ArticleHealth policy and planning2024
Making development assistance work for Africa: from aid-dependent disease control to the new public health order.
Article in Health policy and planning, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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Who cites it
16 citing papers in PubMed.
- Governance of antimicrobial resistance in Central Africa (2015-2025): a systematic review of policies, One Health coordination and funding.JAC-antimicrobial resistance · 2026Review
- Polio transition in the African Region: progress, challenges and prospects for health systems integration.BMC infectious diseases · 2026Review
- Trends in government and donor funding for vertical and horizontal community health worker programmes in sub-Saharan Africa.BMJ global health · 2026Article
- Nigeria's post-COVID-19 vaccine manufacturing ambitions: Opportunities and regional implications.Journal of public health in Africa · 2026Article
- Donor dependency and pandemic readiness: insights from the 2026 Ebola Bundibugyo outbreak in the East African community.Frontiers in public health · 2026Article
- Temporal trends and associations between domestic public health spending, donor funding and tuberculosis outcomes in Africa: a serial cross-sectional study (1990-2022).BMJ public health · 2026Article
- Financing fragility and pandemic preparedness in Central Asia: a policy review of aid volatility, donor dynamics, and health system resilience.Frontiers in public health · 2026Article
- Navigating power, participation, and priorities: critical reflections for Global Financing Facility new strategy.Global health action · 2025Article
- Unwrapping the Global Financing Facility: understanding implications for women's children's and adolescent's health through layered policy analysis.Global health action · 2025Review
- Examining the emergence and implementation experience of Primary Health Care Networks (PCNs) in Kenya: a qualitative process evaluation.BMC health services research · 2025Article
- Strengthening the mpox response: how do we balance pragmatism and equity in resource-constrained settings?Journal of global health · 2025Article
- Understanding Integrated Community Case Management Institutionalization Processes Within National Health Systems in Malawi, Mali, and Rwanda: A Qualitative Study.Global health, science and practice · 2024Article
- Leveraging local health system resources to address quality healthcare gaps in sub-Saharan African: lessons from the SafeCare quality improvement programme in Ghana.BMC health services research · 2024Article
- Global health 2050: the path to halving premature death by mid-century.Lancet (London, England) · 2024Review
- 'We thought supporting was strengthening': re-examining the role of external assistance for health systems strengthening in Zimbabwe post-COVID-19.Health policy and planning · 2024Article
- Still rethinking external assistance for health.Health policy and planning · 2024Article
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The Coronavirus disease (COVID-19) pandemic has revealed the fragility of pre-crisis African health systems, in which too little was invested over the past decades. Yet, development assistance for health (DAH) more than doubled between 2000 and 2020, raising questions about the role and effectiveness of DAH in triggering and sustaining health systems investments. This paper analyses the inter-regional variations and trends of DAH in Africa in relation to some key indicators of health system financing and service delivery performance, examining (1) the trends of DAH in the five regional economic communities of Africa since 2000; (2) the relationship between DAH spending and health system performance indicators and (3) the quantitative and qualitative dimensions of aid substitution for domestic financing, policy-making and accountability. Africa is diverse and the health financing picture has evolved differently in its subregions. DAH represents 10% of total spending in Africa in 2020, but DAH benefitted Southern Africa significantly more than other regions over the past two decades. Results in terms of progress towards universal health coverage (UHC) are slightly associated with DAH. Overall, DAH may also have substituted for public domestic funding and undermined the formation of sustainable UHC financing models. As the COVID-19 crisis hit, DAH did not increase at the country level. We conclude that the current architecture of official development assistance (ODA) is no longer fit for purpose. It requires urgent transformation to place countries at the centre of its use. Domestic financing of public health institutions should be at the core of African social contracts. We call for a deliberate reassessment of ODA modalities, repurposing DAH on what it could sustainably finance. Finally, we call for a new transparent framework to monitor DAH that captures its contribution to building institutions and systems.
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