Division of Health Sector Development, World Health Organization, Regional Office for the Western Pacific, PO Box 2932, Manila, Philippines.
Glob Public Health. 2011;6(6):606-20. doi: 10.1080/17441692.2010.530289.
Viet Nam is one of the brightest stars in the constellation of developing countries. Its remarkable achievements in reducing poverty and improving health and education outcomes are well known, and as a result it has enjoyed generous aid programmes. Viet Nam also has a reputation for taking a strong lead in disciplining its donors and pushing for more efficient and effective forms of aid delivery, both at home and internationally. This article discusses how efforts to improve the effectiveness of aid intersect with policy-making processes in the health sector. It presents a quantitative review of health aid flows in Viet Nam and a qualitative analysis of the aid environment using event analysis, participant observation and key informant interviews. The analysis reveals a complex and dynamic web of incentives influencing the implementation of the aid effectiveness agenda in the health sector. There are contradictory forces within the Ministry of Health, within government as a whole, within the donor community and between donors and government. Analytical frameworks drawn from the study of policy networks and governance can help explain these tensions. They suggest that governance of health aid in Viet Nam is characterised by multiple, overlapping 'policy networks' which cut across the traditional donor-government divide. The principles of aid effectiveness make sense for some of these communities, but for others they are irrational and may lead to a loss of influence and resources. However, sustained engagement combined with the building of strategic coalitions can overcome individual and institutional incentives. This article suggests that aid reform efforts should be understood not as a technocratic agenda but as a political process with all the associated tensions, perverse incentives and challenges. Partners thus need to recognise - and find new ways of making sense of - the complexity of forces affecting aid delivery.
越南是发展中国家群体中的一颗璀璨明星。其在减贫和改善卫生与教育成果方面的显著成就广为人知，因此获得了大量援助计划。越南还以在约束捐助方和推动更高效、更有效的援助交付形式方面发挥强有力的领导作用而著称，无论是在国内还是在国际上。本文讨论了提高援助有效性的努力如何与卫生部门的决策过程相交织。它通过事件分析、参与式观察和关键知情者访谈，对越南的卫生援助流动进行了定量审查，并对援助环境进行了定性分析。分析揭示了影响卫生部门援助有效性议程实施的一个复杂而动态的激励网络。卫生部内部、整个政府内部、捐助界内部以及捐助方与政府之间都存在相互矛盾的力量。从政策网络和治理研究中汲取的分析框架可以帮助解释这些紧张关系。它们表明，越南的卫生援助治理具有多个重叠的“政策网络”，跨越了传统的捐助方-政府界限。援助有效性原则对其中一些群体来说是有意义的，但对其他群体来说则是不合理的，可能导致影响力和资源的丧失。然而，持续参与并建立战略联盟可以克服个人和机构的激励。本文认为，援助改革努力不应被理解为一个技术官僚议程，而应被理解为一个具有所有相关紧张关系、反常激励和挑战的政治过程。因此，合作伙伴需要认识到——并找到新的方法来理解影响援助交付的复杂力量。
