Improving Effectiveness of Development Assistance for Health
In the last two decades, the international community substantially increased its contribution to Development Assistance for Health (DAH) reaching an historical peak of US$38 billion annually in 2013. 

Achieving the expected health results is determined by the way the donor-recipient partnership is shaped and by at least four steps in DAH: a) priority setting (programmatic, geographical, populations); b) by funding policy and strategy definitions and execution; c) by how programs and projects are designed (project/ program cycle, project / grant design, monitoring and evaluation embedded in design), and d) by how specific projects, programs, and portfolios are managed and monitored during implementation  ( program and projects/grants management, portfolio management, monitoring and impact assessment).  

The international community has learned valuable lessons on each of these four critical steps to maximize the impact of DAH. Applying those lessons is now more important at a time when development assistance for health does not seem to be growing in line with historical trends, when some countries with significant economic growth are transitioning away from donor support to own funding and, when leading donors are facing their own fiscal challenges limiting the space for growth.
 
​Most CHD members have a lifetime experience in DAH, both from donor and/or from recipient partners perspectives. DAH priority setting usually takes into account a combination of robust evidence on Burden of Disease and poverty-alleviation objectives and each donor specific priorities and concerns (e.g. its own funding sources, tax-payer mandates, own capabilities, geographical presence). CHD partners with Donor and Recipient countries, based on their respective priorities and constraints, to support the formulation of a sound DAH funding strategy,  program and project design, and program and portfolio management. We also provide advice and work on fiscal space, including alternative options for development funding graduation to help promote long-term DAH success.

DAH Policy and
​Strategy

Funding Policy and Health Development Strategy are the pillars of donor and country engagement in DAH. Based on priorities (programmatic, geographical end population) and in consideration to impact objectives and capacities and capabilities, it defines the road map to judge success.

Health Development Strategy and Funding Policy defines the key parameters of DAH for a donor  -recipient partnership.

Health Development Strategy and funding policy formulation for a donor should address key questions including, among others:
  • What development assistance distribution channels will be used, own program and project development and management or, others such as bilateral and multilateral channels?
  • If other channels, how is success defined and what are the monitoring and metric to monitor it?
  • Although it is usually an aspiration to fully achieve harmonization, how and how much is it possible to achieve harmonization with other donor systems and country systems? Is there alignment in country and donor priorities and systems and among key donors? 
  • What are the specific implications of the strategy and Funding Policy for program / project cycle design, capabilities and capacity on the ground, and monitoring and evaluation of portfolio effectiveness and impact?
For a donor-recipient partnership: 
  • Donor and recipient partners have a clear framework for short and long-term results and based on it, what is to be funded?
  • How will the funding effort be made sustainable in time and how is potential funding (donor and country own) volatility minimized, fiscal contingent liabilities anticipated and managed, and donor transition (graduation) planned and embedded in strategy and funding? 

CHD works and provide advice on Health Development Strategy and Funding Policy, including portfolio and Strategy / Policy alignment and impact assessment.

Program and Project
​Design

Maximizing impact of DAH not only requires clear donor and recipient partner strategy but it requires a careful design of aid programs and projects.  

Some of the key questions to be addressed (ideally by non-team-members review) include, among others:
  • Is there alignment in country and donor priorities and systems and among key donors for the program or project in question? 
  • Does the program include a clear results framework guiding the funding results or inputs and agreed between donor and recipient?
  • Are there clear milestones to assess success of implementation and impact?
  • Are the technical designs clearly aligned with the expected project impact?
  • Are the committed funds (donor and country) credibly commensurate to the expected results (too much-too little)?
  • Is there clarity of what both parties will do/can do if milestones are not achieved? (whatever the nature of the milestone -- expending, developing a product, improving an indicator, building infrastructure, etc)?
  • Is there synergy in the design and few mechanisms between the country own funding and donor funding arrangements? 
  • Are there arrangements to link funding to short and long-term results and performance? 
  • Are there clear financial management, fiduciary, procurement, and other supporting functions appropriately included in the design?
  • Are there effective and timely monitoring and evaluation systems in place? 
International experience indicates that a "project cycle" approach to design programs and projects helps bringing together all the necessary aspects for success (technical, operational, fiduciary, communicational, stakeholders perspectives, and political when appropriate) and allows for a continuous learning of what works and what does not.

​CHD works and provide advice on both, project cycle design for overall portfolio development as well as specific program and projects design. CHD has distinctive experience and expertise on both technical and fiduciary aspects of program design and, particularly in linking funding to results as well as in facilitating donor-country design of donor transition strategies (graduation).

Implementation and Portfolio Management 

A good DAH program  / project design is the beginning of a usually long journey towards impact and health results. There are at least three critical areas for implementation impact: a) effective partnership, support and monitoring of each program and project being implemented by recipient partner with continuous donor-recipient feedback; b) periodic independent review of portfolio effectiveness in view of Funding Policy and Health Development strategy; c) selective impact evaluation of program and projects to test initial results framework.

The journey to success does not end at program /project agreement between donor and recipient partner, it is the beginning of the actual effort for impact. Ensuring that program and project designs are made with a sharp focus on implementation (beyond technical appealing of the design) has proven to be critical in implementation. Similarly, implementation support and supervision of program implementation is critical not only to identify early signs of challenges but to provide experience and expertise that may not be fully familiar to implementing parties particularly at early stages of implementation. Ensuring capacity and capabilities on the ground by donor parties is critical for successful implementation.

The successful execution of a Funding Policy and Health Development Strategy happens in the day-to-day decision-making regarding program and project approvals and implementation adjustments on the ground. Although every program and project may seem coherent in itself when examined in isolation, it is essential to periodically examine the entire country or even donor portfolio to assess whether donor funding is responding to a policy and strategy. Global health development experience suggests that it is critical to avoid "patchwork" fragmentation of donor assistance that occurs in the absence of such reviews and significantly reduces portfolio impact.

Learning how robust is the donor and recipient capacity to link funding to the initial results frameworks and learning the on-the-ground impact of the interventions is a critical task for long term portfolio impact assessment, one that can have substantial positive global knowledge externalities. Selective impact evaluation is key in this learning process. 

CHD works and provides advice on both, project implementation and on portfolio management, alignment with policy and strategy and impact assessment reviews. We partner with distinctive monitoring and evaluation partners for impact evaluations.