AN UNRULY MELANGE - COORDINATING EXTERNAL RESOURCES TO THE HEALTH SECTOR - A REVIEW

The past two decades have witnessed an upsurge in the number of extern al agencies involved in the health sectors of developing countries. Co ncomitantly, there has been an increase in the volume of resources tra nsferred through multilateral, bilateral and non-governmental organiza tions to these health systems. Notwithstanding the beneficial impact o f increased resources, recipients and donors are increasingly concerne d about the effects of this trend. This is particularly pertinent wher e the effort lacks adequate coordination. Recipients despair of an unr uly melange of external ideas and initiatives, that too often results in project proliferation and duplication, unrealistic demands, and ult imately a loss of control over the health development process. Donors on the contrary, are concerned about aid efficiency and effectiveness, two areas it is assumed will gain from increased attention to coordin ation. Both recipients and donors are looking for ways of better manag ing the aid relationship. Although there has been considerable experie nce with coordination strategies, most writing has considered external assistance in general, rather than the health sector in particular. T he literature is striking in its bias towards the needs and perspectiv es of the donor community. There has been little analysis of the manne r in which recipient ministries of health manage donors and the influx of resources. This review begins to fill this gap. Its focus is count ry-level, where most direct gains from co-ordination are to be reaped. The paper begins with an enumeration of the many and diverse trends w hich have raised the salience of aid coordination. A definition of coo rdination, a term used ambiguously in the existing literature, is then developed and the principles of aid coordination outlined. Finally, a ttention is directed to the initiatives of recipients and donors to im prove the coordination of health sector aid. (C) 1997 Elsevier Science Ltd.