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Partenariat pour le développement de la santé

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There is a tension between the often short-term goals of donors, who require quick and measurable results on their investments, and the longer-term needs of the health system.[1] That tension has only heightened in recent years, where the surge in international aid for particular diseases has come with ambitious coverage targets and intense scale-up efforts oriented much more to short-term than long-term goals. Though additional funding is particularly welcome in low-income contexts, it can often greatly reduce the negotiating power of national health system leaders in modifying proposed interventions or requesting simultaneous independent evaluations of these interventions as they roll out.

Harmonizing the policies, priorities and perspectives of donors with those of national policy-makers is an immediate and pressing concern – though with apparent solutions. In addition, the selective nature of these funding mechanisms (e.g. targeting only specific diseases and subsequent support strategies) may undermine progress towards the long-term goals of effective, high-quality and inclusive health systems.

Even where this funding has strengthened components of the health system specifically linked to service delivery in disease prevention and control – such as specific on-the-job staff training – the selective nature of these health systems strengthening strategies has sometimes been unsustainable, interruptive and duplicative. This puts great strain on the already limited and overstretched health workforce. In addition, focusing on "rapid-impact" treatment interventions for specific diseases and ignoring investments in prevention may also send sharply negative effects across the system’s building blocks, including, paradoxically, deteriorating outcome on the targeted diseases themselves.

Five mutually reinforcing principles of the Paris Declaration on Aid Effectiveness (2005)[2]

Many of these issues have been recognized internationally, and a number of donors have agreed to better harmonize their efforts and align with country-led priorities – as outlined in the 2005 Paris Declaration on Aid Effectiveness (see figure). However, although some progress has been made in applying the Paris Declaration principles, it has been slow and uneven. Change in the process and the nature of the relationship between donors and countries requires time, focused attention at all levels, and a determined political will.

This section of the health system profile is structured as follows:

3.4.1 Analytical summary
3.4.2 Partnership for health and coordination mechanisms Partnership coordination mechanisms Main partners by category, objectives and powers
3.4.3 Harmonization and alignment in line with primary health care approach Explicit policy on partners’ coordination Explicit policy on intersectoral collaboration and action Major actions carried out through intersectoral collaboration Stakeholders mapping by level and coordination structures Community awareness and involvement in the implementation of global initiatives – Millennium Declaration, Paris Declaration, etc.
3.4.4 Sector-wide approaches Multi-Donor Budget Support International Health Partnership and related initiatives (IHP+)/development of National Health Compacts Harmonization for Health in Africa Joint Assistance Strategy
3.4.5 Public–private partnership and civil society Private health sector mapping Explicit policy on private sector involvement Forms of engagement with private sector including contractual service agreements
3.4.6 South–South cooperation Existence of formalized South–South cooperation Mapping of areas of cooperation especially those related to health development Experiences to be shared regarding the South–South cooperation


  1. Systems thinking for health systems strengthening (pdf 1.54Mb). Geneva, World Health Organization, 2009
  2. The Paris Declaration on Aid Effectiveness (2005)