The impact of aid is reduced when donors decide separately which programmes to fund based on their own criteria and impose their own planning and reporting arrangements on recipient countries, making aid distribution uncoordinated. The results are duplication of development
efforts, high transaction costs and excessive burdens placed on partner countries. The challenges of harmonisation are particularly pertinent to the health sector where there is a large and increasing number of donors. This chapter draws on evidence from initiatives to
reduce donor proliferation to outlines some of the key blockages to achieving more progress towards harmonisation of donor approaches.