European aid and health system strengthening: an analysis of donor approaches in the DRC, Ethiopia, Uganda, Mozambique and the global fund

External technical assistance and its contribution to donor transition and long-term sustainability: experience from China and Georgia

External technical assistance has played a vital role in facilitating the transitions of donor-supported health projects/programmes (or their key components) to domestic health systems in China and Georgia. Despite large differences in size and socio-political systems, these two upper-middle-income countries have both undergone similar trajectories of 'graduating' from external assistance for health and gradually established strong national ownership in programme financing and policymaking over the recent decades. Although there have been many documented challenges in achieving effective and sustainable technical assistance, the legacy of technical assistance practices in China and Georgia provides many important lessons for improving technical assistance outcomes and achieving more successful donor transitions with long-term sustainability. In this innovation and practice report, we have selected five projects/programmes in China and Georgia supported by the following external health partners: the World Bank and the UK Department for International Development, Gavi Alliance and the Global Fund to Fight AIDS, Tuberculosis and Malaria. These five projects/programmes covered different health focus areas, ranging from rural health system strengthening to opioid substitution therapy. We discuss three innovative practices of technical assistance identified by the cross-country research teams: (1) talent cultivation for key decision-makers and other important stakeholders in the health system; (2) long-term partnerships between external and domestic experts; and (3) evidence-based policy advocacy nurtured by local experiences. However, the main challenge of implementation is insufficient domestic budgets for capacity building during and post-transition. We further identify two enablers for these practices to facilitate donor transition: (1) a project/programme governance structure integrated into the national health system and (2) a donor-recipient dynamic that enabled deep and far-reaching engagements with external and domestic stakeholders. Our findings shed light on the practices of technical assistance that strengthen long-term post-transition sustainability across multiple settings, particularly in middle-income countries.

The European Union's development assistance for health (DAH) in Vietnam: any other purposes than health improvement?

Development Assistance for health (DAH) has increased dramatically these last two decades. While according to the official rhetoric, it aims at 'health improvement' and 'poverty reduction', such apolitical purposes have been questioned by scholars who identified other major objectives. However, few studies have sought to uncover the motivations behind EU's health assistance.To fill such academic gap, this article explores the main drivers that have guided the EU's DAH in Vietnam where the EU celebrated in 2020 its 25 years of health cooperation. Opting for a 'multiple sources of foreign aid model' that considers that no single factor can explain foreign aid decision, and adopting a 'holistic approach' that focuses on the modalities, the narratives, the allocation, and the terms of health assistance, as well as the international and domestic contexts in which it has taken place, this study identifies four major purposes: (a) the confirmation of EU's identities within the global health community. (b) the defense of the relevance of its approach of health assistance to influence international norms framing international health aid, (c) its support to the leading role of the WHO in global health, and (d) the facilitation of trade and investment opportunities for European companies.

Health Coverage and Financial Protection in Uganda: A Political Economy Perspective

BACKGROUND

As countries health financing policies are expected to support progress towards universal health coverage (UHC), an analysis of these policies is particularly relevant in low- and middle-income countries (LMICs). In 2001, the government of Uganda abolished user-fees to improve accessibility to health services for the population. However, after almost 20 years, the incidence of catastrophic health expenditures is still very high, and the health financing system does not provide a pooled prepayment scheme at national level such as an integrated health insurance scheme. This article aims at analysing the Ugandan experience of health financing reforms with a specific focus on financial protection. Financial protection represents a key pillar of UHC and has been central to health systems reforms even before the launch of the UHC definition.

METHODS

The qualitative study adopts a political economy perspective and it is based on a desk review of relevant documents and a multi-level stakeholder analysis based on 60 key informant interviews (KIIs) in the health sector.

RESULTS

We find that the current political situation is not yet conducive for implementing a UHC system with widespread financial protection: dominant interests and ideologies do not create a net incentive to implement a comprehensive scheme for this purpose. The health financing landscape remains extremely fragmented, and community-based initiatives to improve health coverage are not supported by a clear government stewardship.

CONCLUSION

By examining the negotiation process for health financing reforms through a political economy perspective, this article intends to advance the debate about politically-tenable strategies for achieving UHC and widespread financial protection for the population in LMICs.