BioMed Central Page 1 of 10 (page number not for citation purposes) Health Research Policy and Systems Open Access Research The Paris Declaration in practice: challenges of health sector aid coordination at the district level in Zambia Jesper Sundewall* 1 , Birger C Forsberg 1 , Kristina Jönsson 2 , Collins Chansa 3 and Göran Tomson 4 Address: 1 Division of Global Health (IHCAR), Karolinska Institutet, Sweden, 2 Ministry of Health, Lusaka, Zambia, 3 Centre for East and Southeast Asian Studies, Lund University, Scheelevägen 15D 223 63, Lund, Sweden and 4 Division of Global Health (IHCAR) and Medical Management Centre, Karolinska Institutet, Sweden Email: Jesper Sundewall* - jesper.sundewall@ki.se; Birger C Forsberg - birger.forsberg@ki.se; Kristina Jönsson - kristina.jonsson@svet.lu.se; Collins Chansa - cchansa@moh.gov.zm; Göran Tomson - goran.tomson@ki.se * Corresponding author Abstract Background: The increasing resources available for and number of partners providing health sector aid have stimulated innovations, notably, the Paris Declaration on Aid Effectiveness, which aim to improve aid coordination. In this, one of the first studies to analyse implementation of aid coordination below national level, the aim was to investigate the effect of the Paris Declaration on coordination of health sector aid at the district level in Zambia. Methods: The study was carried out in three districts of Zambia. Data were collected via interviews with health centre staff, district managers and officials from the Ministry of Health, and from district action plans, financial reports and accounts, and health centre ledger cards. Four indicators of coordination related to external-partner activity, common arrangements used by external partners and predictability of funding were analysed and assessed in relation to the 2010 targets set by the Paris Declaration. Findings: While the activity of external partners at the district level has increased, funding and activities provided by these partners are often not included in local plans. HIV/AIDS support show better integration in planning and implementation at the district level than other support. Regarding common arrangements used for fund disbursement, the share of resources provided as programme-based support is not increasing. The predictability of funds coming from outside the government financing mechanism is low. Conclusion: Greater efforts to integrate partners in district level planning and implementation are needed. External partners must improve the predictability of their support and be more proactive in informing the districts about their intended contributions. With the deadline for achieving the targets set by the Paris Declaration fast approaching, it is time for the signatories to accelerate its implementation. Published: 8 June 2009 Health Research Policy and Systems 2009, 7:14 doi:10.1186/1478-4505-7-14 Received: 4 December 2008 Accepted: 8 June 2009 This article is available from: http://www.health-policy-systems.com/content/7/1/14 © 2009 Sundewall et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0 ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.