|dc.description.abstract||Previous research on development assistance highlights the importance of the recipient country implementing environment in mediating the impact of aid; however, little is known about the donor side of the donor-recipient relationship. This dissertation fills this gap in understanding by characterizing and assessing the role of this powerful yet neglected set of stakeholders and their influence on aid goals, implementation and effectiveness. It investigates: what are the salient dimensions along which donors differ, how these differences influence health coverage and outcomes, and what features of the domestic policy process shape which approaches donors pursue. I examine these questions using mixed methods: analyses of Congressional hearings, a comparative case study of international donors in the health sector in Peru, and quantitative analyses of the cross-national Development Assistance for Health dataset.
This body of work offers three key insights for development assistance, related to recipient country ownership, donor type and goal alignment. First, the most prominent difference across donors was the extent to which they formally involved recipient country public, private and civil society sectors in problem identification, resource administration,
program design, implementation and governance. The Peruvian context revealed three ownership patterns: ‘doctor knows best’, ‘empowered patient’ and ‘it takes a village’ models, highlighting the dominance of foreign actors and the central government in development activities. The cross-national data support wide variation in donor perception of the capability and roles of recipient country actors, indicating very low levels, infrequent and inconsistent allocation of budget support financing, in which funds are channeled directly through recipient institutions. Second, rather than observing systematic differences between bilateral and multilateral donors, there was greater variation among rather than across donor types. Actors along the aid implementation chain identified multiple entities to whom they were accountable. Third, although there existed considerable goal alignment among stakeholders within donor countries and between donors and recipients, there was little harmonization or coherence across these very wide sets of goals. Taken together, these findings highlight the unrealized potential to substantially expand the formal involvement of recipient country actors, and the need to prioritize among broad sets of foreign assistance and development goals.||en_US