Posted by Duncan Last.
The 2008 Court of Audit assessment of the European Commissions (EC) health sector support to Sub-Saharan Africa raises some important issues in its recommendations, for the broader development community to consider, and, more importantly, beneficiary countries to take note of. The audit found that health sector funding as a proportion of total EC funding has remained unchanged since 2000, indicating a disconnect between the stated objectives of achieving MDGs (where the health sector is one of the priorities) and the actual year-to-year allocation of available funds.
Three highlights may be of particular interest to readers:
First of all, the audit concludes that EC assistance to the health sector is fragmented (using multiple aid instruments) and uncoordinated (with little synergy between instruments). For example, the EC provided significant resources to help start up the Global Fund to fight AIDS, tuberculosis and malaria (created in 2001), but then stepped back from active involvement, preferring to focus on its other health sector projects which enjoyed greater disbursement rates even though sustainability is often more problematic.
A second major issue, is that while predictability of flows to individual countries improved during the present funding cycle (the ninth EDF), under which responsibility for disbursement was devolved to country-based delegations, the audit reports that complex procedures for procuring inputs (works, services, supplies) and approving and implementing work programs still reduce both the speed and the predictability of the flow of funding to EDF health interventions. General budget support continues to be the fastest disbursing instrument, and the most predictable over the medium-term once agreements are in place, although some countries continue to have problems gathering the performance indicator data required for disbursement approval. A few countries had events that triggered suspension of general budget support, which caused, in one case at least, a switch to sector budget support.
Third, the auditors also conclude that EC should increase its use of sector budget support and, where required, provide assistance to strengthen health sector policies essential for effective health service delivery, noting that EC assistance had not given enough attention to strengthening health systems, even though this was an intended priority for the ninth EDF period. It also notes that the EC had insufficient health sector expertise in-house to ensure the most effective use of health funding, and suggests that EC country offices either consider recruiting health expertise or draw on the resources of other partners.
The recommendation to switch from general budget support to more sector focused support will certainly raise eyebrows in many developing countries and in the donor community. General budget support has been the fastest growing aid instrument, endorsed by the donor community and developing World in the Paris Declaration of 2005 on Aid Effectiveness. Indications from the Court implying that health care support provided by European taxpayers to the developing world would benefit from more focused aid instruments, could have major implications for donor-developing world relations.
The Court of Audit Report can be accessed by clicking here: Download 2482316[1]
