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Official Development Assistance to the Moldovan Health Sector – 2011 Fourth Edition 30 March Official Development Assistance to the Moldovan Health Sector – 2011 Fourth Edition 30 March 2012 MINISTERUL SĂNĂTĂŢII AL REPUBLICII MOLDOVA 1

Aim To provide a full picture of the external official development assistance to the Aim To provide a full picture of the external official development assistance to the health sector thus highlight gaps of donor’s assistance across the priorities laid down in the national strategic policy documents and to provide forecasts on future foreign assistance on short and medium term perspectives MINISTERUL SĂNĂTĂŢII AL REPUBLICII MOLDOVA 2

Objectives 1. To picture donors activities in the larger framework of the health system Objectives 1. To picture donors activities in the larger framework of the health system and donors alignment towards the Moldovan health system functions strategies 2. To improve quality of information available for sector coordination and strategic decision-making for strategic planning of financial resources in health sector 3. To illustrate donors’ short and medium term commitments to the Moldovan health sector 4. To review the coordination mechanisms in place MINISTERUL SĂNĂTĂŢII AL REPUBLICII MOLDOVA 3

Differences with previous editions 1. Measurement of aid alignment with health system priorities and Differences with previous editions 1. Measurement of aid alignment with health system priorities and functions 2. Measurement of aid alignment to the Paris Declaration on Aid Effectiveness 3. Web-based interface for data collection 4. Validation process MINISTERUL SĂNĂTĂŢII AL REPUBLICII MOLDOVA 4

Methodology • The study design compelled two phases: questionnaire development and identification of the Methodology • The study design compelled two phases: questionnaire development and identification of the eligibility criteria. • The data collection was conducted through an online interface and strengthened through validation interviews. • Data analysis was conducted by the research team in close collaboration with the software developer MINISTERUL SĂNĂTĂŢII AL REPUBLICII MOLDOVA 5

Eligibility criteria The assistance provided by the agencies covered by this enquiry had to Eligibility criteria The assistance provided by the agencies covered by this enquiry had to fulfill both sets of criteria given by: 1. OECD DAC definition of ODA Grants or loans to countries and territories on the DAC List of ODA Recipients (developing countries) and to multilateral agencies which are: (a) undertaken by the official sector; (b) with promotion of economic development and welfare as the main objective; (c) at concessional financial terms (if a loan, having a grant element of at least 25 per cent). In addition to financial flows, technical co-operation is included in aid. Grants, loans and credits for military purposes are excluded. Transfer payments to private individuals (e. g. pensions, reparations or insurance payouts) are in general not counted. 2. The State Chancellery of Moldova Annex I of Government Decision no. 246 of 8 th April 2010: “List of the technical assistance projects that qualify for international treaties, for tax exemptions, custom taxes and 0% VAT for goods and services provided by them” MINISTERUL SĂNĂTĂŢII AL REPUBLICII MOLDOVA 6

Official Development Assistance in Health Sector implemented in 2011 External Development Partners Bilateral Multilateral Official Development Assistance in Health Sector implemented in 2011 External Development Partners Bilateral Multilateral European Union Delegation in the Republica Moldova United Nations Children’s Fund (UNICEF) GAVI Alliance United Nations Population Fund (UNFPA) The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFTAM) United Nations Office on Drugs and Crimes (UNODC) International Atomic Energy Agency (IAEA) The World Bank Group (WB) Joint United Nations Programme on HIV/AIDS (UNAIDS) World Heath Organization (WHO) United Nations Development Program (UNDP) Austrian Agency for Development (ADA) German Agency for International Cooperation (GIZ) Government of the People’s Republic of China Government of Romania Japan International Cooperation Agency (JICA) Swiss Agency for Development and Cooperation (SDC) Turkish Agency for Development and International Cooperation (TIKA) United States Government (USG)

KEY RESULTS 8 KEY RESULTS 8

Donors and programs/projects 1 GIZ Government of China Government of Romania SDC TIKA UNAIDS Donors and programs/projects 1 GIZ Government of China Government of Romania SDC TIKA UNAIDS UNDP New vaccine for Penta Vaccine Strengthening Tuberculosis Control in the Republic of Moldova, Empowerment of People with Tuberculosis and Communities in Moldova 7 Reducing HIV - related burden in the Republic of Moldova, 2010 - 2014, Scaling up Access to Prevention, Treatment and Care under the National Program for Prevention and Control of 8 9 10 11 12 13 Reducing HIV - related burden in the Republic of Moldova, 2010 - 2014 CIM Expert - Hospital System Planning Support to a Traditional Chinese Medicine Center Supplying a lot of 114 medical ventilators for equipping the departments of reanimation and intensive care Rehabilitation of Blood Transfusion Center in Cahul Modernising the Moldovan Perinatology System Project 3 rd Phase 14 REPEMOL – Regionalization of Pediatric Emergency and Intensive Care Services in Moldova 15 Healthy Generation (Scaling-up Youth Friendly Health Services in Moldova) Development of Community Mental Health Care Services in Moldova (CMH Center in Chisinau) 17 18 19 20 21 22 Ambulance cars for the Republic of Moldova Reconstruction of the Vulcanesti Regional Hospital Support to the National AIDS Programme NHDR and Policy Analysis MDG Governance in Action: Catalyzing Human Rights Change in Social Policy e-Governance 23 GFATM Developing and piloting sheltered housing service for people with mental illness in Moldova 4 5 6 16 GAVI Alliance Capacity assessment and modernization of the Republican Clinical Hospital in Chisinau 3 EU Delegation Sector Policy Support Programme Health 2 Mechanisms strengthened for supervisory and monitoring systems, including for quality assurance in comprehensive reproductive health service delivery, and for reproductive health commodity security UNFPA UNICEF 25 26 MDA 1 R 303 "Increased availability of counselling and information services on sexual and reproductive health, and HIV/AIDS/STIs prevention for young people" Equitable access to quality services Social Policy and Data for Children UNODC 27 Strengthening national capacities in Eastern Europe and Central Asia to address HIV/AIDS in vulnerable populations WB 28 29 Health Services and Social Assistance Project Preventing Hepatitis B and C in Moldova WHO 30 Biennial Collaborative Agreement (BCA) between the Ministry of Health of the Republic of Moldova and the Regional Office for Europe of the World Health Organization 2010/2011 24 9

v o Go # of programs or projects HO 2 W B 1 W v o Go # of programs or projects HO 2 W B 1 W C OD 2 UN EF IC 2 UN A FP 3 UN DP 1 UN DS AI 2 UN CA C 1 SD ia an 4 TI Z na GI hi om f R f C v o 1 Go AT M GF VI GA EU ODA projects or programs per donor 4 3 2 1 1 10

Geographic coverage National, targeted regional and pilots MINISTERUL SĂNĂTĂŢII AL REPUBLICII MOLDOVA 11 Geographic coverage National, targeted regional and pilots MINISTERUL SĂNĂTĂŢII AL REPUBLICII MOLDOVA 11

Aid modalities $ 18, 946, 507, 37% $ 32, 770, 231, 63% Program/project aid Aid modalities $ 18, 946, 507, 37% $ 32, 770, 231, 63% Program/project aid MINISTERUL SĂNĂTĂŢII AL REPUBLICII MOLDOVA Sector Budget Support % of total funds disbursed in 2011 12

Grants and loan $ 5, 500, 000, 11% Grant MINISTERUL SĂNĂTĂŢII AL REPUBLICII MOLDOVA Grants and loan $ 5, 500, 000, 11% Grant MINISTERUL SĂNĂTĂŢII AL REPUBLICII MOLDOVA Loan $46, 216, 738 , 89% % of total funds disbursed in 2011 13

Type of funding 9% 32% Technical Assistance Investments Administrative costs 59% MINISTERUL SĂNĂTĂŢII AL Type of funding 9% 32% Technical Assistance Investments Administrative costs 59% MINISTERUL SĂNĂTĂŢII AL REPUBLICII MOLDOVA % of total funds disbursed in 2011 14

Investments Construction and refurbishment 39% Medical equipment and technology IT technology 13% 3% Medical Investments Construction and refurbishment 39% Medical equipment and technology IT technology 13% 3% Medical supplies Other MINISTERUL SĂNĂTĂŢII AL REPUBLICII MOLDOVA 35% 10% % of funds disbursed for Investments in 2011 15

Technical Assistance Policy Development 16% Capacity Building 56% Guidelines and Protocols Development Legal and Technical Assistance Policy Development 16% Capacity Building 56% Guidelines and Protocols Development Legal and Regulatory Framework Development Other MINISTERUL SĂNĂTĂŢII AL REPUBLICII MOLDOVA 13% 6% 9% % of funds disbursed for Technical Assistance in 2011 16

Health System Core Functions Health Services Provision 37% Resource Generation Health Financing Stewardship and Health System Core Functions Health Services Provision 37% Resource Generation Health Financing Stewardship and Governance MINISTERUL SĂNĂTĂŢII AL REPUBLICII MOLDOVA 50% 2% 11% % of total funds disbursed in 2011 17

Health Service Provision, by components Primary Health Care 48% 40% Hospital Care Public Health Health Service Provision, by components Primary Health Care 48% 40% Hospital Care Public Health Services 6% Emergency Care 6% MINISTERUL SĂNĂTĂŢII AL REPUBLICII MOLDOVA % of funds disbursed for Health Service Provision in 2011 18

Program priority areas 48% Communicable Diseases 7% Non-communicable Diseases Injuries and Violence 3% MCH Program priority areas 48% Communicable Diseases 7% Non-communicable Diseases Injuries and Violence 3% MCH and Reproductive Health Adolescent Health Other MINISTERUL SĂNĂTĂŢII AL REPUBLICII MOLDOVA 15% 3% 24% % of total funds disbursed in 2011 19

Alignment to national health policies Name of policy # Names of Agencies National Health Alignment to national health policies Name of policy # Names of Agencies National Health Policy, 2007 -2021 11 EU, GFATM, Government of Romania, SDC, TIKA, UNDP, UNFPA, UNICEF, UNODC, WB, WHO State Policy on Pharmaceuticals Health Systems Development Strategy, 2008 -2017 1 8 WHO EU, GFATM, GIZ, SDC, TICA, UNICEF, WB, WHO National Strategy for Reproductive Health, 2005 -2015 National Anti-Drug Strategy, 2011 -2018 Primary Health Care Development Strategy, 2010 -2013 4 2 6 SDC, UNFPA, UNICEF, WHO GFATM, UNODC EU, GFATM, SDC, UNAIDS, WB, WHO 3 UNFPA, UNICEF, WHO 3 EU, SDC, WHO National Blood Transfusion Safety Program, 2007 -2011 National Immunizations Program, 2011 -2015 2 3 Government of Romania, WB GAVI, UNICEF, WHO National HIV/AIDS and STI Prevention Program, 2011 -2015 8 EU, GFATM, UNAIDS, UNDP, UNFPA, UNICEF, UNODC, WHO National TB Prevention and Control Program, 2011 - 2015 4 EU, GFATM, UNDP, WHO National Program for Diabetes Control, 2011 -2015 National Programme for Emergency Care Development, 2011 -2015 Hospital Healthcare Development Program, 2010 -2012 National Program for Eradication of Iodine Deficiency Disorders 2011 -2015 Other priorities 0 - 2 SDC, TIKA 4 EU, SDC, WB, WHO 1 UNICEF 2 UNDP, WB Key National Health Policies Key National Programs National Program for Viral Hepatitis B, C and D Control, 2007 -2011 National Program for Health Lifestyle Promotion, 20072015 National Program for Mental Health, 2007 -2011 20

Donor perceptions about MTEF 7 7 5 4 3 2 1 Very high 2 Donor perceptions about MTEF 7 7 5 4 3 2 1 Very high 2 1 High Reasonable Limited Not at all Do not know Extent to which MTEF is fulfilling its functions Extent to which MTEF affects donor programming MINISTERUL SĂNĂTĂŢII AL REPUBLICII MOLDOVA Number of donors 21

Aid Predictability Intention to continue support to health sector, short-term, 2012 -2013 6 4 Aid Predictability Intention to continue support to health sector, short-term, 2012 -2013 6 4 3 Yes (exact amount pledged provided) MINISTERUL SĂNĂTĂŢII AL REPUBLICII MOLDOVA 3 Increasing Same Uncertain Number of donors 22

Findings In 2011 external donors have disbursed an equivalent of US$ 51. 7 mln Findings In 2011 external donors have disbursed an equivalent of US$ 51. 7 mln to health sector in Moldova, which represents a total 14% compared to the public expenditure on health in equivalent of US$ 363 mln. • • Among core health system functions, most donor assistance supports activities related to Health Systems Delivery and Resource Generation, while Stewardship and Governance and Health Financing receives less financial allocations. • Funds are disbursed unevenly in the different health service delivery component: Public Health Sector and Emergency Care is receiving far less attention than Primary Health Care and Hospital Care. • Funds are disbursed unevenly in the different program priority areas: communicable disease are receiving the largest share of the disbursements, while burden of disease lies in noncommunicable diseases. MINISTERUL SĂNĂTĂŢII AL REPUBLICII MOLDOVA 23

 Findings • Geographic coverage is not uniform, Chisinau and Balti receiving most attention Findings • Geographic coverage is not uniform, Chisinau and Balti receiving most attention in targeted regional coverage. Some districts receive focused support from more donors. • In health sector, donors aligned well to support priorities in national health policies and national programs, however programs related to HIV and TB and Hospital Health Care Development received attention from more donors compared to other health priorities. • Due to limitations of MTEF relevance to donor strategic programming, alignment to MTEF categories is far more complicated. MINISTERUL SĂNĂTĂŢII AL REPUBLICII MOLDOVA 24

Findings Checked against the “Results of the 2011 Survey on Monitoring the Paris Declaration Findings Checked against the “Results of the 2011 Survey on Monitoring the Paris Declaration -Moldova” and Paris Declaration general target indicators • Only 14% of the 2011 health sector commitments were recorded in the sector budget (versus 85% Paris Declaration target value). • Donors are concentrating on technical assistance more than they do in other sectors (average 20%). • Funds disbursed in 2011 topped the scheduled ones by 18% points. • The number of donors who could not provide the exact amount of pledged funds for 2012 -13 was high (10/15). On the timeframe 2014 -2020 none of the donors interviewed was able to give the amount pledged. MINISTERUL SĂNĂTĂŢII AL REPUBLICII MOLDOVA 25

 Thank you for your attention MINISTERUL SĂNĂTĂŢII AL REPUBLICII MOLDOVA 26 Thank you for your attention MINISTERUL SĂNĂTĂŢII AL REPUBLICII MOLDOVA 26