Bridging concessional-loan and grant-linked aid for global health: a qualitative content analysis of Korea’s blended-aid model

Background Integrated loan-and-grant aid models are increasingly promoted as a means of addressing fragmentation in global health. However, empirical evidence on how these complex aid models function in the real world remains limited. This study explored how the outcomes and structural constraints of Korea’s Concessional-loan and Grant-linked Aid (CGA) model are represented within institutional evaluation processes. Methods This study employed qualitative content analysis of eight end-of-project evaluation reports of CGA projects in the healthcare sector, implemented across six low- and middle-income countries between 2015 and 2025. Treating the evaluation reports as policy artefacts, we applied a sequential hybrid analytical approach, combining inductive thematic coding with deductive mapping onto the WHO Health System Building Blocks as system domains and the OECD-DAC Evaluation Criteria as evaluative lenses. A total of 73 text segments were analysed across the eight reports. Results The evaluation narratives consistently highlighted immediate, facility-level operational gains, particularly in terms of service delivery, workforce capacity, and medical technology utilisation. However, a recurring pattern of ‘conditional success’ emerged, wherein these achievements coexisted with persistent structural vulnerabilities. The analysis identified critical ‘timeline mismatches’ between the rapid deployment of capital infrastructure through concessional loans and the more gradual processes of human capacity-building through grants. Furthermore, the narratives portrayed long-term system integration as constrained by high staff turnover and limited domestic fiscal capacity for ongoing maintenance. Conclusions The evaluation narratives suggested that, within the studied cases, operational improvements associated with blended-aid arrangements coexisted with continuing challenges to sustained health system integration. They portrayed such integration as contingent not only on financial alignment but also on the coordination of implementation timelines and capacity-development cycles. The findings support considering project-level mechanisms for cross-agency coordination and post-project continuity during early-stage project planning and host-country arrangements. Ultimately, the evaluation narratives highlight the value of reflexive approaches that examine underlying structural constraints alongside reported project-level achievements. Clinical trial number Not applicable.