Yale School of Public Health, New Haven, CT, USA.
Center for Supporting Community Development Initiatives (SCDI), Hanoi, Viet Nam.
Soc Sci Med. 2015 May;132:165-72. doi: 10.1016/j.socscimed.2015.03.027. Epub 2015 Mar 14.
The study objective was to identify how donors and government agencies in Vietnam responded to donor proliferation in health sector aid between 1995 and 2012. Interviews were conducted with key informants from donor agencies, central government, and civil society in Hanoi in 2012 (n = 34 interviews), identified through OECD Creditor Reporting System data, internet research, and snowball sampling. Interview transcripts were coded for key themes using the constant comparative method. Documentary materials were used in triangulation and validation of key informant accounts. The study identified a timeline of key events and key themes. The number of donors providing health sector aid to Vietnam increased sharply during the late 1990s and early 2000s, then leveled off and declined between 2008 and 2012. Reasons for donor entry included Vietnam's health needs, perceptions of health as less politically sensitive, and donor interests in facilitating market access. Reasons for donor withdrawal included Vietnam's achievement of middle-income status, the global financial crisis, and donors' shifting global priorities. Key themes included high competition among donors, strategic actions by government to increase its control over aid, and the multiplicity of government units involved with health sector aid. The study concludes that central government and donor agencies in Vietnam responded to donor proliferation in health sector aid by endorsing aid effectiveness policies but implementing these policies inconsistently in practice. Whereas previous literature has emphasized donor proliferation's transaction costs, this study finds that the benefits of a large number of less coordinated donors may outweigh the increased administrative costs under certain conditions. In Vietnam, these conditions included relatively high capacity within government, low government dependence on aid, and government interest in receiving diverse donor recommendations. Vietnam's experience of donor proliferation followed by donor withdrawal illustrates a trajectory that other countries may experience as they transition from low-to middle-income status.
本研究旨在探讨 1995 年至 2012 年间，越南的捐赠者和政府机构如何应对卫生部门援助中捐赠者激增的情况。2012 年，在河内对来自捐赠机构、中央政府和民间社会的主要信息提供者进行了访谈（n=34 次访谈），这些信息提供者是通过经合组织债权国报告系统数据、互联网研究和滚雪球抽样确定的。访谈记录采用恒定性比较方法进行编码，以确定关键主题。文件材料用于三角验证和主要信息提供者说法的验证。该研究确定了关键事件和关键主题的时间线。在 20 世纪 90 年代末和 21 世纪初，向越南提供卫生部门援助的捐赠者数量急剧增加，然后在 2008 年至 2012 年间趋于平稳并有所下降。捐赠者进入的原因包括越南的卫生需求、认为卫生问题不太敏感，以及捐赠者希望促进市场准入。捐赠者退出的原因包括越南达到中等收入国家地位、全球金融危机以及捐赠者转移全球重点。关键主题包括捐赠者之间的激烈竞争、政府采取战略行动增加对援助的控制，以及参与卫生部门援助的政府单位众多。该研究得出的结论是，越南中央政府和捐赠机构通过支持援助有效性政策对卫生部门援助中的捐赠者激增做出了回应，但在实践中实施这些政策的一致性存在差异。虽然之前的文献强调了捐赠者激增的交易成本，但本研究发现，在某些情况下，大量较少协调的捐赠者的好处可能超过增加的行政成本。在越南，这些情况包括政府内部相对较高的能力、政府对援助的依赖程度较低，以及政府对接受不同捐赠者建议的兴趣。越南经历的捐赠者激增继而出现捐赠者退出的情况表明，其他国家在从中等收入国家向高收入国家过渡时可能会经历类似的轨迹。
