Health Aid in Africa: Placement, Service Utilization, and Benefit

While the health sector has attracted significant foreign aid, evidence on the effectiveness of this support is mixed. This dissertation examines the allocation of health aid within the context of placement, service utilization, and benefit. The first paper examined the sub-national allocation of Chinese development aid projects across Africa. I determined how political preferencing of Chinese aid specifically, allocating aid to the birth region of the current political leader differs across sectors such as health, education, and transportation. I find some evidence that aid, more broadly defined, is subject to political preferencing in recipient countries, which could potentially limit its intended effects. The second paper examines the influence of health aid on malaria service utilization in Malawi. It tests the hypothesis that health aid boosts a facility’s readiness to provide malaria services, thereby increasing the utilization of malaria services in a facility’s service area. Findings indicate that while increased health aid is associated with increased health facility readiness to diagnose malaria, these improvements are not generally related to increased health care utilization. The final project focuses on population level health effects of health aid placement in the Democratic Republic of the Congo, specifically whether all‐cause child mortality is lower in regions receiving malarial aid interventions. Among the most promising evidence xi found on the potential benefit of health aid is that investments, such as malaria bed nets, are associated with reductions in child mortality, particularly in rural settings and among those with low malaria burden. These latter findings suggest health aid should be carefully targeted and should consider local disease risks to fully realize the benefits of population‐level improvements in child health. When taken together, my findings indicate that health aid is positively associated with limited improvements in health outcomes. Overall, these results support a need for researchers to avoid the temptation to aggregate aid flows and health outcomes at the country level, and instead examine sector‐specific aid flows at the lowest sub-national geographic unit possible in order to inform policies designed to allocate health aid