Open Access Peer-reviewed

Donor Support and the Impacts on Health System Strengthening in Sub-Saharan Africa: Assessing the Evidence through a Review of the Literature

Ufuoma Ejughemre
Department of Community Medicine, Delta State University Teaching Hospital, Oghara, Delta State, Nigeria
American Journal of Public Health Research. 2013, 1(7), 146-151. DOI: 10.12691/ajphr-1-7-1
Published online: August 25, 2017


The signing of the United Nations millennium development goals created a platform for the injection of billions of dollars of donor funds into countries with great need. As it were, this funding is meant to accelerate the achievement of these goals by the year 2015 considering that amongst others, they will help in improving healthcare delivery and strengthen health systems. Of particular concern is the situation in sub-Saharan Africa. So far, the impact of donor support in the region has being fairly remarkable with funding to combat major health problems reaching unprecedented levels in recent times with improvements on certain fronts. However, reports have it that besides other issues in many instances funds are allocated only to disease specific projects (“vertical programming”) rather than to broad based investments (“horizontal programming”). Furthermore, the problem of corruption and mismanagement of these funds in many of the recipient countries are bothering issues warranting urgent solutions. As these issues do come to bear, it is critical to state that donor support is only a part of the development picture. There is now the need for sustainable policies for gradually exiting from donor funding for health, without which these countries dependant on humanitarian actors, will continue to cripple their ability to be self-sufficient and self reliant, and should these agencies cease to continue or run out of funding the consequences for the region are dire.


sub-Saharan Africa, donor support, health systems, sustainability
[1]  The United Nations General Assembly Session 55, Meeting 3. 6th September, 2000.
[2]  United Nations Summit Agenda; The largest gathering of world leaders in history meets in New York to discuss the role of the United Nations in the 21st century.". BBC News. 7th December, 2000. Retrieved 22nd November, 2006.
[3]  Hayman, R., Taylor, E.M., Crawford, F., Jeffery, P., Smith, J., Harper, I. The impact of aid on maternal and reproductive health. A systematic review to evaluate the effect of aid on the outcomes of Millennium Development Goal 5. London: 2011. EPPI-Centre, Social Science Research Unit, Institute of Education, University of London.
[4]  Musango L. Impact of HIV Projects on Health Systems in Rwanda. 2007, Kigali, Rwanda. PubMed
[5]  Yu D, Souteyran Y, Banda MA, Kaufman J, Perriëns JH. Investment in HIV/AIDS programs: Does it help strengthen health systems in developing countries? Globalization and Health 2008, 4:8.View Article  PubMed
[6]  Kim, J.Y., Gilks, C.F: Scaling up treatment – why we can't wait. New England Journal of Medicine 2005, 353:2352-2354.View Article  PubMed
[7]  United Nations Millennium Development Goal: Reduce Child Mortality". MDG Monitor. 5th May, 2011. Retrieved 18th October, 2012.
[8]  United Nations Millennium Development Goal: Improve Maternal Health". MDG Monitor. Retrieved 18th October, 2012.
[9]  United Nations Millennium Development Goal: Combat HIV/AIDS, Malaria and Other Diseases. MDG Monitor. Retrieved 18th October, 2012.
[10]  Bryan, L., Conway, M., Keesmat T., McKeena S., Richardson, B. A practical guide to Health System Strengthening in sub-Saharan Africa. Health International, 2009, pp1-3.
[11]  Kirigia M.J, Diarra-Nama A. Can countries of the WHO African Region wean themselves off donor funding for health? Bulletin of the World Health Organization 2008;86:889-895.View Article  PubMed
[12]  Greco, G., Powell-Jackson, T., Borghi, J., Mills, A. Countdown to 2015: Assessment of donor assistance to maternal, newborn, and child health between 2003 and 2006. The Lancet, 2008. 371: 1268-75.View Article
[13]  Powell-Jackson T, Borghi J, Mueller DH, Patouillard E, Mills A. Countdown to 2015: Tracking donor assistance to maternal, newborn, and child health. The Lancet 2006;368: 1077-87.View Article
[14]  Hsiao WC, 2007. Why is a systemic view of health financing necessary? Health Africa (Millwood) 26: 950-961.View Article  PubMed
[15]  Schieber, G., Gottret, P., Fleisher, L., Leive, A., 2007. Financing global health: mission unaccomplished. Health Aff 26: 921.View Article  PubMed
[16]  Okungu V. Has health aid failed to mitigate out-of-pocket expenditure in developing countries? International Health Policies News. 2011. Available at <> Accessed 5th May, 2013.
[17]  World Health Organization. Working Together For Health. The World Health Report 2006.
[18]  Aid to Africa, Policy Brief. 2010. Available Online at <> Accessed 30th April, 2013.
[19]  Leach-Kemon, K., Chou, D.P., Schneider, M.T., Tardif, A., Dieleman, J.L, Brooks, BP. The global financial crisis has led to a slowdown in growth of funding to improve health in many developing countries. Health Africa (Millwood). 2012; 31(1):228-35.View Article  PubMed
[20]  Shiffman, J. Has donor prioritization of HIV/AIDS displaced aid for other health issues? Health Policy and Planning. 2008;23(2):95-100.View Article  PubMed
[21]  Grépin, K.A. Health Services In Sub-Saharan Africa HIV Donor Funding Has Both Boosted And Curbed The Delivery Of Different Non-HIV. Health Affairs, 2012; 31, no.7:1406-1414.View Article  PubMed
[22]  The World Bank’s Commitment to HIV/AIDS in Africa: Our Agenda for Action, 2007-2011,” World Bank, 2008.
[23]  WHO Statistical Information System. Geneva: WHO 2008. Available Online <> Accessed on 30th September 2008.
[24]  WHO Engaging for health. Eleventh General Programme of Work 2006-2015. 2006 Online , available at <> Accessed 25th April, 2013.
[25]  Martinez J. Implementing a sector wide approach in health: the case of Mozambique. 2006. Available at <> Accessed 28th April, 2013.
[26]  Bernstein M, Sessions M. A. Trickle or a flood: commitments and disbursement for HIV/AIDS from the Global Fund, PEPFAR, and theWorld Bank’s Multi-Country AIDS Program (MAP.Washington (DC): Center for Global Development and HIV/AIDS Monitor 2007.
[27]  Information Nigeria. Available at < >2013, Accessed 1st May, 2013.
[28]  World Health Organization Report. Tuberculosis financing and Funding Gaps. 2013. Online < > Accessed 2nd May, 2013.
[29]  Carter Foundation 2013. Available at <> Accessed 2nd May, 2013.
[30]  Hotez. P.J  "How To Cure 1 Billion People? -- Defeat Neglected Tropical diseases". Scientific American. Retrieved 1st January, 2010.
[31]  BBC African News. Did more African aid deliver fewer coups? One Data Report, 2010. Available Online at <> Accessed 27th June,2013.
[32]  Jan De Maeseneer et al. Strengthening primary care: addressing the disparity between vertical and horizontal investment. Br J Gen Pract. 2008 January 1; 58(546): 3-4.View Article  PubMed
[33]  Musango, L. Impact des Projets de Lutte contre le VIH sur le Systeme de Sante´ au Rwanda. 2007, Kigali, Rwanda. PubMed
[34]  Price JE, Leslie JA, Welsh M, Binagwaho A, 2009. Integrating HIV clinical services into primary health care in Rwanda: a measure of quantitative effects. AIDS Care 21: 608-614.View Article  PubMed
[35]  Delph, E. Global Vertical Programmes. The Future of Aid or a Quick Fix? Quezon City, the Philippines: EURODAD. 2008.
[36]  Lewis, M. “Health and Corruption in Developing and Transition Countries”. Presented at the Transparency International Annual Conference, 2003. Seoul, Korea.
[37]  Transparency International. Global corruption report 2006: corruption and health. London: Pluto Press.
[38]  World Bank. 2005a. Doing Business in 2005: Removing Obstacles to Growth. Washington, D.C.: World Bank.
[39]  Lewis, M.“Informal Health Payments in Central and Eastern Europe and the Former Soviet Union: Issues, Trends and Policy Implications” in Funding Health Care: Options for Europe. 2002. Figueres and Moussiales. editors. Buckingham: Open University Press.
[40]  Lewis, M. Governance and Corruption in Public Health Care Systems. Working Paper2006. Pp. 21-22.
[41]  McPake, B.,A. D. Asiimwe, F.Mwesigye, et. al. “Informal Economic Activities of Public Health Workers in Uganda: Implications for Quality and Accessibility of Care.” Social Science and Medicine. 1999; 49: 849-865.View Article
[42]  Paris declaration on aid effectiveness: ownership, harmonization, alignment, results and mutual accountability. Paris: Organisation for Economic Co-operation and Development; 2005.
[43]  World Health Organization “Declaration of Alma Ata: International Conference on Primary Health Care, Alma Ata, USSR 6-12 September, 1978”. Available at < www. /hpr/NPH /docs /declaration_almaata.pdf> Accessed 26th June 2012.
[44]  Kirigia, J.M., Emrouznejad, A., Cassoma, B., Asbu, E.Z., Barry, S.A. Performance assessment method for hospitals: the case of municipal hospitals in Angola. Journal of Medical Systems 2008.View Article  PubMed
[45]  Gottret15. P, Schieber G. Health financing revisited: a practitioner’s guide. Washington, DC: The World Bank; 2006.
[46]  Health16. Financing: a strategy for the African Region. Brazzaville: WHO Regional Office for Africa; 2006.
[47]  Renner, A., Kirigia, J. M., Zere, A.E., Barry, S.P., Kirigia, D.G., Kamara, C., Muthuri, HK. Technical efficiency of peripheral health units in Pujehun district of Sierra Leone: a DEA application. BMC Health Serv Res 2005;5:77.View Article  PubMed
[48]  International Finance Corporation. The business of health in Africa: partnering with the private sector to improve people’s lives. Washington, DC: The World Bank; 2008.
[49]  Vian, T. Review of corruption in the health sector: theory, methods and interventions. Health Policy and Planning, 2008;23:83-94.View Article  PubMed