Dr. Salif Samake, director of the planning and statistics unit in Mali’s Ministry of Health, is part Nepali. At least that’s what he called himself at a recent MLI meeting, and only half in jest. Through an MLI program, Dr. Samake traveled to Kathmandu last year and attended a class with Nepali health officials to learn how to be a better negotiator.

Peer learning is one of MLI’s most important principles, if a difficult one to put into practice.   Working with five countries – Ethiopia, Mali, Nepal, Senegal, and Sierra Leone – MLI faces diverse challenges. All five countries are focused on different priorities, their health systems are distinctly structured, and they don’t share a common language.

Development assistance for health -- aid that can boost a country’s social and economic development -- has risen dramatically in the past decade. But the increase in aid and the multiplying of donors has created a new, unwieldy, and largely fragmented funding landscape for recipient countries to navigate.

It is estimated that on average many developing countries receive over 800 new projects annually, host more than 1,000 monitoring missions, and prepare and present 2,400 quarterly progress reports. Because of this, donors frequently tout the importance of aid effectiveness or donor alignment these days.  Yet on the ground, in developing country ministries of health, there is very little donor support for these efforts including improving a country's capacity to coordinate its donors.  Greater aid effectiveness should be enough incentive for donors to invest more in ministry-based aid coordination systems. But that has not been the case.