Harewelle Archive

PhD Research co-sponsored by Harewelle, closes the knowledge gap!

Aid and health systems development: Understanding complexity, context and socio-political relationships

Each year, an estimated billion of aid is allocated to health globally. This is delivered to country health systems through an increasingly complex and fragmented system of international governance. While there is growing recognition of this complexity by donors, Ministries of Health, non-governmental organisations and the like, there has been only limited research on the issues that this presents, and of the relative merits of different approaches. There is little understanding, for example, of how specific aid or programmatic approaches can shape, support or even constrain the development of health systems in particular resource-poor contexts. There are huge unmet health needs in many poorer countries of the world, and therefore addressing this knowledge gap is paramount if we are to contribute to the achievement of the Millennium Development Goals and global development.

Over the past 3 years, Harewelle has contributed to this effort by co-sponsoring the research of Amy Barnes (a PhD student and now Lecturer in Health Policy at the University of Sheffield), which has looked at the benefits and challenges associated with the way aid for health is managed. More specifically, Amy has explored how the Global Fund to Fight AIDS, Tuberculosis and Malaria, the health Sector-wide Approach (or SWAp), and general budget support are managed in Zambia – a key country office location for Harewelle – and the health system issues associated with these approaches. While the research raises a number of key points, perhaps most importantly it emphasises the importance of social and political relationships to the success of aid management, and in the governance of health system development (see Barnes and Brown, 2010; 2011).

Despite the growing requirement to quantify the impact of aid and results of development programmes, Amy’s research highlights that such ‘measurable’ outcomes are invariably shaped by the complex histories and qualitative ties that exist between local actors. Understanding this, and therefore the specific socio-political context in which aid is delivered and managed is paramount to understanding why it does (or does not) work. Often, aid and development modalities like the Global Fund, health SWAps and budget support bring together a disparate mix of actors, sometimes in confrontation. For managers, government aides, consultants or health professionals, having a good understanding of the local socio-political context, actively managing or navigating these relationships, and good communication are the critical skills that will fundamentally shape the overall outcomes of any project, programme or initiative.

Amy will be heading back out to Zambia in October to try to extend the research and networks of working in the area.

References
Barnes, A and Brown, GW (2011a) The Global Fund to Fight AIDS, TB and Malaria: Expertise, Accountability and the Depoliticisation of Global Health Governance. In: Owain Williams and Simon Rushton (eds.) Partnerships and Foundations in Global Health. London: Palgrave Macmillan. pp.53-75. See: http://www.palgrave.com/products/title.aspx?pid=38274.
Barnes, A and Brown, GW (2011b) Partnership as a normative ideal of the MDGs: From ideal to practice? Third World Quarterly, 32 (10), 165-180