The International Health Partnership aligning for better results

The International Health Partnership: aligning for better results Marjolaine Nicod, IHP+/WHO Maxwell Dapaah IHP+/WB

What is IHP+ is a partnership of countries, development agencies and civil society organizations that aim to accelerate better health services and health outcomes, particularly for the poor, by putting the principles on development effectiveness into practice. Partner commitments recorded in the IHP+ Global Compact Created in 2007 Goal: better results through more effective development cooperation

A strong efficient health system is needed to deliver quality services for country health priorities

IHP+: a response to rising number of partners, duplication, fragmentation International NGOs Bilaterals Medecins Sans Frontieres DCE PSI Belgium Spain Canada Plan International France UNAIDS UNFPA Japan Netherlands Sweden UNICEF GAVI WFP WHO Red Cross Luxembourg USAID China Helen Keller United Nations Global Initiatives Global Fund Against AIDS, TB & Malaria

Unintended burden of multiple missions – reaches district level Missions can consume 10 -20% of a DMO’s time: Number of one-day missions to Temeke during last 6 months TANZANIA DISTRICT EXAMPLES Report writing can consume even more time Number of full days per quarter spent on writing reports (Morogoro) PEPFAR 4 JICA GFATM 2 Finnish NTLP 2 Axios Gates Foundation 1 UNICEF Norwegian TB 1 World Vision EPI 1 Mo. H – TB UNICEF 1 Mo. H – Malaria WHO 1 Mo. H – AIDS NACP 1 Mo. H – EPI NMCP 1 Mo. H – Maternal Health London School 1 Weekly notifiable disease reports Total 16 Harmonizing report writing can help reduce the burden Total *Assumes around 50 working days per quarter and 100 per half year although reported to work in excess of that Source: Mc. Kinsey: In-country interviews; DMO visitor log; team analysis

Supply logistics systems in Kenya

Who is in IHP+? 2007 2016 Developing countries: 8 37 Bilateral donors: 8 17 Int'l agencies and foundations: 11 12 TOTAL 27 66

The seven behaviours: not new but important requires action by all development partners

How does IHP+ work? Mobilises support behind one national health strategy with clear priorities: 1. 2. 3. 4. 5. Inclusive national planning and joint assessment processes Unified support for implementation, through country compacts Harmonized financial management One platform for monitoring and accountability for results South-south exchange on effective development cooperation IHP+ works through its partners – governments, development partners, non state actors including CSOs. Builds on existing processes

Country compacts • Compacts: negotiated agreements between partners on how they will support the national health strategy/plan. Are many equivalent terms e. g. MOU • Compacts can – Bring more partners behind the national strategy – new development partners, civil society, NGOs – Influence greater if commitments are made more explicit, are monitored • Key elements • • – Commitments by governments; development agencies; implementing partners – Aid management modalities – Monitoring arrangements and indicators for tracking progress Experience: 2/3 of IHP+ partner countries have or are developing a compact Verdict of recent analysis: worth the effort, but on their own are not enough to get step change in partner behavior Go to http: //www. internationalhealthpartnership. net/en/key-issues/compacts/

Inclusive national planning and joint assessment processes • Joint assessment of National Strategy (JANS) developed to enhance quality of a national health strategy; to inform funding decisions and reduce transaction costs of multiple assessments – Shared, systematic assessment, using tool and guidelines developed by multipartner IHP+ working group. – Principles: country-led; aligned with in-country processes; inclusive; strong independent element – Product: profile of strengths and weaknesses of a health strategy, not a pass/fail JANS experience to date – Used formally in 12 countries, informally by more. Lessons learned up on IHP+ website. – Helped strengthen national health strategies; less direct link to funding decisions http: //www. internationalhealthpartnership. net/en/key-issues/national-health-planning-jans/

Financial management harmonization and alignment A plethora of FM arrangements for donor funding brings complexity to a whole new level

Harmonized financial management • Problem: – Under-use of country financial management systems – transaction costs due to duplicated financial management assessments, parallel financial management systems. • Action – Approach to joint financial management assessments developed. Standard elements of agreements on 'Joint Financing Arrangements' being defined – Countries encouraged to develop a costed national action plan to strengthen financial management, supported by all key government actors http: //www. internationalhealthpartnership. net/en/tools/financial-management-assessment/

General Principles • Align with country systems whenever they meet the minimum acceptable level. • Harmonize among development partners, when all or part of the national Public Financial Management (PFM) system is not sufficiently developed. • Agree and support implementation of a joint action plan that strengthens the national systems so as to bring about the necessary changes to make the alignment feasible. • Not wait until all problems have been solved, but use a step-wise approach by using elements of country systems as soon as possible as part of the process of improving systems and developing capacity. 19/03/2018

Examples of work done so far Country Burundi Senegal Description of work Conduct joint FM assessment and develop a joint capacity building action plan Align FM arrangements for DP-financed projects with country systems Participating DPs Af. DB, EU, GF, WB USAID, WB, GF Affiliated DPs Belgium Corporation, GAVI & USAID, Swiss Embassy GAVI Status English and French versions of the report have been completed. A workshop to disseminate the report, agree on an FM improvement action plan, and to draft Joint Fiduciary Arrangements (JFA) in March has been postponed due to the political situation in the country. For its HSS grant support to Senegal, GF now uses the country system, joining the WB and USAID in the use of country systems Joint FM Manual has been prepared. The Mo. H recruited two consultants to help finalize the manual. Donor consultations are on-going. A dissemination workshop is planned for July 2016. DR Congo (1) Develop joint FM procedures for government and DPfinanced projects; GF, WB, BTC, Af. DB UNFPA, EU (2) Leverage WB-led PFM reforms to set a Directorate of Financial Management in Mo. H Sierra Leone Set up an Integrated Health Projects Administration Unit GAVI, GF, WB (IHPAU) within Mo. HS Sudan Conduct joint FM assessment and develop a joint capacity building action plan GF, GAVI, WB, UNICEF, UNFPA, UNDP, WHO, Df. ID Liberia Conduct joint FM assessment and develop a joint capacity building action plan UNICEEF, UNFPA, EU, USAID, TBD GAVI, GF, Irish AID & WB Ethiopia Draft a new JFA with DPs support GAVI, Aus. AID, Royal Dutch WHO JICA, EU Review undertaken in May 2016. Assessment misison planing in progress JFMA report under preparation JFA now signed by all major DPs using joint financial management

Today's environment • The Sustainable Development Goals (SDGs) a renewed global commitment to health, underpinned by Universal Health Coverage (UHC). • The inclusion of UHC in the SDGs presents an opportunity to promote a comprehensive and coherent approach to health, to focus on how the health system delivers integrated, people-centred health services. • Domestic resources account for the large majority of health spending even in fragile states and low income countries (LIC) and there is need to focus on levers to strengthen institutions and efficient use of these resources for increased health security and equity. • The Ebola and Zika tragedies have reminded everyone of the importance of public health systems and better ways of engaging with other sectors, to be relevant UHC cannot overlook growing concerns related to health security