the international health partnership
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The International Health Partnership. December 2007 Dr Stewart Tyson, DFID. IHP What is it?. A high level agreement to apply the Paris Principles on aid effectiveness to the health sector –building on SWAP experience in many countries Commitments by all parties to - PowerPoint PPT PresentationTRANSCRIPT
The International Health Partnership
December 2007
Dr Stewart Tyson, DFID
IHP What is it?
A high level agreement to apply the Paris Principles on aid effectiveness to the health sector –building on SWAP experience in many countries
Commitments by all parties to • Back country led national health plans• Include all parties in the plan (non-state providers, CSO) • Better coordinate efforts• Provide assistance in ways that build sustainable health
systems• Mutual accountability for delivery of results • Deliver more effective aid
What it is not
• A new Institution
• A new plan
• A new funding stream
• A new global fund for health
• An exclusive initiative
• About only budget support or pool funding
Apply Paris Declaration to Health
• 56 Action-Oriented Commitments
ContextParis declaration 2005
Post high level forum 2005 - 07
Global Campaign on the Health MDGs
MDGs 2000
IHP Global Business Plan on MDGs 4&5
UNAIDS 3 Ones
Incr
ease
d a
id e
ffec
tive
nes
s
Incr
ease
d r
eso
urc
es
Context (2)
• More aid for health $6-$14bn (2000-2005)• But limited reach of much investment: AIDS, TB,
Malaria ,childhood vaccination• Much aid is off plan-not funding national
priorities • Complex and fragmented architecture • Use of parallel systems rather than government • Large transaction costs for governments • “The result is limited reach and effectiveness of
much aid”(World Bank & AU health strategies)
Complex architecture …..
MOH MOEC
MOFPMO
PRIVATE SECTORCIVIL SOCIETYLOCALGVT
NACP
CTUCCAIDS
INT NGO
PEPFAR
Norad
CIDA
RNE
GTZ
Sida WBUNICEF
UNAIDSWHO
CF
GFATM
USAID
NCTPNCTP
HSSP HSSP
GFCCP
GFCCP
DAC
CCM
T-MAP
3/5
SWAPSWAP
UNTG
PRSP PRSP
Fragmentation…..
Source; Don De Savigny & COHRED
Contra-ceptives and
RHequipment
STIDrugs
EssentialDrugs
Vaccinesand
Vitamin ATB/Leprosy
BloodSafety
Reagents(inc. HIV
tests)
DFID
KfW
UNICEF
JICA
GOK, W B/IDA
Source offunds for
commodities
CommodityType
(colour coded) M OHEquip-ment
Point of firstwarehousing
KEM SA Central W arehouse
KEM SARegionalDepots
Organizationresponsible
for delivery todistrict levels
KEM SA and KEM SA Regional Depots (essential drugs, m alaria drugs,
consum able supplies)
ProcurementAgent/Body
Crow nAgents
Governmentof Kenya
GOK
GTZ(p rocurem ent
im plem entationunit)
JSI/DELIVER/KEM SA LogisticsM anagement Unit (contraceptives,
condom s, STI kits, HIV test kits, TBdrugs, RH equipm ent etc)
EU
KfW
UNICEF
KEPI ColdStore
KEPI(vaccines
andvitam in A)
M alaria
USAID
USAID
UNFPA
EUROPA
Condomsfor STI/
HIV/AIDSprevention
CIDA
UNFPA
USGov
CDC
NPHLS store
M EDS(to M issionfacilities)
PrivateDrug
Source
GDF
Governm ent
NGO/Private
Bilateral Donor
M ultilateral Donor
W orld Bank Loan
Organization Key
JapanesePrivate
Com pany
WHO
GAVI
SIDA
NLTP(TB/
Leprosydrugs
Com modity Logistics System in Kenya (as of April 2004) Constructed and produced by Steve Kinzett, JSI/Kenya - please communicateany inaccuracies to skinzett@ cb.jsikenya.com or telephone 2727210
Anti-RetroVirals
(ARVs)
Labor-atorysupp-
lies
GlobalFund forAIDS, TB
and M alaria
The"Consortium"
(Crow n Agents,GTZ, JSI and
KEMSA)
BTC
M EDS
DANIDA
M ainly District level staff: DPHO, DPHN, DTLP, DASCO, DPHO, etc or staff from the Health Centres,Dispensaries come up and collect from the District level
M EDS
Provincial andDistrict
HospitalLaboratory
Staff
Organizationresponsible fordelivery to sub-
district levels
KNCV
M SF
M SF
Complex in-country Supply Chains!
Transaction costs..
800
750
700
650
600
550
450
Vietnam (791)
Cambodia (568)
Honduras (521)
Mongolia (479) Uganda (456)
10 453 missions in 34 countries in 2005
Number of donor missions in 2005
Developing country messages• current aid make it hard to strengthen health systems• need flexible, predictable and long term financing to budget for long term• high transaction costs of dealing with multiple international partners; who
operate outside of national planning & budgeting processes & compete for scarce resources, particularly staff;
• recognise benefits of targeted investments, but want to see greater coordination and integration of international support; ‘campaign vertically spend horizontally’
• suspicious of new donor initiatives over which they have little influence; • limited faith in their international partner’s performance in delivering on
their commitments
International messages• High-level political commitment for health lacking ; increase & sustain
investment in health; overcome policy, implementation & governance obstacles to progress;
• Little confidence in quality of many national health plans: divorced from meaningful budgets; avoid difficult issues (eg gender, SRHR); exclude the non-state sector;
• Concern over limited capacity to implement health plans; inadequate engagement of supporting sectors such as water, education and transportation;
• Little confidence in accountability mechanisms to citizens;• Must see support translated into improved health outcomes to maintain the
case for aid to taxpayers
CSO messages
• Some irritation at the process and non-engagement
• Look to structured GFATM-like governance structure
• Generally supportive of principles
• AIDS lobby perceive threat to ‘AIDS exceptionalism’ and potential diversion of focus and resources
Mid -2007…a political opportunity
• New health leaders WHO, WB, GFATM• Coordination H8 Group (UN, Major GHI, Gates)• New UK Government-convinced of need for
more effective aid and more aid • Concept note for what became IHP• High level compact-signed by 8 first wave
countries, H8 group, UNDP, EC, IMF, and 8 bilaterals at launch September 2007
Developing countries will…
• Invest more in health• Address policy constraints• Strengthen planning & accountability
mechanisms• Link aid to demonstrable improvements in
outcomes (MDGs, HSS)
Donor partners will…
• Better coordinate their support around National Health Plans
• Provide aid in ways that strengthens health systems
• Where possible, provide long term, more flexible support delivered though national systems
Civil society will
• Engage in design, implementation and review of National Health Plans and the Partnership at global and country level
• Deliver high quality health services, in line with national plans
• The performance of all parties will be subject to a joint review at country and global levels
What will success look like (1)?• All partners work to achieve national health objectives as laid out in
robust national plans that include the contributions of public, private and civil society providers.
• All share a collective commitment to help implement the plan effectively and deal with bottlenecks to progress and emerging issues.
• All external support is provided in ways that strengthen health systems and facilitate the delivery of a coordinated package of basic services that respond to all major health challenges and achieve results.
• More resources are provided as long term, flexible aid with a greater proportion delivered through national systems.
• There is a clear, inclusive, credible monitoring mechanism that is able to demonstrate progress in improving health outputs/outcomes on an annual basis.
• International agencies are encouraged to rely on joint appraisal and reporting systems rather than requiring their own separate arrangements.
What will success look like (2)?
Signatories… so far• Zambia, Nepal, Kenya, Burundi, Mozambique,
Ethiopia, Kenya, Mali
• UK, Norway, Netherlands, Germany, France, Italy, Portugal, Canada
• WHO, UNAIDS, UNICEF, UNFPA, World Bank, GFATM, GAVI, UNDP, IMF, ILO, AfDB, EC, Gates
Next steps
• Multilateral lead WHO/WB
• Develop country level compacts
• UK resources for process via WHO/WB and to first wave countries
• Engage US and Japan –G8
• Meeting of first wave countries in 01/08
• Ministerial meeting -margins WHA 05/08
Lessons from DFID SWAp Review
• Takes time to get processes working – IHP to build on these and not start again
• SWAp structures help coordination, allocation – IHP to encourage discipline
• Staff or minister changes – anticipate them, coordinate response, contingency plans
Lessons from DFID SWAp Review
• Mix of aid instruments is desirable – plan across donors – IHP role in this?
• Participation – neglected early on, IHP to address and learn lessons?
• Mutual accountability – often poor EDP performance, IHP to push accountability