Dialogue Politique National

Wim Van LerbergheWHO, Geneva

Stratégies, Plans, Politiques?

• Tous les gouvernements tentent de rèpondre: – A leurs problèmes de santé– Aux problèmes de leur système

des santé– Aux défis politiques et de

développemtn

• Bien ou mal, explicite, implicite ou par défaut

Bottom-up participatory planning cycle

CSO

CSO

CSONGO

NGO

GHIpartners

5 year plan

Annual Review

Annual Review

Annual Review

Annual Review

Political priorities

partners

Lobbies

Elections

Programmes

Private sector 5 year plan

Government plan

Operational plan disease x

Civil service reform

Idealised planning processes

Real-life planning processes

Une confusion terminologique•Plan paraplui et plans spécifiques

National Health Strategic Plan(measures and instruments for implementation,

operational implications and budget)

Dis

ea

se s

pe

cific

na

t st

rate

gy

/ p

lan

National Health Policy(vision statement and policy directions)

Na

tion

al E

sse

ntia

l D

rug

s P

olic

y

Dis

ea

se

spe

cific

na

t st

rate

gy

/ p

lan

HR

H

Pla

n

Dis

ea

se s

pe

cific

na

t st

rate

gy

/ p

lan

Medium term plan & expenditure framework

District Operati

onal Plan

Medium term plan & expenditure framework

Medium term plan & expenditure framework

District Operati

onal Plan

District Operati

onal Plan

YEARS

Oth

ers

Des motifs différents

· Dissatisfaction with fragmentation· Dissatisfaction with inequalities and

progress· Backlash against withdrawal of the

State

· Failure to reach the MDGs· Limitations of “CE interventions”· Recognition of HS bottlenecks and

of adverse effects of global fragmentation

At country level At global level

Recognition of importance of clarity on “broad policy directions (UC, PHC, HiAP, …)

Country interest in national policy dialogue on health (cfr elections, media,

lobbies)

Global interest in “one plan, one funding mechanism, one M&E framework)

E.g. China, USA, Switzerland, Thailand... E.g. IHP+, Common funding platform...

Tout se tient

Country leadership■ Value given to health, equity, solidarity, social

justice■ Individual & institutional

capacities

Financing

Policy Directions universal coverage, primary

care, health in all policies

Strategies Plans

Pharmaceuticals Technology

Infrastructure

Infor-mation

Workforce

Policy dialogue within and

beyond health sector

Comprehensive, integrated,

continuous and people-centred care along the

life-cycle

Cost-effective and safe interventions: clinical &

public health

Universal access to close-to-client

networks, responsible for a

defined population

Including interventions for MDGs 4, 5, 6

Trust in health authorities:● Fairness

● Protection● Competence● Accountability

Health Equity

Health & health

security

Service Delivery

Outcomes

Social inclusion

and participation

Including MDGs 4-5-6

IncludingMDGs 4-5-6

Regulation & Management

institutions, rules,

incentives

Effective aid■ Ownership,

■ Alignment

■ Harmonization

■ Mutual accountability

Governance

Political commitment Mobilise & channel aid

Provide balanced inputs to support HS

Adapt service delivery models (integration, people centredness,

chronic care, access…)

Assist situation analysisAlign programme plans with

National Health PlanInclude stakeholders

Provide guidance on cost-effective interventions

Critical Subsystems

IncludingMDG 3

Les principes de Paris

• Ownership• Alignment• Harmonization• Results• Mutual accountability

Mainstreaming IHP+ as an approach

• Donors: Sceptical alignment: Paris, IHP+ • Validation • → “assessment” • → “joint assessment” of desirable attributes:

• (i) situation analysis and programming; • (ii) development and endorsement • (iii) financial and auditing systems; • (iv) Implementation and management arrangements; and • (v) results, monitoring and review mechanisms

• Use for • Making external financing decisions (“don’t give them the criteria”)• Getting better plans

• WHO: back as a top (?) priority, “as if there were no donors”– Global– Country– Internal debate: toolboxes, resources, guidance, do’s and don’ts, ….

Common HS Funding Platform

• High level task force on innovative financing• TGF & GAVI reaction, + WB• WHO facilitates• Crisis, difficult alignment with IHP+• Options 1, 2a and 2b

A priority without blueprints, but…

Content• Situation analysis

– Need– Expectations– Performance

• Strategy– Policy directions– Implications for BB– Resource implications & costs

• Arrangements– Financing– Roles– Monitoring– Legal

Process• Broad consultation• Priority setting & detailed design• Active mngmnt political process• Feedback mechanisms• Alignment develpmnt plans• Ownership

Where can we improve things?

1. Situation analysis and priority setting2. Shift from pilots to dealing with the challenge3. NHS & Programmes: balance and coherence4. Resource planning & costing5. M&E + feedback6. Process management

1. Situation analysis & priority setting

• Inclusive and comprehensive

• Needs, expectations and performance

• Current and anticipated

• Toolboxes• Bringing it all together:

CHIP:– Numbers and narrative– Problems and systems– Consensus building &

peer review

2. Shift from pilots to dealing with the challenge

0

10

20

30

40

50

60

2009 2010 2011 2012 2013 2014 2015

num

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3. Balance and coherence

0

5

10

15

20

25

30

35

40

45

cMYP (v

accin

ation

)

Mat

erna

l hea

lth ro

ad m

ap

HIV/A

IDS p

lan

TB plan

GAVI HSS g

rant

s

GF HIV

/AID

S pro

jects

GF Mala

ria p

rojec

ts

GF TB p

roje

cts

number of countries

Not synchronizedwith the NationalHealth Plan

Synchronized withthe NationalHealth Plan

4. Resource planning & costing

• Resource planning– Programmes as part of systems– iHTP or similar tools

• Costing of:– Resource requirements– Reaching targets (UN Costing tool)

5. M&E + feedback

• For partners: Chess; single framework• For domestic use:

– Numbers– Narrative– Political intelligence– Institutions: Observatory model? CSOs as

watchdogs? Others?

6. Process management

• Inclusiveness (trust, presence), particularly during design phase and for feedback

• Continuity and long term perspective (presence, legal frameworks)

• Exchange of experience and peer review

Support functions

• Align partners• Assist negotiation / accountability

• Support inclusive strategy development• Assist implementation