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Health Policy and Planning; 9(4): 371-384
© 1994

research-article

Donor funding for health reform in Africa: is non-project assistance the right prescription?

ANNE-MARIE FOLTZ

Department of Epidemiology and Public Health, School of Medicine, Yale University, USA

Correspondence: Dr Anne-Marie Foltz, 43 Lincoln Street, New Haven, CT 06511, USA.

During the past 10 years, donors have recognized the need for major reforms to achieve sustainable development. Using non-project assistance they have attempted to leverage reforms by offering financing conditioned on the enactment of reform. The experience of USAID's health reform programmes in Niger and Nigeria suggest these programmes have proved more difficult to implement than expected. When a country has in place a high level of fiscal accountability and high institutional capacity, programmes of conditioned non-project assistance may be more effective in achieving reforms than traditional project assistance. However, when these elements are lacking, as they were in Niger, non-project assistance offers nothing inherently superior than traditional project assistance. Non-project assistance may be most effective for assisting the implementation of policy reforms adopted by the host government.


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