Critical barriers to sustainable capacity strengthening in global health: a systems perspective on development assistance [version 2; peer review: 2 approved, 1 approved with reservations]
Background: Development assistance for health (DAH) is an important mechanism for funding and technical support to low-income countries. Despite increased DAH spending, intractable health challenges remain. Recent decades have seen numerous efforts to reform DAH models, yet pernicious challenges per...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
F1000 Research Ltd
2023-01-01
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| Series: | Gates Open Research |
| Subjects: | |
| Online Access: | https://gatesopenresearch.org/articles/6-116/v2 |
| _version_ | 1797948294942425088 |
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| author | Nosa Orobaton Dyness Kasungami Amanda Coile Barbara Knittel Sweta Saxena Annette Zou Doris Bartel Logan Brenzel Rose Kambarami Cecilia Abimbola Williams Ishrat Husain Dipak Prasad Tiwari Jane Achan Godfrey Sikipa Banny Banerjee John Ovuoraye Ajiwohwodoma |
| author_facet | Nosa Orobaton Dyness Kasungami Amanda Coile Barbara Knittel Sweta Saxena Annette Zou Doris Bartel Logan Brenzel Rose Kambarami Cecilia Abimbola Williams Ishrat Husain Dipak Prasad Tiwari Jane Achan Godfrey Sikipa Banny Banerjee John Ovuoraye Ajiwohwodoma |
| author_sort | Nosa Orobaton |
| collection | DOAJ |
| description | Background: Development assistance for health (DAH) is an important mechanism for funding and technical support to low-income countries. Despite increased DAH spending, intractable health challenges remain. Recent decades have seen numerous efforts to reform DAH models, yet pernicious challenges persist amidst structural complexities and a growing number of actors. Systems-based approaches are promising for understanding these types of complex adaptive systems. This paper presents a systems-based understanding of DAH, including barriers to achieving sustainable and effective country-driven models for technical assistance and capacity strengthening to achieve better outcomes Methods: We applied an innovative systems-based approach to explore and map how donor structures, processes, and norms pose challenges to improving development assistance models. The system mapping was carried out through an iterative co-creation process including a series of discussions and workshops with diverse stakeholders across 13 countries. Results: Nine systemic challenges emerged: 1) reliance on external implementing partners undermines national capacity; 2) prioritizing global initiatives undercuts local programming; 3) inadequate contextualization hampers program sustainability; 4) decision-maker blind spots inhibit capacity to address inequities; 5) power asymmetries undermine local decision making; 6) donor funding structures pose limitations downstream; 7) program fragmentation impedes long-term country planning; 8) reliance on incomplete data perpetuates inequities; and 9) overemphasis on donor-prioritized data perpetuates fragmentation. Conclusions: These interconnected challenges illustrate interdependencies and feedback loops manifesting throughout the system. A particular driving force across these system barriers is the influence of power asymmetries between actors. The articulation of these challenges can help stakeholders overcome biases about the efficacy of the system and their role in perpetuating the issues. These findings indicate that change is needed not only in how we design and implement global health programs, but in how system actors interact. This requires co-creating solutions that shift the structures, norms, and mindsets governing DAH models. |
| first_indexed | 2024-04-10T21:41:06Z |
| format | Article |
| id | doaj.art-1f384154f6b4496dbb320c5066d40bd9 |
| institution | Directory Open Access Journal |
| issn | 2572-4754 |
| language | English |
| last_indexed | 2024-04-10T21:41:06Z |
| publishDate | 2023-01-01 |
| publisher | F1000 Research Ltd |
| record_format | Article |
| series | Gates Open Research |
| spelling | doaj.art-1f384154f6b4496dbb320c5066d40bd92023-01-19T01:00:00ZengF1000 Research LtdGates Open Research2572-47542023-01-01615683Critical barriers to sustainable capacity strengthening in global health: a systems perspective on development assistance [version 2; peer review: 2 approved, 1 approved with reservations]Nosa Orobaton0https://orcid.org/0000-0001-6440-8118Dyness Kasungami1https://orcid.org/0000-0002-3944-7817Amanda Coile2https://orcid.org/0000-0002-4898-4745Barbara Knittel3https://orcid.org/0000-0003-4447-8615Sweta Saxena4https://orcid.org/0000-0003-1500-5747Annette Zou5Doris Bartel6Logan Brenzel7https://orcid.org/0000-0002-7506-7686Rose Kambarami8https://orcid.org/0000-0002-0049-4974Cecilia Abimbola Williams9Ishrat Husain10Dipak Prasad Tiwari11https://orcid.org/0000-0003-4967-2329Jane Achan12https://orcid.org/0000-0001-8111-025XGodfrey Sikipa13Banny Banerjee14John Ovuoraye Ajiwohwodoma15https://orcid.org/0000-0001-6393-1046Bill & Melinda Gates Foundation, Seattle, WA, 98109, USAJSI Research & Training Institute, Inc., Arlington, VA, 22202, USAJSI Research & Training Institute, Inc., Arlington, VA, 22202, USAJSI Research & Training Institute, Inc., Arlington, VA, 22202, USAUnited States Agency for International Development, Washington, DC, 20523, USAGlobal ChangeLabs, Portola Valley, CA, 94028, USAIndependent Researcher, Washington, District of Columbia, USABill & Melinda Gates Foundation, Seattle, WA, 98109, USAUniversity of Zimbabwe, Harare, ZimbabweIndependent Consultant, Abuja, NigeriaUnited States Agency for International Development, Washington, DC, 20523, USABagmati Province Health Office, Ministry of Health, Chitwan, NepalMalaria Consortium, Kampala, UgandaCOMPRE Health Services, Harare, ZimbabweGlobal ChangeLabs, Portola Valley, CA, 94028, USAFederal Ministry of Health, Abuja, NigeriaBackground: Development assistance for health (DAH) is an important mechanism for funding and technical support to low-income countries. Despite increased DAH spending, intractable health challenges remain. Recent decades have seen numerous efforts to reform DAH models, yet pernicious challenges persist amidst structural complexities and a growing number of actors. Systems-based approaches are promising for understanding these types of complex adaptive systems. This paper presents a systems-based understanding of DAH, including barriers to achieving sustainable and effective country-driven models for technical assistance and capacity strengthening to achieve better outcomes Methods: We applied an innovative systems-based approach to explore and map how donor structures, processes, and norms pose challenges to improving development assistance models. The system mapping was carried out through an iterative co-creation process including a series of discussions and workshops with diverse stakeholders across 13 countries. Results: Nine systemic challenges emerged: 1) reliance on external implementing partners undermines national capacity; 2) prioritizing global initiatives undercuts local programming; 3) inadequate contextualization hampers program sustainability; 4) decision-maker blind spots inhibit capacity to address inequities; 5) power asymmetries undermine local decision making; 6) donor funding structures pose limitations downstream; 7) program fragmentation impedes long-term country planning; 8) reliance on incomplete data perpetuates inequities; and 9) overemphasis on donor-prioritized data perpetuates fragmentation. Conclusions: These interconnected challenges illustrate interdependencies and feedback loops manifesting throughout the system. A particular driving force across these system barriers is the influence of power asymmetries between actors. The articulation of these challenges can help stakeholders overcome biases about the efficacy of the system and their role in perpetuating the issues. These findings indicate that change is needed not only in how we design and implement global health programs, but in how system actors interact. This requires co-creating solutions that shift the structures, norms, and mindsets governing DAH models.https://gatesopenresearch.org/articles/6-116/v2Development assistance for health capacity strengthening system design donor funding reform donor-recipient relationships aid reformeng |
| spellingShingle | Nosa Orobaton Dyness Kasungami Amanda Coile Barbara Knittel Sweta Saxena Annette Zou Doris Bartel Logan Brenzel Rose Kambarami Cecilia Abimbola Williams Ishrat Husain Dipak Prasad Tiwari Jane Achan Godfrey Sikipa Banny Banerjee John Ovuoraye Ajiwohwodoma Critical barriers to sustainable capacity strengthening in global health: a systems perspective on development assistance [version 2; peer review: 2 approved, 1 approved with reservations] Gates Open Research Development assistance for health capacity strengthening system design donor funding reform donor-recipient relationships aid reform eng |
| title | Critical barriers to sustainable capacity strengthening in global health: a systems perspective on development assistance [version 2; peer review: 2 approved, 1 approved with reservations] |
| title_full | Critical barriers to sustainable capacity strengthening in global health: a systems perspective on development assistance [version 2; peer review: 2 approved, 1 approved with reservations] |
| title_fullStr | Critical barriers to sustainable capacity strengthening in global health: a systems perspective on development assistance [version 2; peer review: 2 approved, 1 approved with reservations] |
| title_full_unstemmed | Critical barriers to sustainable capacity strengthening in global health: a systems perspective on development assistance [version 2; peer review: 2 approved, 1 approved with reservations] |
| title_short | Critical barriers to sustainable capacity strengthening in global health: a systems perspective on development assistance [version 2; peer review: 2 approved, 1 approved with reservations] |
| title_sort | critical barriers to sustainable capacity strengthening in global health a systems perspective on development assistance version 2 peer review 2 approved 1 approved with reservations |
| topic | Development assistance for health capacity strengthening system design donor funding reform donor-recipient relationships aid reform eng |
| url | https://gatesopenresearch.org/articles/6-116/v2 |
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