Provision of aid has long been influenced by the political priorities of donors, and there is substantial evidence that the administrative rules and regulations of donor organisations create problems for recipient countries. For as long as this fact has been understood, there have been efforts to address it: most recently, spear-headed by the Paris Declaration on Aid Effectiveness and its associated efforts. This thesis seeks to deepen understanding of this tension by examining the aid relationships in the health sector using analytical frameworks drawn from governance, political economy and health policy. Part 1 ‘defines the territory’ by describing the aid effectiveness challenges faced in the sector in qualitative and quantitative terms. Part 2 seeks to understand why these challenges persist by examining the political and institutional forces which affect provision of aid from (following Reich) ‘above, within and below’. I begin by looking at the ‘high’ political forces affecting aid provision by locating health aid as an instrument of international relations. Then, I look in greater detail the central tension in governance of health aid: the ‘push’ and ‘pull’ between efforts to promote greater coherence and the reality of diversity. Finally, I explore the internal (institutional) forces within aid agencies which affect a particular dimension of aid provision: the length of donor commitments. Part 3 presents in-depth case study research which demonstrates how the political forces from above, within and below play out in practice. The emerging conclusion is that the aid effectiveness agenda, as set out in the Paris Declaration, is only ever likely to be partially successful, for two reasons. First, because global health governance is inherently iterative, dynamic and diverse it cannot be regulated through further global processes (such as aid effectiveness). Second, the aid effectiveness agenda is structured around simple concepts and solutions which (while useful for global advocacy purposes) are no match for the political, institutional and economic complexity which characterises the aid relationship at country level. Indeed, the diversity that global health creates at country level has to be managed by recipient countries themselves, according to their timetable, and in a way tailored to their own context and circumstances.
| Identifer | oai:union.ndltd.org:ADTP/286245 |
| Creators | Rebecca Dodd |
| Source Sets | Australiasian Digital Theses Program |
| Detected Language | English |
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