Channeling Health: Explaining Bilateral and Multilateral Development Assistance for Health

Abstract

President Obama’s 2014 budget requests proposed a continued drop in funding in a prominent bilateral global health initiative (PEPFAR) and a continued increase in US funding for the multilateral Global Fund. But, why do states fund multilateral aid institutions? Aid, even humanitarian-driven aid, is not entirely altruistic: states use foreign assistance to achieve their political, commercial, and policy goals. Realists argue that health aid allocation is a means of influence — to create stability, shore up national interests, and invest in geostrategic allies; thus, multilateralism would tend to be a preference of last resort, as bilateralism ensures more policy-wielding power. Neoliberal institutionalists, though, argue that using established international institutions can reduce uncertainty, reduce transaction costs, and promote gains from cooperation. Liberal theorists believe that state behavior with regard to multilateral aid allocation will depend on the structure of domestic preferences. This project uses data from the 23 member states of the OECD-DAC to test these three theoretical explanations, with the objective to better understand the choice for aid allocation in development assistance for health.

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