Opening remarks from the PMAC launch by Dr Kumanan Rasanathan about the critical moment for external assistance for health
The Millennium Development Goals and the Sustainable Development Goals have driven long-term investments in health, especially in the form of external assistance for health for low- and middle-income countries to achieve the MDGs and SDGs. This has made external assistance for health an important resource for LMICs, not only supporting health programmes and interventions but also strengthening health systems. Alongside that support, however, have come important questions and challenges, like:
- where can external assistance for health best serve a catalytic and systems strengthening function;
- how can coverage of services be sustained when donors decrease or end their funding;
- and how can external assistance for health best support country-led responses and align with national priorities.
More recently, several interlinked crises, from conflicts to the COVID-19 pandemic, have spurred economic upheavals, shifted governments’ spending priorities and changed dynamics both for donor and recipient countries of external assistance for health.
In this context, the Alliance for Health Policy and Systems Research (the Alliance) and the WHO Health Financing and Economics Department started a programme of work in 2021 to look at three main areas of research: how external assistance for health has been used in relation to domestic health spending, how domestic health financing managed to take ownership and sustain services previously covered by external assistance for health and how new models can be informed by an analysis of current models. The programme of work was followed by a call for abstracts in Health Policy and Planning, resulting in a supplement that was launched today at a side meeting of the Prince Mahidol Awards Conference 2024 in Bangkok, Thailand.
The supplement features a mix of original research articles and commentaries. One of the original research articles is a cross-country analysis of studies from four countries supported by the Alliance to implement research studies – China, Georgia, Sri Lanka, and Uganda. This paper gives insights into how cessation of EAH affects coverage of the interventions supported, and it examines the political, financing and health system factors that influence the sustainability of those interventions. The supplement also features three original research articles and one innovation and practice report from these four countries. One research paper discusses experiences from China and Georgia of adaptations of national data systems for transitioning from external assistance for health, while an innovation and practice report highlights the contributions of external technical assistance in both countries and how such assistance contributes to long-term sustainability in service delivery. Other papers discuss the impacts on HIV services in Eastern Uganda following the shifts in PEPFAR funding and the factors influencing sustained coverage while transitioning from external assistance for health in Sri Lanka.
The supplement was edited by Zubin C. Shroff, Susan P. Sparkes, and Kara Hanson. Articles include:
- Editorial: Still rethinking external assistance for health
- Commentary: When one size does not fit all: aid and health system strengthening for Small Island Developing States
- Original Research: Understanding China’s shifting priorities and priority-setting processes in development assistance for health
- Original Research: Making development assistance work for Africa: from aid-dependent disease control to the new public health order
- Original Research: Leveraging global investments for polio eradication to strengthen health systems’ resilience through transition
- Original Research: HIV programme sustainability in Southern and Eastern Africa and the changing role of external assistance for health
- Innovation and Practice Report: Donor coordination to support universal health coverage in Malawi
- Innovation and Practice Report: Enabling cross-country learning and exchange to support universal health coverage implementation
- Innovation and Practice Report: Sustaining essential health services in Lao PDR in the context of donor transition and COVID-19