Research for stronger health systems during and after crisis

Sub-national assessment of aid effectiveness: A case study of post-conflict districts in Uganda

Freddie Ssengooba, Justine Namakula, Vincent Kawooya and Suzanne Fustukian.

Globalization and Health (2017) 13:32 DOI 10.1186/s12992-017-0251-7

This paper reports on ReBUILD’s research in northern Uganda, undertaken to assess the aid-effectiveness in post-conflict districts of the country. The study looked at aid relationships among actors at sub-national level, who represent a vital lever for health system development. In settings affected by conflict or crisis, many state and non-state actors interact at these sub-national levels in rebuilding health systems by providing funds, delivering vital interventions and building capacity of local governments.

The study found that sub-national assessment of aid effectiveness is feasible with indicators adapted from the global parameters. But with the study finding more focus on “results” domain and less on “ownership” and “resourcing” domains, the authors conclude that the capacity and space for sub-national level authorities to negotiate local priorities for health systems development in crisis-affected settings requires more attention.

This study was led by the Makerere University School of Public Health, ReBUILD’s partner in Uganda.

You can download the full paper here.

[A further paper based on this research has also been published: Application of social network analysis in the assessment of organization infrastructure for service delivery: a three district case study from post-conflict northern Uganda]

Abstract:

Background: In post-conflict settings, many state and non-state actors interact at the sub-national levels in rebuilding health systems by providing funds, delivering vital interventions and building capacity of local governments to shoulder their roles. Aid relationships among actors at sub-national level represent a vital lever for health system development. This study was undertaken to assess the aid-effectiveness in post-conflict districts of northern Uganda.
Method: This was a three district cross sectional study conducted from January to April 2013. A two stage snowball approach used to construct a relational-network for each district. Managers of organizations (ego) involved service delivery were interviewed and asked to list the external organizations (alters) that contribute to three key services. For each inter-organizational relationship (tie) a custom-made tool designed to reflect the aid-effectiveness in the Paris Declaration was used.
Results: Three hundred eighty four relational ties between the organizations were generated from a total of 85 organizations interviewed. Satisfaction with aid relationships was mostly determined by 1) the extent ego was able to negotiate own priorities, 2) ego’s awareness of expected results, and 3) provision of feedback about ego’s performance. Respectively, the B coefficients were 16%, 38% and 19%. Disaggregated analysis show that satisfaction of fund-holders was also determined by addressing own priorities (30%), while provider satisfaction was mostly determined by awareness of expected results (66%) and feedback on performance (23%). All results were significant at p-value of 0.05. Overall, the regression models in these analyses accounted for 44% to 62% of the findings.
Conclusion: Sub-national assessment of aid effectiveness is feasible with indicators adapted from the global parameters. These findings illustrate the focus on “results” domain and less on “ownership” and “resourcing” domains. The capacity and space for sub-national level authorities to negotiate local priorities requires more attention especially for health system development in post-conflict settings.
Keywords: Aid-effectiveness, Aid assessment tool, Sub-national level, Post-conflict, Uganda