Transcript UNIS Template

Sector wide approaches in health:
Pacific experiences and lessons learned
SYDNEY
MEDICAL SCHOOL
AAAPS
Conference
| 9 April 2010
Joel Negin
Methodology
› Project was conducted for the Nossal Institute for Global
Health’s Health Policy and Health Finance Knowledge Hub
› Working papers available from the Nossal Institute
› Literature review of academic, aid agency, multilateral agency
reports
› Key informant interviews
› Trip to Solomon Islands
2
Background to the Study
› Project aid seen as ineffectual – not achieving sought after
health goals
› Proliferation of actors leading to duplication, too many vertical
projects and huge burden on Ministries of Health
› Commitment to do development better
Sector Wide Approaches
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What are SWAps?
› Sector-wide approach:
- Agreed health sector plan
- Ownership by partner government
- Partnership between all or most donors and governments
- Increased funding availability and longer term commitments
- Efforts to streamline funding arrangements
- Institutional capacity and good governance
- Stability of donor and partner government personnel
› Aim to reduce duplication, increase harmonisation, support
country ownership and build capacity
How SWAps are supposed to work
What do we know about SWAps?
› Implemented in Africa and Asia from the mid-90s (Zambia,
Bangladesh, Mozambique, Malawi, Nepal)
› Mixed success and not much firm evidence
› Yet are aligned closely with Paris Declaration, IHP+, Accra
Agenda for Action
› The future of development assistance?
SWAps in the Pacific
› Education and water SWAps
› Health SWAp in PNG from early 2000s – not doing well by
most accounts
› Health SWAp in Samoa and Solomon Islands
› AusAID and NZAID committed to future SWAps in the region
SWAps in the Pacific
› This study examined the process of establishment
and implementation of health SWAps in Samoa and
Solomon Islands to extract lessons learned for
development actors in the region
Samoa SWAp
› Driven largely by government
› In partnership with World Bank, NZAID, AusAID
- NZAID is donor day-to-day contact agency
- Pooled funding in one account
› Increased funding and increased activity
› SWAp Secretariat within MoH
› Solid progress
Solomon Islands SWAp
› Driven initially by AusAID
› Contentious early relationship between AusAID and WB
› Initially a “SWAp of One”
› Limited government buy-in until April 2009
› Much better progress now
› Limited pooled funding but improving harmonisation and
collaboration
› Limited local capacity to manage various donors and take full
ownership
› Lots of work to do but positive momentum
SWAp Elements
Samoa SWAp
Solomon Islands SWAp
Agreed health sector plan
Available and used as basis for SWAp
despite problems with baseline
benchmarks
Available and used despite some concerns
with performance orientation
Ownership by partner government
Despite initial difficulties in the
Ministry of Finance-MOH
relationship, consensus that the SWAp
is now owned by government
Poor ownership by government
throughout SWAp development, with
some very recent encouraging signs
Partnership between all or most
donors and partner governments
and among donors
Strong collaboration between four
main actors: government, NZ, World
Bank, Australia
Very contentious early history among
donors has recently turned a corner
Increased funding availability and
longer term commitments
Five year commitments of additional
resources
Limited commitments with some players
only recently joining SWAp
Efforts to streamline funding
arrangements
Yes: pooled funding between all four
major actors, but not through
government systems.
Only Australia providing budget support
though other partners are slowly seeking
to streamline funding
Institutional capacity and good
governance
Strong capacity but financial
management systems need
strengthening
Generally weak capacity but national
financial management systems are being
used by SWAp
Stability of donor and partner
government personnel
Stability within MOH; transition from
AusAID to NZAID had difficulties
High turnover of consultants and MOH
executive
Movement towards a full SWAp
› SWAps are best seen as a process, as a means rather than an end
Source: Walford 2003
Pacific Aid Effectiveness Principles
Pacific Aid Effectiveness Principles
Principle 1: Country ownership through national development planning which is
adequately resourced using national budget and financial management system
Principle 2: Multi-year commitments by development partners and countries
aligned to nationally identified priorities as articulated in national strategies, with
agreement on performance indicators and M&E mechanisms
Principle 4: Development Partners and Countries pursue a coordinated and
harmonised approach in the delivery of assistance.
Principle 5: Strengthened institutional mechanisms and capacity in countries to
enable increased use of local systems by development partners.
Principle 6: Provision of technical assistance, including in aid
coordination/management, that ensures that capacity is built with tangible benefits
to the country to support national ownership.
Principle 7: Use of an agreed M&E framework that will ensure joint assessments
of the implementation of agreed commitments on aid effectiveness.
Lessons Learned
› Government ownership is critical
› SWAps are now more about partnership and coordination –
“sitting together at the same table”
› Relationships are vitally important
› Must build management capacity
› Cross-country learning is useful
Critiques and Challenges
› SWAps increase transaction costs
- More meetings, more money, more activity
› SWAps distract from service delivery
- So much emphasis on procedures and meetings and bank accounts
distract from getting the job done
- ‘We are a long way from having sound discussions about implementation of
priorities with governments and with development partners’
- ‘the nuts and bolts of service delivery are ignored’
› Some vertical and regional projects don’t link in well to
SWAps
- Global Fund, SPC
› Technical assistance has not built Pacific capacity
Implications
› SWAps are not a panacea to better health outcomes
› But greater harmonisation is needed on all sides
› Strengthening Pacific capacity to lead the health sector is a long-term
endeavour and momentum is in the right direction
› How serious are donors and Pacific governments about the Paris
Declaration and the Pacific Principles on Aid Effectiveness