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Original research
Transitioning from donor aid for health: perspectives of national stakeholders in Ghana
  1. Wenhui Mao1,
  2. Kaci Kennedy McDade1,
  3. Hanna E Huffstetler1,
  4. Joseph Dodoo2,3,
  5. Daniel Nana Yaw Abankwah4,
  6. Nathaniel Coleman5,
  7. Judy Riviere1,
  8. Jiaqi Zhang1,
  9. Justice Nonvignon5,
  10. Ipchita Bharali1,
  11. Shashika Bandara1,
  12. Osondu Ogbuoji1,
  13. Gavin Yamey1
  1. 1Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, North Carolina, USA
  2. 2Policy Planning Monitoring and Evaluation Directorate, Policy Coordination Unit, Ghana Ministry of Health, Accra, Greater Accra, Ghana
  3. 3School of Public Health and Family Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa
  4. 4Department of Social and Behavioral Sciences, University of Ghana School of Public Health, Accra, Greater Accra, Ghana
  5. 5University of Ghana School of Public Health, Accra, Greater Accra, Ghana
  1. Correspondence to Dr Gavin Yamey; gavin.yamey{at}duke.edu

Abstract

Background Ghana’s shift from low-income to middle-income status will make it ineligible to receive concessional aid in the future. While transition may be a reflection of positive changes in a country, such as economic development or health progress, a loss of support from donor agencies could have negative impacts on health system performance and population health. We aimed to identify key challenges and opportunities that Ghana will face in dealing with aid transition, specifically from the point of view of country-level stakeholders.

Methods We conducted key informant interviews with 18 stakeholders from the government, civil society organisations and donor agencies in Ghana using a semistructured interview guide. We performed directed content analysis of the interview transcripts to identify key themes related to anticipated challenges and opportunities that might result from donor transitions.

Results Overall, stakeholders identified challenges more frequently than opportunities. All stakeholders interviewed believe that Ghana will face substantial challenges due to donor transitions. Challenges include difficulty filling financial gaps left by donors, the shifting of national priorities away from the health sector, lack of human resources for health, interrupted care for beneficiaries of donor-funded health programmes, neglect of vulnerable populations and loss of the accountability mechanisms that are linked with donor financing. However, stakeholders also identified key opportunities that transitions might present, including efficiency gains, increased self-determination and self-sufficiency, enhanced capacity to leverage domestic resources and improved revenue mobilisation.

Conclusion Stakeholders in Ghana believe transitioning away from aid for health presents both challenges and opportunities. The challenges could be addressed by conducting a transition readiness assessment, identifying health sector priorities, developing a transition plan with a budget to continue critical health programmes and mobilising greater political commitment to health. The loss of aid could be turned into an opportunity to integrate vertical programmes into a more comprehensive health system.

  • health policy
  • qualitative study
https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjgh-2020-003896

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    Footnotes

    • Handling editor Edwine Barasa

    • Twitter @kennedy_kaci, @gyamey

    • WM and KKM contributed equally.

    • Contributors All authors have contributed to, reviewed and agreed to the submission of this manuscript. All authors declare no competing interests. GY, OO, JN and JD conceptualised the study. WM, KKM, HEH, JD, NYA, NC, RJ, JZ, JN, IB and SB contributed to the data collection, transcribing, coding and analysis. WM and KKM drafted the manuscript with inputs from all authors.

    • Funding This project was funded by a Duke Global Health Institute pilot grant and Bill & Melinda Gates Foundation (OPP1199624). We thank Dr Gilbert A. Abiiro from the Department of Planning, University for Development Studies, Ghana, for insightful comments on an early draft of the manuscript, and Zoha Farooqi and Xinqi Zhang from the Duke Global Health Institute, Duke University, for their help with the literature review.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval Ethical approval for this study was obtained from the Duke University Institutional Review Board (Campus IRB #2019-0015) and the Ghana Health Service Ethical Review Committee (GHS-ERC011-/08/18).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Upon the request of IRB, interview transcripts used for the analysis are confidential (as they could identify the participants).

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.