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Health Policy Plan. 1999 Sep;14(3):243-53.

Managing external resources in Mozambique: building new aid relationships on shifting sands?

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1
Ministry of Health, Maputo, Mozambique.

Abstract

The Mozambican health sector is recovering from war and general disruption. This massive endeavour is supported by several donor agencies, which contribute a substantial proportion of national health expenditure. The final years of the war and the transition period have seen an extreme fragmentation of the health sector. To correct it, serious efforts to coordinate the plethora of aid agencies and related external inputs have taken place. This paper reviews the actors present on the Mozambican health scene and their interactions. The existing aid management mechanisms are described and their effectiveness appraised. The factors affecting both the process and its outcomes are analyzed. Given the prevailing complexity, this research presents a number of tentative conclusions. First, the evidence suggests that coordination efforts have paid off. However, progress has required intense and sustained work. Incremental approaches, where donor demands are progressively raised as the system is strengthened, have been crucial. The initiative has come mainly from donors, with the Ministry of Health receptive and reactive. When the recipient administration has been able to take advantage of donor initiatives, success has ensued. Individual people have been crucial in shaping the process. Critical factors contributing to positive developments on both sides of the donor-recipient relationship have been frankness, risk-taking and a long-term perspective.

PIP:

This paper evaluates the interactions between actors present in the Mozambican health scene. Analyses are done in its existing aid management mechanism, factors influencing the effectiveness of coordination mechanisms and its outcomes. This study is based on a review of documents and interviews with key government and donor informants carried out in 1997. Mozambique has changed from a socialist state to a market oriented economy. During this transition, a dramatic increase in aid dependence has taken place. The process of aid management has been incremental and innovative, where there's an open-ended process of its budget support. It showed that coordination efforts in Mozambique have paid off even in an unstable environment. However, the progress requires intense and sustained work among the key government and donors. Furthermore, incremental approaches, where donor demands are progressively raised as the system is strengthened. The initiative has come mainly from donors, with the Ministry of Health being receptive and reactive. Successful coordination emerged from trial and error, where it can be ensued when administration has been able to take advantage of donor initiatives. Factors contributing to positive development among donor-recipient relationship are risk-taking, labor-intensive, and a long-term perspective.

PMID:
10621241
[Indexed for MEDLINE]
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