INTERNATIONAL HEALTH PARTNERSHIPS CONTEXT PROCESS COUNTRY EXPERIENCES

INTERNATIONAL HEALTH PARTNERSHIPS CONTEXT, PROCESS, COUNTRY EXPERIENCES & EXPECTATIONS Mr. Nicholas Chikwenya Deputy Director – Health Planning & Budgeting Ministry of Health Zambia

Presentation Layout Context Country and Donor Experiences with Aid Architecture A New Initiative for Aid Harmonisation – IHP and Process of implementation Country Expectations Progress so far

Context. . Better health lies at the centre of the MDGs Yet at the mid point to 2015 many countries are seriously off track in their efforts to realize the health related MDGs External resources for health have more than doubled since 2000 and many countries have increased domestic resources There is still a long way to go in meeting overall financing gaps for health and producing significant results

Context. . . There has been minimal progress in maternal and child health, reproductive health, and better coordinated donor support is required to strengthen programmes Much of the recent increased investments have targeted specific diseases (HIV/AIDS, Malaria, TB) and vaccinations Achieving better health outcomes requires more and better integrated investments in health systems (including HRH) and new approaches to resource allocation at all levels

Country Lamentations on Aid Architecture Delivering sustainable results requires strengthening the systems that make health services work such as production, training, and retention of health workers We need greater levels of flexible and predictable financing for health if we are to budget in long terms We face high transaction costs in dealing with multiple cooperating partners who often operate outside the national planning and budgeting processes

Country Lamentations on Aid Architecture. . . We do not need separate multiple plans and budgets. We already have one-sector strategic plan which articulated our public health priorities Targeted investments can have benefits but we want to see greater coordination and integration We are suspicious of new donor initiatives over which we have little influence Efforts to strengthen national health systems need to be country driven

Donor Lamentations on Aid Modalities within Recipient Countries There is a need for partner countries to demonstrate high level political commitment by increasing and sustaining domestic investment in health There is little confidence in the quality of many national health plans There is limited capacity to implement the health plan, and inadequate engagement of other sectors There is little confidence in the accountability mechanisms to citizens and other stakeholders They need to see their support better translated into improved health outcomes

IHP - New Initiative for Aid Harmonisation The IHP aims to accelerate action to scale up coverage and use of health services and deliver improved outcomes Partner countries will increase their own resources for health, change policies and practices that are obstacles to efficient use of these resources, strengthen planning and accountability mechanisms International Partners will better coordinate external support around priorities set in national health strategic plans, provide aid in ways that strengthen health systems

IHP - New Initiative for Aid Harmonisation International Partners will, where possible, provide financial and technical resources in a more long term, predictable and flexible manner, coordinated under the national plan and with a greater proportion through national systems Civil society will play an important role in planning and implementation and in holding all parties to account

How will it be implemented? • Country-focused and country-led • Builds on existing structures, mechanisms, and country health plans • Provides long term, predictable financing for results-oriented national plans and strategies • Ensures mutual accountability for delivering on compact commitments

The Country Compact Development Partners H 8 Agencies Civil Society Donors Bilaterals/ multilaterals Country Ownership Existing country mechanisms One common M&E and mutual accountability Long-term, Fix health framework predictable Systems financing bottlenecks One costed, results-oriented Inter-agency One common national health country health review process/ plan and budget sector teams validation Country Compact Scaling Up Effective Coverage Improved Outcomes for MDGs 1 b, 4, 5, & 6

Country Expectations. . . A shift towards a holistic approach to financing health service delivery and ultimately moving towards more sustainable health system strengthening including HRH and infrastructure as exemplified by GAVI, GF, WB, Sida, CIDA, USAID, EU A paradigm shift in aid delivery through efforts by development partners to harmonise support to the health sector within our Government-led health systems, plans and procedures.

Country Expectations. . . Development partners will commit to investing resources on national priorities as articulated in our respective national health plans. Strengthened planning and accountability mechanisms More inclusive and transparent planning and accountability mechanisms that are better linked to external support and improvements in health outcomes.

Country Expectations. . . Financing: With the signing of compacts, we expect partners to fill identified resource gaps More importantly, one single country plan, one single budget, one single policy and results framework, one single M&E framework and process and one single fiduciary process

IHP+ Achievements since Sept ‘ 07 IHP global compact signed by 8 Countries (Burundi, Cambodia, Ethiopia, Kenya, Mozambique, Nepal Zambia, and Mali) 9 international organizations (WHO, World Bank, Global Fund, GAVI Alliance, UNFPA, UNAIDs, UNICEF, UNDP, EC) 5 bilateral donors (UK, Norway, Germany, France, Italy, Portugal and Netherlands) Other donors (Bill & Melinda Gates Foundation & African Development Bank) SIDA, Madagascar, and Nigeria signed last week

IHP+ Achievements since Sept ‘ 07 First Inter-country consultative meeting – February 2008, Lusaka - Zambia Costing of the National Health Strategic Plan to determine resource required to scale up MDG attainment and gap analysis (Ethiopia, Zambia, Mozambique) Review of Mo. U to identify weaknesses and gaps (Zambia)

A Costed NHSP in Ethiopia A gap of $2. 8 billion needed to scale up!

IHP+ Achievements since Sept ‘ 07 • Country Compacts – first compacts to be agreed by Sept 2008 • Monitoring and Evaluation and External Review – draft single M&E framework agreed and under discussion at country level; external review to be completed by Sept 2008. • Growing Civil Society Engagement IHP+ linked to: ü Paris Declaration on Aid Effectiveness ü Results-based Financing ü Other global partnerships and initiatives ü Ouagadougou Declaration on Primary Health Care

Conclusion: The Way Forward • Enhance strong political commitments to long-term, predictable financing for health MDGs • There is need to strengthen mutual accountability by all parties • Widen engagement in IHP+ to include more key players • Remove bottlenecks in the global health architecture • The IHP should be incorporated in the UN reforms • The Vision is to harmonize Cooperating Partners at global and country levels towards better health outcomes