AID COORDINATION FOR HEALTH SECTOR REFORM - A CONCEPTUAL-FRAMEWORK FOR ANALYSIS AND ASSESSMENT

Recent widespread interest in health sector policy and institutional r eform in lower income countries has coincided with heightened concern for aid coordination. Because the health budgets of many low income co untries are highly aid dependent, donors are strongly placed to make a id conditional on health care reforms. However, given the growing numb er and heterogeneity of multilateral, bilateral and international non- governmental donors operating in many of these countries, there is con cern that if external efforts are not coordinated, the aims of health care reform-namely improving efficiency, effectiveness and equity-will not be met. Evidence is mounting that without effective coordination arrangements, donors may weaken rather than improve fragile health sys tems, undermining attempts to reform those systems. This paper traces the factors fuelling current interest in coordination, in particular w ith reference to its contribution to the goals of health sector reform . Aid coordination is defined and its principles elaborated. A framewo rk is developed by which to assess the variety of coordination mechani sms which are evolving at the country level. In light of this framewor k, a case is made for greater and more critical analysis of aid coordi nation arrangements. The paper concludes that if health sector reform is to be successful in low income countries, current enthusiasm for co ordination needs to be harnessed. The framework offered here provides away of assessing the variety of coordination mechanisms currently pro liferating, which could be used to enhance health sector reform.