GLOBAL HEALTH AND INTERNATIONAL RELATIONS: ANALYSIS OF INTERNATIONAL DONOR AGENCIES IN THE NIGERIAN HEALTH

CHAPTER ONE

INTRODUCTION

Background to study

The influence of governments, multilateral agencies and private agencies that provide funds or conduct activities with the stated aim of improving health in low- and middle-income countries (LMICs) (collectively termed ‘donors’) remains prominent in the health policy process of recipient countries (Ollila 2005; Fraser and Whitfield 2009; Ravishankar et al. 2009). It is well documented that donor influence, or their ability to direct the decisions or priorities of national health policymakers, occurs when there is substantial reliance of recipient countries on external funding. For example, this can occur through the use of conditionality in policy-based lending or through the funding of vertical programmes, informed by particular policy approaches (Okuonzi and Macrae 1995; Rutkowski 2007; Groves and Hinton 2013).

However, in some countries, donor influence on health priority setting has been prominent even in the absence of substantial funding flows (Sridhar and Gomez 2011). Even when donors have reduced conditionality on funding, or provided direct budgetary assistance, questions have been raised about the use of alternative mechanisms by donors to continue to influence national policy processes (Mosley et al. 1995; Koeberle 2003; Swedlund 2013). Indeed, Harrison (2001) has used the term ‘postconditionality’ to reflect new modalities by which donors continue to influence recipient countries through more routine and centralized practices, such as national plans, surveys or budgeting and monitoring exercises; although these mechanisms have not yet been fully investigated, Harrison’s findings resonate with what Molenaers and Renard (2008) refer to as a ‘new aid approach,’ in which donors have started to support changes to planning and decision-making structures and processes (in addition to previous modalities of vertical project funding or horizontal budget support).