A recent story in an African newspaper on the high level forum on aid effectiveness, just wrapping up as I type in Accra, suggests that recipient countries actually receive a very small share of all money "donated" or "committed" to countries. The article suggests that between 60-75% of donor funds actually remains in the donor countries, usually paying for technical assistance or the purchase of commodities.

Is this also true in health? The truth is that we really don't know all that well as there really is not a good financial tracking mechanism that provides transparency in terms of how aid money is spent. Perhaps some of the best news coming out of the Accra forum is an announcement by the UK government to lead an initiative to help create such a tracking mechanism.

The hard working folks at the Center for Global Development in Washington recently did help uncover some evidence that does shed some light on this question in the context of the PEPFAR program. Through the freedom of information act, the Center for Public Integrity was able to obtain data on how PEPFAR spends its money. CGD analysis suggests that only about 30% of PEPFAR funds goes to locally based agents, with wide variation from nearly zero in some countries to a much higher level in countries such as Botswana. CGD has an excellent report on their site that summarizes this work, and they even make the data available to those who want to learn more.

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