Examining aid fragmentation and collaboration opportunities in Cambodia's health sector.

BACKGROUND: Cambodia's health sector faces significant challenges exacerbated by aid fragmentation, where development aid is dispersed among numerous small, uncoordinated projects. This study examines the distribution of health sector aid among Cambodia's principal donors to identify priorities, overlaps, and potential collaboration opportunities, addressing the urgent need for aid efficiency and alignment with national health priorities. METHODS: Utilizing OECD datasets and the Herfindahl-Hirschman Index (HHI) for the years 2010-2021, this study quantifies aid fragmentation within Cambodia's health sector. It analyzes aid allocations from the top five donors-United States, Australia, South Korea, Japan, and Germany-across various health projects and initiatives, evaluating the extent of fragmentation and identifying areas for potential donor collaboration. RESULTS: This study's findings highlight a pervasive issue of aid fragmentation within Cambodia's health sector, evident through the sector's low HHI score. This indicates a widespread distribution of aid across numerous small-scale initiatives, rather than targeted, unified efforts. A notable example includes Japan and Korea, which exhibit lower HHI scores, indicating a more pronounced fragmentation in their aid allocation. These countries' contributions are spread across various sectors without a dominant focus, contrasting with the United States' significant dedication to infectious disease control. However, beyond this specific area, the US's aid distribution across other priority health areas shows signs of fragmentation. This scattered approach to aid allocation, even amidst instances of focused support, illustrates the overarching challenge of aligning donor contributions with the holistic needs of Cambodia's health infrastructure. CONCLUSIONS: This investigation highlights the critical need for enhanced collaboration and strategic harmonization among international donors to mitigate aid fragmentation in Cambodia's health sector. It underscores the importance of adopting integrated and priority-aligned aid strategies to improve the efficiency and impact of health aid. By fostering synergistic partnerships and harmonizing donor efforts, there is a potential to create a more cohesive support framework that resonates with Cambodia's comprehensive health requirements and contributes to sustainable health outcomes. Such harmonization not only aligns with Sustainable Development Goal 3 by optimizing health services and outcomes but also strengthens global partnerships under Sustainable Development Goal 17, fostering a unified approach to international development.

Aid fragmentation and volatility in the Pacific.

In this article we comprehensively document aid volatility (short-term changes in aid flows) and aid fragmentation in the Pacific. We study two types of fragmentation: fragmentation across countries and fragmentation across projects. Our research draws on a new dataset compiled by the Lowy Institute. The dataset includes aid flows to the Pacific from non-traditional donors such as China. This allows us to undertake the first-ever study of Pacific aid volatility and fragmentation factoring in non-traditional donors. We contrast the Pacific with other regions, finding that while fragmentation across donors is less in the Pacific, project fragmentation is worse, as is aid volatility. We find fragmentation across donors is increasing in the Pacific. We find a similar trend for fragmentation across projects. We find no evidence that non-traditional donors such as China are driving these trends. However, we find some evidence that non-traditional donors give more volatile aid.

Does donor proliferation in development aid for health affect health service delivery and population health? Cross-country regression analysis from 1995 to 2010.

BACKGROUND: Previous literature suggests that increasing numbers of development aid donors can reduce aid effectiveness but this has not been tested in the health sector, which has experienced substantial recent growth in aid volume and number of donors. METHODS: Based on annual data for 1995-2010 on 139 low- and middle-income countries that received health sector aid from donors reporting to the OECD's Creditor Reporting System, the study used two-step system generalized method of moments regression models to test whether the number of health aid donors and an index of health aid donor fragmentation affect health services (measured by DTP3 immunization rate) or health outcomes (measured by infant mortality rate) for three subsectors of health aid. RESULTS: For total health aid and for the general and basic health aid subsector, controlling for economic and political conditions, increases in the number of donors were associated with increases in DTP3 immunization rate and reductions in infant mortality while increases in the donor fragmentation index were associated with decreases in DTP3 immunization rate and increases in infant mortality, though none of these relationships were statistically significant. For the population and reproductive health aid subsector, a one percent increase in the number of donors was associated with a 0.23 percent decrease in DTP3 immunization ( P < 0.01) while a one percent increase in donor fragmentation was associated with a 0.54 percent increase in DTP3 immunization rate ( P < 0.01); associations with infant mortality rates for this subsector were similar to those for total health aid. CONCLUSION: The results do not provide clear evidence in support of the hypothesis that donor proliferation negatively impacts development results in the health sector. Aid effectiveness policy prescriptions should distinguish responses to donor proliferation versus donor fragmentation and be adapted to specific subsectors of health aid.