Pathway to Universal Health Coverage: The Role of Development Assistance for Health

This thesis contributes to the global debate on aid effectiveness, an issue gaining urgency amid growing concerns over the future of development assistance. It examines how Development Assistance for Health (DAH) affects health outcomes in low- and middle-income countries (LMICs), with a particular focus on the mechanisms through which it enhances population health. Chapter 1 provides a landscape analysis of DAH programming. It shows that while year-on-year disbursements have remained relatively stable, there was a surge during the COVID-19 period – likely due to the response and recovery efforts. Chapter 2 forms the analytical foundation by systematically reviewing existing evidence on the impact of DAH. Although DAH yields health improvements, its effectiveness varies depending on the analytical methods used, the health outcomes measured, and the context in which it is delivered. Governance quality, health system capacity, and aid delivery models all shape these effects. The review also highlights key constraints, including fragmented funding streams, weak coordination, and a lack of alignment with national priorities. Building on these insights, Chapter 3 examines the role of Public Financial Management (PFM) systems in enhancing the effectiveness of aid. PFM determines how governments allocate and utilise public resources, including on-budget DAH. Using data from 67 LMICs (2005–2021), the analysis employs Generalised Methods of Moments to assess whether stronger PFM systems improve the impact of DAH. The results suggest that while both DAH and PFM contribute independently to modest health gains, there is limited evidence that PFM significantly amplifies the effectiveness of DAH – likely because most aid flows outside government systems. Chapter 4 presents a case study of DAH-funded tuberculosis (TB) diagnostics in Malawi. A Python-based individual-level simulation shows that GeneXpert testing is both cost-effective and sustainable. While mobile screening also yields health benefits, it offers lower value for money. Chapter 5 reflects on the findings. Overall, maximising the long-term and sustained impact of DAH depends on stronger governance, institutional capacity and the effective integration of aid within national systems.