Transcript IHP Presentation to HDG Meeting 11.10.07

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
Paris declaration 2005
Post high level forum 2005 - 07
UNAIDS 3 Ones
Global Campaign on the Health
MDGs
IHP
Global Business Plan
on MDGs 4&5
Increased aid effectiveness
Increased resources
MDGs 2000
Context
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 …..
GTZ
Norad
CIDA
WHO
UNAIDS
RNE
Sida
USAID
INT NGO
3/5
UNICEF
WB
T-MAP
MOF
UNTG
CF
DAC
GFCC
P
PEPFAR
GFATM
CCM
HSSP
MOH
PMO
PRSP
MOEC
SWAP
NCTP
CTU
CCAIDS
NACP
LOCALGVT
CIVIL SOCIETY
PRIVATE SECTOR
Fragmentation…..
Complex in-country Supply Chains!
Constructed and produced by Steve Kinzett, JSI/Kenya - please communicate
any inaccuracies to [email protected] or telephone 2727210
Commodity Logistics System in Kenya (as of April 2004)
Commodity
Type
(colour coded)
Contraceptives and
RH
equipment
Condoms
for STI/
HIV/AIDS
prevention
STI
Drugs
W
H
O
Vaccines
and
Vitamin A
Essential
Drugs
Blood
Safety
Reagents
(inc. HIV
tests)
TB/Leprosy
Malaria
AntiRetro
Virals
(ARVs)
MOH
Equipment
Laboratory
supplies
Organization Key
Government
World Bank Loan
Bilateral Donor
Multilateral Donor
NGO/Private
Source of
funds for
commodities
Procurement
Agent/Body
Point of first
warehousing
Organization
responsible
for delivery to
district levels
Organization
responsible for
delivery to subdistrict levels
U
S
A
I
D
K
f
W
E
U
U
N
F
P
A
U
S
A
I
D
K
f
W
E
U
R
O
P
A
U
N
F
P
A
KEMSA
Regional
Depots
NLTP
(TB/
Leprosy
drugs
D
F
I
D
Crown
Agents
GOK
B
T
C
J
I
C
A
Government
of Kenya
KEMSA Central Warehouse
KEMSA and KEMSA Regional Depots
(essential drugs, malaria drugs,
consumable supplies)
C
I
D
A
G
A
V
I
Japanese
Private
Company
UNICEF
G
D
F
K
N
C
V
S
I
D
A
D
A
N
I
D
A
GTZ
UNICEF
MEDS
(procurement
implementation
unit)
KEPI Cold
Store
JSI/DELIVER/KEMSA Logistics
Management Unit (contraceptives,
condoms, STI kits, HIV test kits, TB
drugs, RH equipment etc)
US
Gov
GOK, WB/
IDA
C
D
C
The
"Consortium"
(Crown Agents,
GTZ, JSI and
KEMSA)
MEDS
KEPI
(vaccines
and
vitamin A)
Mainly District level staff: DPHO, DPHN, DTLP, DASCO, DPHO, etc or staff from the Health Centres,
Dispensaries come up and collect from the District level
Global
Fund for
AIDS, TB
and Malaria
MEDS
(to Mission
facilities)
MSF
MSF
NPHLS store
Provincial and
District
Hospital
Laboratory
Staff
Private
Drug
Source
Transaction costs..
10 453 missions in 34 countries in 2005
800
Vietnam
(791)
Cambodia
(568)
Honduras
Mongolia
Uganda
(521)
(479)
(456)
750
700
650
600
550
450
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 nonengagement
• 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.
What will success look like (2)?
• 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.
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