The Political Economy of Global Health

Abstract

Abstract This chapter investigates the phenomenon of parallel systems for global health projects in Malawi. Whereas donors have committed to a set of aid effectiveness principles, their practices at the point of action often belie these commitments. Drawing on the literature on aid effectiveness for development, this chapter therefore argues that despite the common rhetoric on ownership and alignment with government policies, donor-funded projects still sometimes create parallel systems—through hiring practices, project implementation, or other aid delivery mechanisms—that undermine the health systems-strengthening goals they claim to uphold. Using intensive ethnographic methods, this chapter illustrates various ways through which parallel systems are created, and how these are often overlooked or justified as reasonable decisions on the part of project staff. These findings have implications for global health practice, developing country governments, and donor practice, and they provide evidence of a common problem in the political economy of development.