"It’s About the Idea Hitting the Bull’s Eye": How Aid Effectiveness Can Catalyse the Scale-up of Health Innovations

Abstract

Background: Since the global economic crisis, a harsher economic climate and global commitments to address the problems of global health and poverty have led to increased donor interest to fund effective health innovations that offer value for money. Simultaneously, further aid effectiveness is being sought through encouraging governments in low- and middle-income countries (LMICs) to strengthen their capacity to be self-supporting, rather than donor reliant. In practice, this often means donors fund pilot innovations for three to five years to demonstrate effectiveness and then advocate to the national government to adopt them for scale-up within country-wide health systems. We aim to connect the literature on scaling-up health innovations in LMICs with six key principles of aid effectiveness: country ownership; alignment; harmonisation; transparency and accountability; predictability; and civil society engagement and participation, based on our analysis of interviewees’ accounts of scale-up in such settings. Methods: We analysed 150 semi-structured qualitative interviews, to explore the factors catalysing and inhibiting the scale-up of maternal and newborn health (MNH) innovations in Ethiopia, northeast Nigeria and the State of Uttar Pradesh, India and identified links with the aid effectiveness principles. Our interviewees were purposively selected for their knowledge of scale-up in these settings, and represented a range of constituencies. We conducted a systematic analysis of the expanded field notes, using a framework approach to code a priori themes and identify emerging themes in NVivo 10. Results: Our analysis revealed that actions by donors, implementers and recipient governments to promote the scale-up of innovations strongly reflected many of the aid effectiveness principles embraced by well-known international agreements - including the Paris Declaration of Aid Effectiveness. Our findings show variations in the extent to which these six principles have been adopted in what are three diverse geographical settings, raising important implications for scaling health innovations in low- and middle-income countries. Conclusion: Our findings suggest that if donors, implementers and recipient governments were better able to put these principles into practice, the prospects for scaling externally funded health innovations as part of country health policies and programmes would be enhanced.

Ownership in Name, But not Necessarily in Action Comment on "It’s About the Idea Hitting the Bull’s Eye": How Aid Effectiveness Can Catalyse the Scale-up of Health Innovations"

“…The paper by Wickremasinghe et al adopts the Paris Declaration’s definition, that recipient countries develop their own development strategies, behind which all donors align. 1 However, this definition is very broad, and difficult to apply and assess in practice. Studies have shown that the principle of country ownership is interpreted differently by country-level and global stakeholders, and from the texts of aid effectiveness declarations.…”

“…What this has meant in reality in countries like Tanzania and Malawi, is that to meet the principle of ownership the government held separate budgetary meetings with donors, but then still made their decisions behind closed doors; the donors could report on these meetings as meeting ownership, but this created a whole parallel system of accounting for resources which was not government-led and did not reflect the priorities of the recipient government. 3,5 In all cases (including the Paris Declaration), government leadership is seen as essential to country ownership (also to alignment and harmonisation 1,3,6 ).…”

“…A recently-published paper by Wickremasinghe et al analyses the scalability of three maternal health programs in three different countries using the aid effectiveness agenda as an analytical framework to explore constraints and facilitating factors to programme scalability. 1 This is a welcome, novel and practical use of the aid effectiveness agenda. The results show that the different aid effectiveness principles were adopted to different degrees in the three settings, and that this had an impact on programme scale-up.…”

“…The article makes particular emphasis on the principle of country ownership, which the authors describe as facilitating donor alignment and harmonisation, being essential to scale up interventions and to guarantee programme sustainability beyond the support of external partners. 1 Country ownership has been a principle of all declarations prior and subsequent to the Paris Declaration. In the Accra Agenda for Action, which superseded the Paris Declaration, it was considered the “first priority.”…”

Effective Aid for Hitting the Bull’s Eye Comment on "It’s About the Idea Hitting the Bull’s Eye": How Aid Effectiveness Can Catalyse the Scale-up of Health Innovations"

“…The article “It’s About the Idea Hitting the Bull’s Eye”: How Aid Effectiveness Can Catalyse the Scale-up of Health Innovations” 1 studies how applying six key aid effectiveness principles can help “hit the bull’s eye” that is, scale up maternal and newborn health (MNH) interventions. The principles were selected based on the principles of the Paris Declaration of 2005 2 and on other international agreements signed by the focus countries.…”