duncan Mortimer
- Centre for Health Economics, Monash Business School, Monash University, Australia.
| | - Rohan Sweeney
- Centre for Health Economics, Monash Business School, Monash University, Australia.
| | - Maame Esi Woode
- Centre for Health Economics, Monash Business School, Monash University, Australia.
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Achim MV, Văidean VL, Borlea SN. Corruption and health outcomes within an economic and cultural framework. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:195-207. [PMID: 31587123 DOI: 10.1007/s10198-019-01120-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 09/23/2019] [Indexed: 06/10/2023]
Abstract
The purpose of this paper is to investigate the relationship between corruption and population health. Our cross-sectional sample covers 185 countries (54 high-income and 131 low-income countries) and the period of the analysis is 2005-2017. This research provides clear evidence that the level of corruption significantly affects physical health (expressed as life expectancy and Mortality rate) and mental health (expressed by happiness), under the moderating role of economic development and cultural framework. Moreover, we validate a powerful and positive correlation between the income level and both physical and mental health. Culture also has an important role in the corruption-health nexus, because we find evidence supporting four out of the six dimensions of culture (individualism versus collectivism, indulgence versus restraint, uncertainty avoidance and masculinity vs femininity) as having influence upon the physical and mental health of individuals. When we estimate the results on subsamples of countries (high-income and low-income countries), we validate a crisscross effect of corruption. Thus, a high level of corruption more deeply affects the physical health of population in low-income countries than in high-income countries. On the other hand, mental health is more pronouncedly affected by corruption in high-income countries than in low-income countries. This study may have important implications for national or international policy makers who need to acknowledge that anti-corruption policies play an important role in increasing population health, but they also need to adopt them according to the economic and cultural context of each nation.
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Affiliation(s)
- Monica Violeta Achim
- Faculty of Economics and Business Administration Cluj-Napoca, Department of Finance, "Babeş-Bolyai University", Street Teodor Mihali, No. 58-60, Cluj-Napoca, Romania.
| | - Viorela Ligia Văidean
- Faculty of Economics and Business Administration Cluj-Napoca, Department of Finance, "Babeş-Bolyai University", Street Teodor Mihali, No. 58-60, Cluj-Napoca, Romania
| | - Sorin Nicolae Borlea
- Faculty of Economics, Informatics and Engineering, Department of Economics, 'Vasile Goldis' Western University of Arad, B-dul Revolutiei, No. 94, Arad, Romania
- Faculty of Economics, Doctoral Scool of Economics, University of Oradea, Street Universitatii No. 1, Oradea, Romania
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Khalid H, Gill S, Fox AM. Global aid for nutrition-specific and nutrition-sensitive interventions and proportion of stunted children across low- and middle-income countries: does aid matter? Health Policy Plan 2019; 34:ii18-ii27. [DOI: 10.1093/heapol/czz106] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2019] [Indexed: 11/13/2022] Open
Abstract
AbstractDevelopment assistance for health (DAH) has increased dramatically over the past two decades, and this increase has led to a debate on the benefits and perverse effects of scaling-up vs scaling back DAH, and the type of interventions DAH should support. Nutrition remains a contested category viewed as essential to achieving primary healthcare objectives but as falling outside of the direct ambit of the health system. Thus, despite the increase in DAH, it continues to remain an underfunded area and little is known about the relationship between aid for nutrition-specific and nutrition-sensitive interventions and the proportion of stunted children across low- and middle-income countries. We hypothesize that as nutrition-specific aid targets local needs of countries and is less fungible than nutrition-sensitive aid, it will contribute more to a reduction in the proportion of stunted children, with the steepest gains among countries that have the highest burden of malnutrition. We use fixed-effects regressions to examine the relationship between the proportion of stunted children and aid for nutrition interventions (specific and sensitive) to 116 low- and middle-income countries (2002–16). We construct our panel using the Creditor Reporting System, Institute of Health Metrics and Evaluation, Food and Agriculture Organization, World Health Organization and World Development indicators databases. We find a one-dollar increase in per capita nutrition-specific aid is associated with a reduction in the proportion of stunted children by 0.004 (P < 0.05). When stratified by burden of malnutrition, a one-dollar increase in per capita nutrition-specific aid to countries with the highest burden of malnutrition is associated with sharper reductions in the proportion of stunted children (0.013, P < 0.01). We also find a significant association for per capita nutrition-sensitive aid and proportion of stunted children when per capita aid for nutrition is lagged by 3 and 4 years (0.0002, P < 0.05), suggesting a long-run association between nutrition-sensitive aid and proportion of stunted children. Our findings suggest that in spite of criticisms that development assistance fails to adequately reach its intended beneficiaries, aid for nutrition has been successful at reducing the proportion of stunted children. Our findings imply a need to scale-up nutrition funding and improve targeting of aid.
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Affiliation(s)
- Hina Khalid
- School of Humanities and Social Sciences, Information Technology University, Arfa Software Technology Park, Ferozepur Road Lahore, Pakistan
| | - Sitara Gill
- School of Humanities and Social Sciences, Information Technology University, Arfa Software Technology Park, Ferozepur Road Lahore, Pakistan
| | - Ashley M Fox
- Rockefeller College of Public Affairs and Policy, University at Albany, State University of New York, Albany, NY, USA
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Abstract
Background: The Global Fund to Fight AIDS, Tuberculosis and Malaria has proven highly effective at fighting the world’s major killers. Strong governance and robust development institutions are necessary, however, for improving health long-term. While some suggest that international aid can strengthen institutions, others worry that aid funding will undermine governance, creating long-term harm. The Global Fund is a unique aid institution with mechanisms designed to improve transparency and accountability, but the effectiveness of this architecture is not clear. Objectives: This study seeks evidence on the effects of Fund financing over the past 15 years on national governance and development. Methods: A unique dataset from 112 low- and middle-income countries was constructed with data from 2003 to 2017 on Global Fund financing and multiple measures of health, development, and governance. Building a set of regression models, we estimate the relationship between Fund financing and key indicators of good governance and development, controlling for multiple factors, including the effects of other aid programs and tests for reverse causality. Findings: We find that Global Fund support is associated with improved control of corruption, government accountability, political freedoms, regulatory quality, and rule of law, though association with effective policy implementation is less clear. We also find associated benefit for overall adult mortality and human development. Conclusion: Our data are not consistent with recent claims that aid undermines governance. Instead our findings support the proposition that the Global Fund architecture is making it possible to address the continuing crises of AIDS, tuberculosis, and malaria in ways that improve institutions, fight corruption, and support development. Amidst the complex political economy that produces good governance at a national level, our finding of a beneficial effect of health aid suggests important lessons for aid in other settings.
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An analysis of the development assistance for health (DAH) allocations for STD control in Africa. HEALTH ECONOMICS POLICY AND LAW 2019; 15:458-476. [PMID: 30968812 DOI: 10.1017/s1744133119000197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Sustainable Development Goals set by the United Nations recognize the importance of making progress in the eradication and treatment of sexually transmitted deceases (STD). STD are among the most widespread diseases in the world and have the highest prevalence in Sub-Saharan Africa. The current study explored the associations between the allocation of the development assistance for health (DAH) in 54 African countries and key development indicators - STD incidence, Gross Domestic Product per capita, health expenditure, and life expectancy at birth. It employed descriptive statistical methods, the matrix scatter plot analysis and the Pearson correlation test for this purpose. The findings indicated that there was a considerable increase in the volume of the DAH given to control and prevent STD in Africa over the period of 2002-2011. A statistically significant positive association was detected between the STD incidence and the health aid allocations. At the same time, the imbalance in the distribution of the health aid between the major and minor aid recipients in the continent increased. The study concludes by discussing policy implications that can be drawn from these findings.
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Martinsen L, Ottersen T, Dieleman JL, Hessel P, Kinge JM, Skirbekk V. Do less populous countries receive more development assistance for health per capita? Longitudinal evidence for 143 countries, 1990-2014. BMJ Glob Health 2018. [PMID: 29515915 PMCID: PMC5838402 DOI: 10.1136/bmjgh-2017-000528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Per capita allocation of overall development assistance has been shown to be biased towards countries with lower population size, meaning funders tend to provide proportionally less development assistance to countries with large populations. Individuals that happen to be part of large populations therefore tend to receive less assistance. However, no study has investigated whether this is also true regarding development assistance for health. We examined whether this so-called 'small-country bias' exists in the health aid sector. Methods We analysed the effect of a country's population size on the receipt of development assistance for health per capita (in 2015 US$) among 143 countries over the period 1990-2014. Explanatory variables shown to be associated with receipt of development assistance for health were included: gross domestic product per capita, burden of disease, under-5 mortality rate, maternal mortality ratio, vaccination coverage (diphtheria, tetanus and pertussis) and fertility rate. We used the within-between regression analysis, popularised by Mundluck, as well as a number of robustness tests, including ordinary least squares, random-effects and fixed-effects regressions. Results Our results suggest there exists significant negative effect of population size on the amount of development assistance for health per capita countries received. According to the within-between estimator, a 1% larger population size is associated with a 0.4% lower per capita development assistance for health between countries (-0.37, 95% CI -0.45 to -0.28), and 2.3% lower per capita development assistance for health within countries (-2.29, 95% CI -3.86 to -0.72). Conclusions Our findings support the hypothesis that small-country bias exists within international health aid, as has been previously documented for aid in general. In a rapidly changing landscape of global health and development, the inclusion of population size in allocation decisions should be challenged on the basis of equitable access to healthcare and health aid effectiveness.
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Affiliation(s)
- Lene Martinsen
- Department of International Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Trygve Ottersen
- Department of International Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Joseph L Dieleman
- Institute for Health Metrics and Evaluation (IHME), University of Washington, Seattle, USA
| | - Philipp Hessel
- Alberto Lleras Camargo School of Government, University of the Andes, Bogotá, Colombia
| | - Jonas Minet Kinge
- Department of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Vegard Skirbekk
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
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Grépin KA, Pinkstaff CB, Hole AR, Henderson K, Norheim OF, Røttingen JA, Ottersen T. Allocating external financing for health: a discrete choice experiment of stakeholder preferences. Health Policy Plan 2018; 33:i24-i30. [PMID: 29415237 PMCID: PMC5886273 DOI: 10.1093/heapol/czx017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2017] [Indexed: 11/24/2022] Open
Abstract
Most donors of external financing for health use allocation policies to determine which countries are eligible to receive financial support and how much support each should receive. Currently, most of these policies place a great deal of weight on income per capita as a determinant of aid allocation but there is increasing interest in putting more weight on other country characteristics in the design of such policies. It is unclear, however, how much weight should be placed on other country characteristics. Using an online discrete choice experiment designed to elicit preferences over country characteristics to guide decisions about the allocation of external financing for health, we find that stakeholders assign a great deal of importance to health inequalities and the burden of disease but put very little weight on income per capita. We also find considerable variation in preferences across stakeholders, with people from low- and middle-income countries putting more weight on the burden of disease and people from high-income countries putting more weight on health inequalities. These findings suggest that stakeholders put more weight on burden of disease and health inequalities than on income per capita in evaluating which countries should received external financing for health and that that people living in aid recipient may have different preferences than people living in donor countries. Donors may wish to take these differences in preferences in mind if they are reconsidering their aid allocation policies.
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Affiliation(s)
- Karen A Grépin
- Department of Health Sciences, Wilfrid Laurier University, 75 University Ave, W. Waterloo, ON N2L3C5, Canada
| | - Crossley B Pinkstaff
- International Food Policy Research Institute, 2033 K Street, N.W. Washington, D.C. 20006, U.S.A
| | | | - Klara Henderson
- Independent Consultant, Warringah Street, North Balgowlah, NSW 2093, Australia
| | | | - John-Arne Røttingen
- Infectious Disease Control and Environmental Health, Norwegian Institute of Public Health, Lovisenberggata 8, 0456 Oslo, Norway, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, 655 Huntington Ave, Boston, MA 02115, USA, Department of Health Management and Health Economics, University of Oslo, Forskningsveien 3a/2b, 0373, Oslo, Norway and
| | - Trygve Ottersen
- Department of International Public Health, Norwegian Institute of Public Health, Norway, Marcus Thranes gate 2, 0473 Oslo, Norway, Oslo Group on Global Health Policy, Department of Community Medicine and Global Health and Centre for Global Health, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway, Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, 5018 Bergen, Norway
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Lee HH, Lee SA, Lim JY, Park CY. Effects of food price inflation on infant and child mortality in developing countries. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2016; 17:535-551. [PMID: 26003132 DOI: 10.1007/s10198-015-0697-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 05/11/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND After a historic low level in the early 2000s, global food prices surged upwards to bring about the global food crisis of 2008. High and increasing food prices can generate an immediate threat to the security of a household's food supply, thereby undermining population health. This paper aims to assess the precise effects of food price inflation on child health in developing countries. METHODS This paper employs a panel dataset covering 95 developing countries for the period 2001-2011 to make a comprehensive assessment of the effects of food price inflation on child health as measured in terms of infant mortality rate and child mortality rate. RESULTS Focusing on any departure of health indicators from their respective trends, we find that rising food prices have a significant detrimental effect on nourishment and consequently lead to higher levels of both infant and child mortality in developing countries, and especially in least developed countries (LDCs). DISCUSSION High food price inflation rates are also found to cause an increase in undernourishment only in LDCs and thus leading to an increase in infant and child mortality in these poorest countries. This result is consistent with the observation that, in lower-income countries, food has a higher share in household expenditures and LDCs are likely to be net food importing countries. CONCLUSIONS Hence, there should be increased efforts by both LDC governments and the international community to alleviate the detrimental link between food price inflation and undernourishment and also the link between undernourishment and infant mortality.
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Affiliation(s)
- Hyun-Hoon Lee
- Department of International Trade and Business, Kangwon National University, Chuncheon, 200-701, Republic of Korea
| | - Suejin A Lee
- Field of Economics, Cornell University, Ithaca, NY, 14853, USA
| | - Jae-Young Lim
- Department of Food and Resource Economics, Korea University, Seoul, 136-701, Republic of Korea.
| | - Cyn-Young Park
- Economics and Research Department, Asian Development Bank, Mandaluyong, 1550, The Philippines
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Sweeney R, Mortimer D. Has the Swap Influenced Aid Flows in the Health Sector? HEALTH ECONOMICS 2016; 25:559-577. [PMID: 25762110 DOI: 10.1002/hec.3170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 11/05/2014] [Accepted: 01/30/2015] [Indexed: 06/04/2023]
Abstract
The sector wide approach (SWAp) emerged during the 1990s as a mechanism for managing aid from the multiplicity of development partners that operate in the recipient country's health, education or agricultural sectors. Health SWAps aim to give increased control to recipient governments, allowing greater domestic influence over how health aid is allocated and facilitating allocative efficiency gains. This paper assesses whether health SWAps have increased recipient control of health aid via increased general sector-support and have facilitated (re)allocations of health aid across disease areas. Using a uniquely compiled panel data set of countries receiving development assistance for health over the period 1990-2010, we employ fixed effects and dynamic panel models to assess the impact of introducing a health SWAp on levels of general sector-support for health and allocations of health-sector aid across key funding silos (including HIV, 'maternal and child health' and 'sector-support'). Our results suggest that health SWAps have influenced health-sector aid flows in a manner consistent with increased recipient control and improvements in allocative efficiency.
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Affiliation(s)
- Rohan Sweeney
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Victoria, Australia
| | - Duncan Mortimer
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Victoria, Australia
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Do Sector Wide Approaches for health aid delivery lead to ‘donor-flight’? A comparison of 46 low-income countries. Soc Sci Med 2014; 105:38-46. [DOI: 10.1016/j.socscimed.2013.12.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Revised: 10/09/2013] [Accepted: 12/20/2013] [Indexed: 11/18/2022]
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