Bilateral health aid: lessons from Europe

OBJECTIVE: The objective of this study is to document current issues in policy and planning for development assistance in health from the perspective of key bilateral aid donors in Europe, and to explore its relevance for Australia. METHODOLOGY: This study is based on seventy-seven interviews and documentary analysis undertaken between July and December 1999 with policy, technical and field staff of major European bilateral aid donors, the World Health Organisation (WHO), and key academic institutions. Notes were taken of interviews, and relevant documentation collected. Forty-five key interviews were tape recorded and transcribed for analysis. RESULTS: The shift towards program and Sector Wide Approaches in development assistance reflects broader political changes in Europe since the collapse of the Communist block. Increasingly, achieving an impact on poverty is seen as linked to better governance, improved policy frameworks, and collaboration between donors and partner governments, and between donors themselves, reflected in the broad support for Sector Wide Approaches to development assistance. CONCLUSIONS: These perspectives bring new demands to donors such as Australia: structural changes, procedural changes, collaborative approaches to programs, closer relationships with counterparts. IMPLICATIONS: The uncertainty in which health sector reform operates necessitates a reflective and adaptive approach to management of aid, and responsiveness to monitoring and evaluation and the development of new knowledge. Given Australia's strategic positioning in its sphere of influence, the experience from Europe should inform the development of our own future directions.