Chapter 35 - Understanding the Global Health Architecture

Summary

The Chapter describes the ‘global aid architecture’ that comprises different players providing international assistance for health to countries, plus the mechanisms and modalities by which assistance is provided. Broadly, there are three groups of actors - bilateral donors, multilaterals donors, and non-governmental agencies and increasingly the private sector. Assistance includes financial aid as grants and concessional loans, aid in-kind, and technical cooperation, and each has its strengths and limitations. Global health governance includes decision-making and oversight at multiple levels and is inherently political. To be effective it should respond to the needs of the countries it serves, and be accountable to people and communities. Empirical evidence does not show clear link between aid flows and countries’ needs for financing. Aid frequently substitutes domestic funding in low-income countries and can undermine building of national institutions. Countries need to prioritize health in their national budgets and identify specific areas for donors to intervene. The COVID-19 pandemic has further shed light on the weaknesses of these arrangements that are often fragmented and uncoordinated.