Aid Effectiveness and Intervention Outcomes in a Fragile Situation: Comparative Evaluation of Three Aid Management Modalities in Timor-Leste’s Health Sector
In the context of ongoing discourse on development effect of foreign aid on the recipient country, the Paris Declaration (2005) espoused five principles of aid effectiveness: recipient country ownership, alignment, harmonization, managing for results, and mutual accountability. Studies are limited so far to evaluate compliance of different aid management modalities in a fragile state with these principles and if such compliance results in better programmatic outcomes. Employing a theory driven realist evaluation approach, this research attempted to pilot test an approach and range of analytical tools to critically evaluate and compare effectiveness of three externally funded projects in Timor-Leste’s health sector and their possible relations with compliance with the Paris principles. These projects were: AusAID and World Bank funded Health Sector Strategic Plan Strengthening Project (HSSP-SP) that used a sector wide approach (SWAp), the Global Fund funded National HIV/AIDS and STI Programme (NAP) that used government mechanism but different financial management and monitoring systems, and USAID funded Immunizasaun Proteje Labarik (IPL) that used NGO contracting mechanism. Mixed methods and tools used in this research included balanced scorecards for stakeholder perceptions, cost-effectiveness and technical efficiency analysis, data envelopment analysis (DEA), and correlations analysis. A quasi-experimental design was used for cost-effectiveness analysis by mathematically modeling the counterfactual scenarios of likely effect of absence of an intervention on outcomes. Results were validated by comparing and triangulating findings from different techniques in relation to their underlying programme theories. With identified limitations, analytical tools and techniques used in this research showed potential as an approach for comparatively evaluating national level aid funded projects. Analysis of the research findings indicates that aid management modalities possibly matter in achieving programmatic outcomes and health systems strengthening in a fragile situation. However, investigation on the correlation between compliance with the Paris principles and better programmatic outcomes could not be concluded due to small sample size. The approach employed in this research would be more useful with increased sample size and more sophisticated statistical analysis.
Advisor: Gauld, Robin; Hill, Philip
Degree Name: Doctor of Philosophy
Degree Discipline: Department of Preventive and Social Medicine
Publisher: University of Otago
Keywords: aid effectiveness; impact evaluation; fragile state; Paris Declaration; health systems
Research Type: Thesis