When a country's health system is reliant on external aid, who gets to decide the country's health priorities ? The giver, or the receiver ?

External funds driving policy: report
14 December 2017
- A new study has found that external donors wield outsize influence in determining national health care policies in Cambodia. The research was published earlier this month in the journal of the London School of Hygiene and Tropical Medicine. The study focused on Cambodia and Pakistan, where researchers interviewed “informants” from each country’s domestic health sector. Dr Mishal S Khan, one of the authors and an assistant professor at the London School of Hygiene and Tropical Medicine, said these countries were selected given their history of “a fairly high level of dependence on donor funding”.

“External donors can have power to influence health polices in Cambodia because they control the financial resources … but even if the financial resources do not come from external donors, they can influence health polices because domestic policy makers rely on them for technical knowledge and for skills around turning scientific evidence into polices,” she wrote in an email.

The study finds that, overall, policymakers in Cambodia felt that the level and availability of external funding often dictated which issues were placed high on national agendas, as well as the types of interventions chosen to address the health issues.

An interviewee in Cambodia told researchers that targets based on a global HIV/AIDS strategy “have been powerful in influencing programme implementation in the country because of international support”.

Having funding and policy dictated by external agencies “can mean that issues important in the Cambodian context are not given due attention”, the researcher Khan said.

For example, one international NGO representative and policy adviser in Cambodia interviewed for the study used mental health in the Kingdom as an example to show researchers how much dependence on donor funding impacts health policy.

“She explained that even though domestic stakeholders were aware of the urgent need to address mental health issues – owing to the genocide perpetuated in the country – this was not a priority health area until 2016 … because of a lack of donor funding, on which the government is reliant,” the study reads.

Another informant in Cambodia reported that he had seen a sudden increase in NGOs focusing on specific topics, which were often not linked to national priorities or even the NGOs’ own mandates, as “they were dependent on wining grants to continue their operations”...
http://www.phnompenhpost.com/national/e ... icy-report

Donor Transitions From HIV Programs: What Is The Impact On Vulnerable Populations?
December 14, 2018
Many middle-income countries are transitioning away from donor-funded health programs in a range of areas including immunization, maternal and child health, tuberculosis, malaria, and HIV. Unless these donor exits are managed well, they could imperil the sustainability of the remarkable gains that have been achieved over the past two decades in fighting killer infectious diseases and maternal and child health conditions.

Donor exits could particularly jeopardize gains in global HIV control. Countries and donors have spent more than $500 billion on HIV programs in low- and middle-income countries over the past two decades, but the gains from these investments are fragile. When donor funding for HIV programs ends, there is an especially acute risk of HIV re-emerging among “key populations”: vulnerable minority groups such as sex workers, men who have sex with men, people who inject drugs, transgender populations, and prisoners.

Too little attention has been paid to date to the needs of key populations during transition. This is a mistake. Unless departing donors and “graduating” countries address the risks that key populations face, these populations could suffer serious health setbacks, and the larger national achievements in fighting HIV/AIDS could easily be undermined or even reversed.

Almost everywhere in the world, key populations have higher rates of HIV infection than the general population, often 10-20 times higher. They face stigma, discrimination, and persecution, which in some countries can be enshrined in local laws and perpetrated even by health professionals. These communities thus require specially-designed and targeted prevention, counseling, and treatment services, often best delivered by peer groups and non-governmental organizations (NGOs).

At the same time, circumstances in these countries make it highly uncertain whether HIV programs for key populations will continue after donors depart.
Because key populations are highly marginalized and stigmatized, and because of the political “unpopularity” of helping these groups, programs for key populations tend to be heavily supported by outside donor organizations such as the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) and the US President’s Emergency Plan for AIDS Relief (PEPFAR).
When these donors leave, it is unclear – in some cases doubtful – whether national governments will pick up the tab for services targeted at vulnerable communities. In addition, many of the most effective programs for key populations are carried out by local NGOs, and governments are often reluctant or legally unable to provide funds through “social contracting” to these NGOs once donor support ends.

What Happens When Donors Leave?
To understand the risks that key populations face as a result of transition, we conducted an in-depth study of HIV donor transitions and key populations. This study was one of the first to examine in depth the risks and challenges of HIV transitions for key populations, looking both backward and into the future. We examined the global literature and data on a set of over 20 middle-income countries that have just transitioned or are on the verge of transitioning from donor aid in the next few years.

We then selected six countries. Three had recently “graduated” from donor assistance for HIV (China, Mexico, Romania) and the other three (Nigeria, Malaysia, and Cambodia) are scheduled to transition soon. We read the published and gray literature on these countries and conducted more than 15 interviews with experts...
https://www.healthaffairs.org/do/10.137 ... 3294/full/