Development cooperation for health: reviewing a dynamic concept in a complex global aid environment

In late November 2011 global stakeholders met in Busan, South Korea for the 4th High Level Forum on Aid Effectiveness, planning the next iteration in the evolution of aid effectiveness. The Aid Effectiveness Agenda has roots that extend well before the 2005 declaration of the Paris Principles, with their emphasis on ownership, alignment, harmonisation, managing for results and mutual accountability [1]. For health, the 1978 Alma-Ata declaration, which focussed international attention and resources on Primary Health Care, also marked a more fundamental paradigm shift-establishing the notion of international responsibility for health, the idea that rich countries should help poorer ones to achieve health goals [2].With international responsibility came increasing formalisation of arrangements for development assistance and-in parallel with the growth of the broader aid industry-an increasing number of development partners active in the health sector. Within two decades there were complaints of an "unruly mélange" of development initiatives providing support to health [3]. Indeed, calls for better coordination of aid are almost as common as calls for more aid, and have remained a central theme of every subsequent international health initiative since Primary Health Care.This review examines how the concept of aid coordination, and its application to health systems, has evolved over the last two decades, and provides a base from which to consider further change. In this time international health has been re-shaped by globalisation, confronted by transitions in health and disease and has coped with unanticipated and resurgent epidemics. The development landscape has also changed substantially, with new resources, new players and new relationships, in turn leading to new forms of global health governance [4]. In this dynamic and shifting environment one idea has retained traction: that aid needs to be better managed and co-ordinated. Though, as we describe below, the ways