What is the evidence on providing health funding support through unearmarked sector budget support as opposed to disease specific funds or programmes? Are there specific outcomes that can be attributed to different funding modalities? Are there any outcomes (or outputs) that can be linked to the way support is provided including sustainability or institutional strengthening? Is one way or the other way better or worse for outcomes?
This report examines the evidence on the success of health funding through unearmarked sector budget support and disease specific and programme funding. It considers the following areas:
- Budget support and sector wide approaches (SWAps)
- Sector budget support in practice, ODI and Mokoro
- Disease specific programmes
- Papers on different funding modalities for health
- Aid effectiveness
Williamson et al. (2008) find the deployment of uncoordinated project aid in many sectors has contributed and continues to contribute towards a vicious circle, compounding poor sector governance. They suggest a balance of sector-based aid and general budget support. They suggest better dialogue at sector level and avoiding projects and common funds. The incentives within donor agencies and recipients also need to be addressed. Ultimately, the likelihood of reform relies on political support and technical leadership within government. This is very difficult for the donor community to influence.
SWAps can be important in making sector budget support work. SWAps have been found to be successful in putting tools and processes in place for improved sector coordination but made only modest achievements of national health objectives (Villaincourt, 2009). The sequencing of efforts to develop and use local skills and systems can mitigate the risks of delayed implementation and a weak results focus.
Global health partnerships can result in a ‘brain drain’ of individuals best placed to provide national technical and managerial leadership. This report also provides some case studies. And has some useful discussion on the pros and cons of budget support and other funding mechanisms.