What results can be expected from the agenda for aid effectiveness?

Introduction: Currently there is a climate of high expectations with regard to producing demonstrable results of aid effectiveness in the health sector. Yet, commitments to aid effectiveness have only partially been implemented so far. Existing evaluation frameworks developed in the context of the Paris Declaration and International Health Partnership (IHP+) are not sufficiently geared toward whether and how practices have changed at donor, central and operational levels, and thus how reforms have actually been implemented. Measuring their impact also presents methodological challenges.
Methods: This communication aims to present an outline of how to measure results from the agenda for aid effectiveness. It argues that it should be carried out at three levels. A first, critical step for evaluating the results from the Paris Declaration and IHP+ is to evaluate its implementation process and the direct effects it has had on changes in behaviour for all stakeholders (donors, government, service providers, etc.). A second level of evaluation is to assess how far donor support and implementation of Paris principles have contributed to health system strengthening (HSS) up to the level of service delivery. The third level where improvement is expected and should be measured is at health outcome/status level. Qualitative methods can help to understand what constraining factors are, what reforms have led to improvements and why, and finally the impact on population health.
Results: This three-level assessment was made in Mali. We found that some progress and positive changes have been observed in recent years that can be attributed to the agenda for aid effectiveness; outcome and impact indicators have also improved in the past years. However, donors have not fulfilled all their commitments.
Conclusion: Whilst changes in behaviour and practices are occurring, adherence to the principles of aid effectiveness is far from complete, thus expectations should be realistic.