DFID influencing in the health sector: A preliminary assessment of cost effectiveness

November 2009
Jeremy Clarke, Enrique Mendizabal, Henri Leturque, Veronica Walford, Mark Pearson

The evaluation aimed to assess whether DFID’s influencing and policy dialogue activities in the health sector provided good value for money. The core of the work involved six case studies. An initial survey indicated that health advisers saw influencing as central to their work. More than 70% thought DFID gets good value for money or high returns from influencing efforts. Respondents thought effective influencing required: good communication, networking and an understanding of political drivers and incentives.

Influencing strategies were diverse and based on: lesson learning; evidence based approaches; leadership of the harmonisation agenda; and influencing through membership of global programmes and funds. Several of the case studies involved an influencing effort alongside a much larger programme of financial support to the sector.

In four out of the six cases, the policy change that DFID was trying to influence in partner Governments or organisations did actually take place, the main determinant being the level of political commitment by partners. DFID made a significant contribution to policy changes that took place, either directly or indirectly by working with the wider donor community. Key factors were:
• understanding political interests;
• effective collaboration with other donors;
• the quality and skills of DFID staff;
• the flexible and rapid provision of technical assistance.

However, only 20% of respondents thought DFID was systematic in assessing opportunities and stakeholders. The case studies revealed that whilst the goals of the influencing efforts and programmes were clearly stated and understood by DFID teams, the specific outputs were not always explicitly articulated in strategy or project documents. In several case studies, the objectives and approach evolved in the light of the experience and the opportunities that arose. Only in the case of GFATM were policy objectives articulated publicly and reflected in a log frame.