Critical barriers to sustainable capacity strengthening in global health: a systems perspective on development assistance
نویسندگان
چکیده
Background: Development assistance for health (DAH) is an important mechanism funding and technical support to low-income countries. Despite increased DAH spending, intractable challenges remain. Recent decades have seen numerous efforts reform models, yet pernicious persist amidst structural complexities a growing number of actors. Systems-based approaches are promising understanding these types complex adaptive systems. This paper presents systems-based DAH, including barriers achieving sustainable effective country-driven models capacity strengthening achieve better outcomes Methods: We applied innovative approach explore map how donor structures, processes, norms pose improving development models. The system mapping was carried out through iterative co-creation process series discussions workshops with diverse stakeholders across 13 countries. Results: Nine systemic emerged: 1) reliance on external implementing partners undermines national capacity; 2) prioritizing global initiatives undercuts local programming; 3) inadequate contextualization hampers program sustainability; 4) decision-maker blind spots inhibit address inequities; 5) power asymmetries undermine decision making; 6) structures limitations downstream; 7) fragmentation impedes long-term country planning; 8) incomplete data perpetuates 9) overemphasis donor-prioritized fragmentation. Conclusions: These interconnected illustrate interdependencies feedback loops manifesting throughout the system. A particular driving force influence between articulation can help overcome biases about efficacy their role in perpetuating issues. These findings indicate that change needed not only we design implement programs, but actors interact. requires co-creating solutions shift norms, mindsets governing models.
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ژورنال
عنوان ژورنال: Gates open research
سال: 2023
ISSN: ['2572-4754']
DOI: https://doi.org/10.12688/gatesopenres.13632.2