A Dilemma

The value of aid is an ongoing issue of debate, but Pallas and colleagues [1] delineate an interesting dilemma in a qualitative study based on extensive interviews with donor NGOs and government agencies in a recipient country – Ghana. They document the proliferation of donor agencies, the fragmentation of services that result, and the sensible response of government to co-ordinate the use of donor money across sectors and to pool certain funding streams. But here is the problem – the more effective the co-ordination effort, the less easy it is to hypothecate improvements on any particular donor contribution. This makes it difficult for donor agencies to demonstrate impact. The resulting perceived risk to further funding may prompt donors to dis-invest selectively from the best-managed donor programmes. What is the way out of the conundrum? Perhaps education of those who fund donor agencies so that they adopt a more nuanced approach to performance management.

— Richard Lilford, CLAHRC WM Director


  1. Pallas SW, Nonvignon J, Aikins M, Ruger JP. Responses to donor proliferation in Ghana’s health sector: a qualitative case study. Bull World Health Organ. 2015; 93: 11-8.

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