The Effectiveness of Official Development Assistance in the Health Sector in Africa

A Case Study of Uganda

by Cyriaque Sobtafo (Author)
©2023 Monographs XVI, 136 Pages
Series: Africa in the Global Space, Volume 7


Over recent decades, developing nations have been the beneficiaries of Official Development Assistance (ODA) from European and North American countries. ODA remains the central mechanism in sustaining and financing actions and processes related to international development. Despite these investments, experts continue to raise concerns about Africa’s poor performance on several development indicators.
This book discusses the main challenges to aid effectiveness in Africa, with a specific focus on the health sector. It provides policymakers, scholars, and development experts with innovative strategies and policy recommendations for refining aid management. The book also provides critical analysis of several global developmental frameworks and related international action plans and commitments, ranging from the 2030 Global Development Agenda and Sustainable Development Goals to the Paris Climate Agreement. Lastly, the book also analyzes several theoretical frameworks on development, including modernization, world systems, international dependency, neoclassical growth, the concept of gross national happiness, and human development.

"Dr Sobtafo brings a wealth of experience and broad practice to bear in what is an important reflective analysis on aid effectiveness and the nexus with development performance. There are lessons and insights that reach beyond Africa."
—Michael Upton, New Zealand Ambassador to Ethiopia and the African Union

"The book does first of all place people at the centre of the analysis, hence the pertinence of health and development as a focus. It further questions the common certainties on ODA and economic development and expands the discussion to include key drivers of human development and the necessity of partnership in an interdependent world. A pragmatic approach to deepen our understanding of complex issues that require more than simple solutions. Great ideas and questions for scholars, policy makers, and health and development practitioners."
— Elhadj As Sy, Chairman, Koffi Annan Foundation; Former Secretary General, The International Federation of Red Cross Crescent Societies (IFRC); and Former UNICEF Regional Director, Eastern and Southern Africa

Table Of Contents

  • Cover
  • Title
  • Copyright
  • About the author
  • About the book
  • This eBook can be cited
  • Contents
  • Preface: “Improving governance and accountability as a key step in improving ODA effectiveness in Africa”
  • Acknowledgments
  • Chapter 1. Understanding the Problematic Relationship Between Official Development Assistance and Health Development Indicators in Africa
  • Chapter 2. Theoretical Framework of ODA
  • Chapter 3. Global Development Framework and Related International Action Plans and Commitments
  • Chapter 4. Historical Review of Official Development Assistance (ODA) Effectiveness
  • Chapter 5. ODA to Health Sector
  • Chapter 6. ODA to the Ugandan Health Sector: Methodology of the Case Study
  • Chapter 7. ODA to Ugandan health Sector: Analysis of Results
  • Chapter 8. Conclusion and Suggestions

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It is my pleasure to introduce this research work that has addressed the effectiveness of Official Development Assistance (ODA), one of the critical issues of the international cooperation agenda, through a case study of its impact in the health sector in Uganda.

During the 25 years of working in the United Nations, I have traveled around the world, from my native continent, Africa, to Europe, Nord America and Oceania serving the United Nations in both in development and humanitarian contexts. The exposure and practical field experience on humanitarian and development issues has inspired me in embarking on this research journey that seeks to provide policymakers and development practitioners another perspective on the utilization of ODA. Over the past decades, developing nations have been the beneficiaries of ODA from European and North American countries. Stakeholders (e.g., members of the international community) of developed and developing countries view the ODA as a tool to ensure that underprivileged countries follow sustainable development approaches. African countries remain a major beneficiary of ODA over the years. Despite these investments, several experts continue to raise concerns about Africa’s poor performance on several development indicators.

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On an average, life expectancy at birth in several sub-Saharan African countries is below 50 years, whereas it is at least 70 years in developed nations. The maternal mortality ratio per 100,000 live births is more than 500 in several African countries compared to a ratio of less than 10 mortalities per 100,000 live births in developed countries. African health systems are underfunded, understaffed, overstretched and poorly equipped, making it seriously challenging to address the triple disease burden of communicable and non-communicable diseases and pandemics such as Ebola and COVID-19. According to the recent statistics of the WHO Africa has recorded approximately 25% of the world’s disease burden while – alarmingly – its share of global health expenditure is less than 1% and the continent houses only 3% of global health workers. It manufactures less than 2% of the medicines consumed in Africa. Most Africans, including those in the middle-income category, depend on underfunded public health facilities and only a very small elite minority can afford access to well-funded private health care.

In April 2001, heads of the state of African Union countries met in Abuja and committed to set a target of apportioning at least 15% of their annual budget to improving the health sector. Simultaneously, the African Union appealed to donor countries to their commitment to meeting the target of 0.7% of their GNP as official Development Assistance for developing countries. The Abuja declaration drew the attention of the entire world to the shortage of resources for improving health care in Africa. However, 20 years later, very few African countries have met this commitment.

With the commencement of the millennium development goal in 2000 until its end in 2015, despite substantial progress, several assessments and evaluation reports have consistently shown that performance on many health indicators is still lagging. Several challenges were enumerated, including weak institutional capacity; inadequate internal and external resources allocated to achieving the millennium development goals (MDGs); poor human resources; weak institutional capacity; inadequate statistical health data; and inadequate monitoring and evaluation capacity.

To streamline international development efforts, the international community launched in New York on 25 September 2015 the Sustainable Development Goals (SDGs) of the United Nations 2030 Agenda for Sustainable Development. This major development framework is built on an approach different than the preceding MDGs and is more universal in scope, with an emphasis on local adaptation and an accent on sustainability, while looking to expand integration across actors and domains for attaining results.

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The results of this case study on Uganda have emphasized on the governance and accountability system of the recipient country that includes establishing an accountable health management system framework, an appropriate role delineation policy for various levels of health facilities, a transparent process of procuring health commodities and clear anti-corruption policies with an effective law enforcement mechanism as the main prerequisite for ODA effectiveness and sustainable development at large.

This book also includes an expansion on providing in Chaps. 2 and 3, a detailed critical analysis on the theoretical frameworks on development and International Consensual Development Frameworks, commonly called the Global Agenda or Platform for Action, respectively. The aid management has been at the heart of various economic development theories since academics believe that recipient countries and donor countries can strengthen their co-operation with an appropriate model. Modernization, world systems, international dependency, neoclassical growth, basic needs model, the concept of gross national happiness and human development are some of the theories that have been reviewed in this study, because they provide insight into the aid management and its associated challenges in Africa.

I encourage all of you to read and disseminate this research work that represents another step in our collective efforts in promoting the achievement of sustainable development goals in Africa.

Dr Cyriaque Rene Sobtafo Nguefack

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I would like to convey my deepest gratitude to my three mentors at the University of Phoenix, Dr Yohannes Mariam, Dr Zoba Madueke, and Dr Cristal Lupo for their time and commitment in providing me with guidance and assistance.

My sincere appreciation also goes to all participants, the developmental cohorts working in Uganda, who voluntarily participated in this study, sacrificed their time to engage with me and held a vested interest in this study.


XVI, 136
ISBN (Hardcover)
Publication date
2023 (May)
Official Development Assistance health development indicators Aid effectiveness Technical cooperation health care governance Sustainable Development Goals International Development Cooperation The Effectiveness of Official Development Assistance in the Health Sector in Africa A Case Study of Uganda
New York, Berlin, Bruxelles, Lausanne, Oxford, 2023. XVI, 136 pp., 2 b/w ill., 2 tables.

Biographical notes

Cyriaque Sobtafo (Author)

Dr. Cyriaque Rene Sobtafo Nguefack has over 25 years of experience serving as Senior International Development Expert at the United Nations. He has worked in Africa, North America, Europe, and Oceania. He holds a PhD in Management from the School of Advanced Studies at the University of Phoenix (US), a Dynamic Leadership Certificate from Harvard Business School (US), and an engineer’s degree in food technology from the University of Ngaoundere (Cameroon).


Title: The Effectiveness of Official Development Assistance in the Health Sector in Africa