Transcript National Strategy Applications and Health Systems Funding

National Strategy Applications and Health
Systems Funding Platform
Joint Assessment and Multi-Stakeholder Involvement
Regional Workshop for Civil Society
14 October 2010
Context
Growing complexity of global health aid architecture
Creation and growth of
Global Fund
Paris Principles (2005) & Accra Agenda for Action
(2008)
International Health
Partnership (IHP)
Joint Assessment of
National Strategies (JANS)
Global Fund initiatives to
simplify and streamline
funding
HSFP
NSAs
New grant
architecture
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Session Overview
Joint Assessment
National Strategy Applications
Health Systems Funding Platform
Multi-stakeholder involvment
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What is joint assessment?
Background
International Health Partnership (IHP), Joint Assessment of National Strategies (JANS)
–
Principles for joint assessment
–
Attributes of sound national strategies (JANS Tool)
Definition
Joint assessment is a process by which country stakeholders and international partners
come together to carry out an independent assessment of a national strategy and its
accompanying documentation. It is based on JANS principles and tool.
Scope
Can be applied to national health sector strategies or sub-sector strategies (e.g. disease
strategies).
Purpose
1. provide countries with constructive feedback on the national strategy documentation; and
2. provide international agencies with relevant information to help them make technical
support and/or funding decisions.
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Joint Assessment
JANS principles
IHP JANS Principles including the following:
– country-demand driven and country-led;
– building as appropriate on existing in-country processes and
experience
– strong independent element;
– inclusive process, involving civil society and other stakeholders;
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Civil society consultation on Global Fund initiatives
JANS Tool/Attributes
Commonly agreed basis for assessing technical soundness of national strategies
Category
Focus of attributes (for full language see IHP website)
1. Situation Analysis and
Programming
•Sound situational and response analysis
•Clearly defined priority areas, objectives and interventions,
contributing to improved health outcomes
•Planned interventions, cost effectiveness, sustainability
•Risk assesment and mitigation strategies
2. Process
•Multi-stakeholder involvement in development and
endorsement of national strategy documentation
•Consistency with higher and lower level strategies
3. Finance and Auditing
•Comprehensive budget/costing, financial gap analysis
•Specification of allocation of funds
•Financial management system
4. Implementation and
Management
•Operational plans, resource deployment
•Procurement policy
•Governance, management and coordination framework
5. Results, Monitoring and
Review
•Monitoring and evaluation
•Joint periodic performance reviews
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Joint Assessment
Attribute related to MSI
Multi-stakeholder1 involvement in development of
national strategy (which is led by government, with a
transparent consultative/participative process) and multistakeholder1 final endorsement of national strategy.
1: Including government, civil society (according to the UN definition) and the private sector
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Joint Assessment
JANS Principles and Tool
JANS applied so far in two different areas, using same principles and tool:
IHP-led joint assessment
of national health sector
strategies
Global Fund-led
assessments of national
disease strategies
3-4 countries in 2010 so
far. Process ongoing.
7 assessments in First
Learning Wave of NSAs
in 2009
Feeding (in some cases)
into donor funding
decisions.
5 NSA grants approved
November 2009
Some differences in emphasis and details of process
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Session Overview
Joint Assessment
National Strategy Applications
Health Systems Funding Platform
Multi-stakeholder involvment
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National Strategy Applications
NSA concept
Countries
“National strategy application” to Global Fund
(= jointly assessed national strategy
+ minimal additional information)
National
strategy
documentation*
Application
(“NSA”)
National strategy
‘joint assessment’
Grant
management
Funding decision-making process for other funder(s)
Joint assessment
report
* National strategy documentation = national strategy + complementary documents (e.g., operational plan)
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National Strategy Applications
Anticipated benefits of NSA approach
Puts focus on development, financing and implementation of robust
national disease strategies aimed at improving health outcomes and
supports Paris aid effectiveness principles and Accra Agenda for Action
Anticipated benefits:
• Alignment with country priorities, national programmatic and
budgetary timeframes;
• Reduced transaction costs and paperwork for countries;
• Improved harmonization with other donors;
• Opportunity to extend multi-stakeholder inclusion to the scope of
the national strategy;
• A focus on managing for results and accountability within national
disease strategies;
• Improved quality and credibility of national strategic frameworks
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National Strategy Applications
First Learning Wave of NSAs
At the end of 2008, Global Fund Board decided to launch a phased roll-out
of NSAs, beginning with a “First Learning Wave” of NSAs in 2009, with
aim to draw lessons to inform the future, broader roll-out of NSAs
Unique characteristics:
• Compressed timeline (to be ready in same timeframe as R9 proposals)
• Limited number of countries (22 countries invited)
• Review of national disease strategies by TRP only (exceptional since
no joint mechanism in place)
5 NSAs approved in November 2009
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National Strategy Applications
Reports on FLW & message on value of NSA approach
Conducted by
Scope
TRP
All NSA countries
UNAIDS- commissioned The 3 countries that submitted NSA for HIV
consultants
McKinsey,
commissioned by GF
12 countries, spanning all three diseases and
different FLW outcomes
All 3 reports indicate perceptions of value of NSA approach
from both country- and global-level stakeholders to be
broadly positive
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National Strategy Applications
Second Wave of NSAs
In April 2010, Global Fund Board approved the initiation of a Second Wave of
NSAs, drawing on the lessons from the First Learning Wave, with the following
characteristics:
• Timing
– allow countries more time for key process steps
– have NSA funding decisions at end of 2011
• Approach to country participation
– include a limited but incrementally larger number of countries than the First
Learning Wave
– move towards longer-term vision of open “self-selection” process
• National strategy assessment
– move towards a credible, joint assessment approach
• Multi-stakeholder involvement
– strengthen approach used in First Learning Wave
+ also ensure consistency with new Global Fund grant architecture
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Second Wave of NSAs
Joint assessment for Second Wave of NSAs
The long-term vision of the joint assessment in the NSA approach is to move towards
a truly ‘joint’ process. This is currently in evolution:
First Learning Wave: GF-driven, GF-organised, TRP conducted
Purpose: learn about assessment of national disease strategies and link with GF NSA
funding application
Second Wave: GF/donor-driven, jointly-organised, jointly conducted
Purpose: learn how to do a country-driven
joint assessment of a national disease strategy that can form the basis of
funding/support decisions of international agencies
Intended future model: country-driven, jointly organised, jointly conducted
Purpose: enable countries to conduct joint assessment at time that bests suits their
national calendar, and use it as basis of funding/support requests as these arise.
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Second Wave of NSAs
Joint assessment approach
Will follow JANS Principles and use JANS Tool.
In addition, joint assessment of national disease strategies needs to be
sufficiently reliable to allow the Global Fund and other donors to use its
outcome as the basis of their technical support and/or funding decisions.
Hence, some key requirements (agreed by Multi-Partner Working Group), including:
• All joint assessment team members independent (no involvement in drafting the
national strategy and no conflict of interest with regards to assessment outcome);
‘national facilitators’ possible in addition;
• Assessment team leader external to country;
• A few experts nominated and paid for by donors included in team;
• At least one member with expertise in multi-stakeholder involvement;
• Agenda developed consultatively;
• Assessment report to present strengths and weaknesses of national strategy.
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Second Wave of NSAs
Joint assessment process
Key steps
1. Nominate a joint assessment organizing body;
2. Identify a joint assessment team leader and assessment dates;
3. Prepare the joint assessment (define scope and focus; identify other
assessment team members; prepare agenda);
4. Provide an update on joint assessment preparations;
5. Conduct the in-country joint assessment.
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Session Overview
Joint Assessment
National Strategy Applications
Health Systems Funding Platform
Multi-stakeholder involvment
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Health Systems Funding Platform (HSFP)
Background
•
Health Systems Funding Platform (the Platform) is a joint partner initiative of the
GAVI Alliance (GAVI), the Global Fund and the World Bank, with facilitation from the
World Health Organization (WHO)
•
Goes back to a letter from the Global Fund ED and the GAVI CEO in March 2009 to
the co-Chairs of the High Level Taskforce on Innovative Financing for Health
Systems proposing collaboration on HSS funding
•
High Level Taskforce welcomed proposal and recommended Platform as a
mechanism to “…coordinate, mobilize, streamline and channel the flow of existing
and new international resources to support national health strategies.”
•
Aim is to make better use of new and existing funds for health systems
strengthening (HSS) through simplification of countries’ access to HSS support, and through harmonization and alignment of the way this support is
provided
•
Principles of the Platform are in line with those of the Paris Declaration, the Accra
Agenda for Action on Aid Effectiveness and the International Health Partnership
(IHP+) .
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Health Systems Funding Platform
Anticipated benefits
• Greater Value for Money
• Improved outcomes for the three diseases
and immunization
• Contributing to MDGs 4, 5 & 6
1
Aligning partner support to national plans and
strategies, through an inclusive process
2
Reduced transaction costs (for both funders and
implementers)
3
Coordinated funding for HSS
Improvement of
Aid Effectiveness
(Paris and Accra
Principles)
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Health Systems Funding Platform (HSFP)
Platform applies to existing and new HSS funding
Track 1
“Existing
financing”
1
Opt 2 Opt 1
Track 2
“New
financing”
Harmonization1 of existing HSS grants/credits
Access via joint proposal form
Access via jointly assessed
national health strategy
Grant/credit
management1
Harmonized monitoring & evaluation and fiduciary frameworks (incl. procurement)
Global Fund Board Decision from April 2010:
•
Continue rapid implementation of Track 1
•
Development of joint proposal form for HSS with GAVI (for Round 11)
•
Design pilot for 4-5 countries to submit funding requests based on jointly assessed
national health strategies (parallel to Round 11)
•
Scope of GF HSS support to be maintained for the purposes of the Platform
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Health Systems Funding Platform (HSFP)
Track 1 - Existing funding: Progress to date
Cambodia:
• First joint country mission (with GAVI, WB and WHO representatives) in early
June 2010
• Ministry of Health approved approach in August 2010, and has given
permission for work to go ahead.
• All three Platform funding partners have harmonized performance indicators
with those of national strategy and have agreed to strengthen country’s health
information system.
• Further work planned to support upcoming mid-term review of the national
health strategy
DRC:
•
Mission in August 2010 to discuss harmonization of performance frameworks
(GAVI and GF grants managed by same MoH project management unit)
Benin:
• Joint partner work started to harmonize and align, with a potential focus on
performance frameworks and financial management.
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Work in progress
Health Systems Funding Platform (HSFP)
Track 2.1: Joint proposal form with GAVI
Step 1
Step 2
Step 3
Step 4
Step 5
Step 6
Joint process
(but not in all instances)
Proposal
Development
Submission
of
joint
proposal
Independent
review
by
TRP/IRC
Key elements (current thinking):
Board
approval
Financial
arrangements
Grant
management
Based on joint
mechanism/framework
Separate
•
One form to request HSS funding from GAVI and/or Global Fund (same structure, same M&E and
financial management framework) – this will reduce transaction cost
•
Applicants still requested to delineate amounts requested from each of the agencies
•
Possible to submit joint requests to GAVI and the Global Fund, but could also be individual
requests to either agency (form is replacing current GF 4B/5B for HSS cross cutting component)
•
Joint requests will be developed and signed off by CCM and health sector coordinating body –
strong coordination required
•
Joint request and joint review by TRP/IRC (for joint requests) enables holistic view on HSS
needs in country
•
Grant management based on harmonized M&E and financial management procedures (if
requested within the parameters of a joint financing agreement)
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Pending PSC approval
Health Systems Funding Platform (HSFP)
Track 2.2: Pilot for funding based on assessed strategy
Step 1
Step 2
Step 3
Step 4
Step 5
Step 6
Joint process
(but not in all instances)
Joint
Assessment
Board
Funding
Independent
approval
request
review
World Bank project appraisal
process
Financial
arrangements
Grant/credit
management
Based on joint
mechanism/framework
Separate
Key elements (current thinking):
•
Joint assessment of national health strategy based on IHP+ JANS tool and
process including all relevant stakeholders (incl. civil society)
•
Light funding request predominantly consisting of existing documentation (could
be joint request to GAVI/GF) – therefore directly aligned with country priorities
•
Development and submission of funding request by CCM under strong coordination
with health sector coordinating body
•
Joint review by TRP/IRC (for joint requests)
•
Grant management based on harmonized M&E and financial management
procedures (if requested be within the parameters of a joint financing agreement)
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Health Systems Funding Platform (HSFP)
Next steps
• Continue joint partner work and consultations (including
monthly phone calls with civil society representatives of all
three Platform funding partners)
• Policy and Strategy Committee reviewing proposed design
for HSFP pilot for approval (25/26 October)
• Portfolio and Implementation Committee reviewing draft
joint proposal form for sign off (Feb 2011)
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Session Overview
Joint Assessment
National Strategy Applications
Health Systems Funding Platform
Multi-stakeholder involvement
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Multi-stakeholder involvement
Context
• Multi-stakeholder involvement (MSI) is an absolutely essential
principle for GF. Application of joint assessment in Global Fund
context needs to be designed in accordance with this core principle.
• The question is not whether but how we should achieve this.
• NSA approach in fact provides an opportunity to extend MSI to
development of a national strategy (as opposed to just development
of a GF-specific proposal – as in regular rounds-based approach)
• Need to see this as an evolutionary process; learn as you go
• Key objective in ‘early’ NSA waves and HFSP pilot is to learn what
mechanisms are appropriate and effective to achieve this more
ambitious level of MSI over time (including via positive incentives)
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Multi-stakeholder involvement
Various entry points for MSI
Strategy development process
Decision to participate in joint assessment
Joint assessment team and process
Decision to develop and submit NSA
Grant implementation and oversight
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Multi-stakeholder involvement
Joint assessment stage (NSA)
Requirements on joint assessment of national disease strategies for purposes of
NSA Second Wave:
•
Requiring that joint assessment organizing body incorporates multistakeholder representatives and/or consults them systematically during
preparation process
•
Assessment of national strategies against IHP+ attributes of sound national
strategies, including attribute focusing on “multi-stakeholder involvement
in the development […] and final endorsement of a national strategy”;
•
At least one assessment team member with specific responsibility and
expertise for examining MSI;
•
Joint assessment team discussions with civil society stakeholders as part
of in-country visit;
•
Requiring that details of the joint assessment (including organizing body,
agenda, and outcome briefing) are published transparently
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Multi-stakeholder inclusion
Global Fund application stage (NSA and HSFP Pilot*)
Existing Global Fund mechanisms maintained:
*Current thinking
– input required
Development of funding request:
•Maintaining role of CCM and eligibility criteria for CCMs (ensuring appropriate multistakeholder representation)
•CCM decides on how to apply for funding:
• For NSA Second Wave: CCM to decide whether to submit NSA (based on jointly
assessed national disease strategy) or whether to apply through regular proposal
• For HSFP Pilot: CCM to decide whether funding request should be based on jointly
assessed health strategy or whether regular proposal should be developed
Submission of funding request:
•Submission by CCM
•In addition: In case of joint assessment showing insufficient multi-stakeholder inclusion in
development of the strategy, need for CCM to describe „remedial actions“
Selection of PRs:
•Maintaining of Dual-Track Financing policy
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Multi-stakeholder involvement
Issues requiring further elaboration
1. How to ensure joint assessment organizing body at country level
incorporates civil society as part of preparation process?
2. How to ensure selection of an appropriately qualified and unbiased
‘civil society expert’ for assessment team?
3. How to ensure consistent and thorough assessment of ‘MSI
attribute’ across countries?
4. What mechanism to support development and application of
appropriate ‘remedial actions’ where weaknesses found in ‘MSI
attribute’, and follow up on these?
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