In the early 2000s, the international aid community started to fund health programs through Global Health Initiatives (GHIs) which provide aid and support for tackling infectious diseases, and for implementing immunization programs against childhood diseases. However priorities set by GHIs and by governments are not always the same. New research published in BioMed Central's open access journal Globalization and Health uses 'agency theory' to examine the conflicts between donor and recipient countries.
In order to find out how GHIs have been operating, researchers from the London School of Hygiene &Tropical Medicine and Queen Margaret University, Edinburgh undertook detailed interviews with policy makers and officials from GHIs, and with the Ugandan government. They also examined both published and unpublished documentation, and observed policy meetings regarding the allocation of GHIs funds.
Using agency theory, designed to look at the conflict between two sets of people with interest in the same assets, such as shareholders and company managers, the results from Uganda show a strong conflict of interest between the priorities set by the GHIs, such as The President's Emergency Plan for AIDS Relief in Africa (PEPFAR) and the Global Fund, which tackles HIV/AIDS, tuberculosis and malaria, and those of the government. It seemed that while the GHIs approach was good at providing short-term aid, the government would have preferred to have resources allocated in a more flexible manner, allowing them to use the additional contributions as part of their general (or health) budgets, investing in long term benefits.
Dr Oliveira-Cruz said, "The problem is that often the aid bureaucracy is too complex. Each organization is made up of different individuals, who each have their own motivations, resulting in conflicting priorities being pursued by the GHIs and the government. While funds provided by GHIs are alleviating the suffering of many, more needs to be done to improve co-operation between aid organizations and governments and so improve the health status of the poor."
Dr Oliveira-Cruz continued, "It is understandable that the GHIs need to show results for their investment and offer value for money a particular concern in times of economic crisis. However it is all the more important to know that donations are getting to the right people at the right time and are being used in the most effective way possible."
Global Health Initiatives and aid effectiveness: insights from a Ugandan case study, Valeria Oliveira Cruz and Barbara McPake, Globalization and Health (in press)