Why donor coordination is so frustratingly hard
Pretty much every statement on aid effectiveness ever issued mentions better donor coordination. Most recently, it was the Paris declaration, which committed to “Eliminating duplication of efforts and rationalising donor activities to make them as cost-effective as possible.”
Donor coordination is especially important in global health, where it’s vital to standardize things like treatment regimens, provider training, and systemic approaches. If everyone comes in and pushes for a different system for tracking polio outbreaks, the Ministry of Health will have to waste time and effort getting donors to come to an agreement or, worse yet, attempt to implement all the different systems with chaos as a result.
Everyone agrees that donor coordination is for the public good but it’s really difficult to actually make happen. It’s easy to put that down to incompetence, but the real answer is more complicated. It has to do with how global health is funded within countries, and the way coordination has to be timed.
In most countries, foreign assistance (and therefore global health) budgets are set by parliament. They may set general numbers for each recipient country, or they may establish line items for broad categories like health, education, and good governance. Parliamentary decisions are based on what elected representatives believe is best. They are not often influence by global proclamations on aid effectiveness. It’s hard to blame them for that – foreign aid is a tiny part of what most elected officials do. They don’t have time to become experts.
These broad numbers are then made more specific by the donor country’s development body. In the UK, it’s the Department for International Development. In Japan, it’s the International Cooperation Agency. In the US, there are actually several foreign assistance bodies, the most important being the US Agency for International Development. These government bodies have internal standards and best practices to ensure that aid is given effectively and appropriately.
And donors give for a lot of reasons. Certainly they want to support international development, but they have secondary needs. Domestic constituencies need to support foreign aid, or the money to support it vanishes. A nation may have strategic goals in a particular country or region, and it may have laws governing what kind of aid it can provide. All of these factors mean that nations end up making their foreign assistance plans alone.
All this means that when the time comes for donors to coordinate, they can’t just make their plans together. Instead, they’re forced to take existing plans and somehow make their plans fit. There is very little room to modify or change what’s been developed. More often than not, donors do one of two things. They claim regions of a country, one per donor, or they just make a big list of who’s doing what and where, and call that list coordination.
Everyone involved is making a good faith effort to do better global health work, but the institutional roadblocks are hard to overcome.
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