title: Does donor proliferation in development aid for health affect health service delivery and population health? Cross-country regression analysis from 1995 to 2010.
abstract: BACKGROUND
  Previous literature suggests that increasing numbers of development aid donors can reduce aid effectiveness but this has not been tested in the health sector, which has experienced substantial recent growth in aid volume and number of donors.
  
  
  METHODS
  Based on annual data for 1995-2010 on 139 low- and middle-income countries that received health sector aid from donors reporting to the OECD's Creditor Reporting System, the study used two-step system generalized method of moments regression models to test whether the number of health aid donors and an index of health aid donor fragmentation affect health services (measured by DTP3 immunization rate) or health outcomes (measured by infant mortality rate) for three subsectors of health aid.
  
  
  RESULTS
  For total health aid and for the general and basic health aid subsector, controlling for economic and political conditions, increases in the number of donors were associated with increases in DTP3 immunization rate and reductions in infant mortality while increases in the donor fragmentation index were associated with decreases in DTP3 immunization rate and increases in infant mortality, though none of these relationships were statistically significant. For the population and reproductive health aid subsector, a one percent increase in the number of donors was associated with a 0.23 percent decrease in DTP3 immunization ( P <  0.01) while a one percent increase in donor fragmentation was associated with a 0.54 percent increase in DTP3 immunization rate ( P <  0.01); associations with infant mortality rates for this subsector were similar to those for total health aid.
  
  
  CONCLUSIONS
  The results do not provide clear evidence in support of the hypothesis that donor proliferation negatively impacts development results in the health sector. Aid effectiveness policy prescriptions should distinguish responses to donor proliferation versus donor fragmentation and be adapted to specific subsectors of health aid.
authors.forename: Sarah Wood
authors.initials: SW
authors.lastname: Pallas
authors.affiliation: Current address: Perelman School of Medicine and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Jennifer Prah
authors.initials: JP
authors.lastname: Ruger
mesh_terms: D003695:Delivery of Health Care / Q000191:economics; D003906:Developing Countries / Q000191:economics; D005381:Financing, Organized / Q000191:economics / Q000639:trends*; D014943:Global Health; D019981:Health Care Sector / Q000191:economics*; D006801:Humans; D007391:International Cooperation
keywords:  Aid effectiveness; aid fragmentation; development assistance for health (DAH); global health