The evaluation of the Paris declaration on aid effectiveness: what does it tell us? What results for the health sector?

Five years after the signing of the Paris Declaration on aid effectiveness by donors and developing countries, there is a climate of high expectations about the results achieved and the impact at sector level. Several evaluations and monitoring surveys have been conducted by the OECD to measure progress made so far in implementing the principles of ownership, alignment, harmonisation, results and mutual accountability. For the health sector, results have also been documented in the context of the International Health Partnership (IHP+). We critically reviewed all the aid effectiveness surveys and evaluations published since 2005 by the OECD and IHP+ so as to analyse what results have been achieved so far as well as the relevance of the frameworks used. To date, results of the implementation of the Paris Declaration are mixed. In the health sector, good progress has been achieved in terms of country ownership and coordination, while alignment and use of country systems, managing for results and mutual accountability lag behind. However, the results recorded often reflect different interpretation of the indicators depending on the respondent, the data available or the time of the survey. Making generalisations is therefore difficult and comparisons between country surveys and over time may not be appropriate. Linking progress in aid effectiveness with improvements in health outcomes is also controversial. Results from the evaluations of the Paris Declaration should be used with caution in the current debate about aid effectiveness. What do the indicators used actually tell us? How realistically can aggregated scores reflect complex issues such as aid effectiveness in different countries, by different donors and over time? Improved evaluation is clearly needed. Data collection should be more rigorous and at sector level contextual factors and behaviour change should be better assessed, over a longer term and through more qualitative comprehensive methods.