International Cooperation and Foreign Policy

1. International Cooperation and Foreign Policy Conceptual and Analytical Framework Dr. Mario Cruz Peñate Regional Advisor on Health Systems Strengthening Area of Health Systems based on PHC PAHO

2. International Cooperation The concept of cooperation for development does not have just one, right and complete definition that is valid for every place and time. Cooperation for development has had content added to and taken from it over time according to the dominant thoughts and values regarding development and the sense of co-responsibility that the richer countries had towards the situation of other populations.

3. Foreign Policy Coulumbis and Wolfe define it as follows: reduced to its fundamental ingredients, foreign policy consists of two elements: national objectives that must be met and the means for attaining them.

4. International Cooperation and Foreign Policy International Agenda MDG Paris Declaration Health Agenda for the Americas • International Cooperation: • Health • Volume • Main actors • Means of coopeartion • Internatioanl Relations: • Health • Spaces for Participation • Position of key topics • Historical background • Models of Development (ideology) • Geopolitical interests • Abilities and needs for Cooperation Model of Analysis FOREIGN POLICY National Interests

5. Actors in International Cooperation OFICIAL AID NON OFFICIAL AID

6. Actors in International Cooperation

7. Behavior of the Volume of Official Development Aid 1990-2010 0.35 Increase needed to achieve goals in 2010 0.33 0.33 0.28 ODA as % of GNI 0.22 Total ODA Source: OECD database

8. Americas in the Global Context • Loss of the relative importance of Latin America as a receptive region of ODA. • In the last two years, the ODA destined for the region, as a percentage of all ODA for developing coutnries, is the lowest in a decade. • Latin America receives, in per capita terms, one third of what Eastern Europe or Sub-Saharan Africa receive.

9. Health Aid According to Source 2007 Source: PAHO with data from the Institute for Health Metrics and Evaluation. University of Washington http://www.healthmetricsandevaluation.org/resources/pubs.html

10. Harmonization and Alignment Key principles

11. Why is there a need for H&A? "…two of the oldest challenges in international development: poor alignment of donor strategies with national efforts and poor harmonisation among donor procedures for aid management" The lancet, 25 November 2006

12. Why is there a need for H&A? "There are currently 40 bilateral donors, 26 UN agencies, 20 global and regional funds, and 90 global health initiatives…" The lancet, 25 November 2006

13. HMN PMI International Health Partnership KfW PEPFAR AusAid EC GAVI GTZ UNITAID Global Fund to Fight ATM DFID Catalytic Initiative JICA BTC AECI AFD Stop TB CDC PMNCH MOH KOICA USAID RBM WB ADB UNFPA MSFBelgium MSFFrance UNAIDS SC WHO ClintonHAI RACHA KHANA CARE UNICEF WFP UNDP HU Kantha Bopha PSI SRC HNI RHAC Oxfam URC 100+ health partners

14. Background • International efforts towards aid effectiveness • UN reform • International conference of financing for Development, Monterrey (2002) • Rome Declaration on Harmonisation (2003) • Joint Marrakech Memorandum on Managing for Development Results (2004) • Paris High-Level Forum on Harmonization, Alignment and Results (2005) • Accra High Level Forum, Accra Agenda for Action and Doha Declaration on Financing for Development (2008)

15. The Paris Declaration Endorsed in March 2005 by 90 developed and developing countries, and 27 aid agencies. Based on earlier poverty reduction commitments. Non binding.

16. The Paris Declaration: main idea Main idea is 'alignment and harmonization': • Country needs to own the poverty reduction process • Development assistance should be delivered in accordance with government priorities and relying on country systems • Development partners must harmonize their work in common procedures and joint arrangements

17. The Paris Declaration: principles Five mutually reinforcing principles: • Government ownership • Alignment with national priorities and systems • Harmonization among development partners • Results based management • Mutual accountability

18. Framework for aid effectiveness (Countries)

19. Paris Declaration: indicators Indicators of progress • 12 indicators • Targets for 11 indicators set for 2010 • 2006 OECD DAC conducted baseline survey in 34 countries • First quarter 2008, mid-term monitoring survey with results presented at Accra, Ghana meeting in Sept 08

20. Paris Declaration:The 12 Indicators Ownership 1. Partners have operational development strategies Alignment 2. Reliable country systems 3. Aid flows are aligned on national priorities 4. Strengthen capacity by co-ordinated support 5a Use of country systems 5b Use of country public financial management systems 6. Strengthen capacity by avoiding parallel implementation structures 7. Aid is more predicable 8. Aid is untied Harmonization 9. Use of common arrangements or procedures 10. Encourage shared analysis Managing for results 11. Results oriented frameworks Mutual accountability 12. Mutual accountability

21. Ownership: definition When the country sets the health agenda and can play its part at the 'ownership' level of the aid effectiveness pyramid.

22. Ownership: impact for health The impact for health depends on the capacity of the Minister of Heath and other decision makers to adequately include health in the countries development strategies

23. Capacity definitions Capacity is the ability of people, organizations, and society as a whole to manage their affairs successfully. Capacity development is the process whereby people, organizations, and society as a whole unleash, strengthen, create, adapt, and maintain capacity over time OECD DAC

24. Alignment: definition Alignment is when development assistance is delivered in accordance with countries’ priorities; and when partners rely on country systems and procedures.

25. Alignment: impact for health The impact of alignment for health depends on how well the countries health priorities are defined in national plans and strategies, and how well the whole development community is aligned with those priorities

26. Alignment: opportunities for health The alignment principle encourages: • Clear health priorities in government plans • Effective country systems, procedures, standards and processes • Shift in focus from project to programme approaches • Development partners to work on country priorities

27. Harmonization: definition Harmonization is when there is increased coordination and streamlining of the activities of different aid agencies to develop common arrangements; simplify procedures; and share information.

28. Harmonization: impact for health The impact of harmonization for health depends on how well the development partners and governments collaborate to strengthen health systems, use common arrangements, conduct joint missions and share analyses.

29. Harmonization: opportunities for health The harmonization principle encourages: • Simplified and common arrangements • Collective approach to challenges • Harmonized performance assessment • Shared systems • Joint capacity building

30. Managing for results and mutual accountability definitions Managing for results To better demonstrate results and exhibit a greater focus within and across programmes; to improve the targeting of resources and the integration of all sources of funds; and to demonstrate greater transparency and accountability of programme management. Mutual accountability Where partner countries and donors are both accountable to each other as well as to their own governments and constituents towards improving development results.

31. Managing for results and mutual accountability: impact for health The impact for health of results based management and mutual accountability depends on the usefulness and reliability of frameworks, mechanisms and systems

32. Challenges of A&H Some cross-cutting challenges affecting A&H are: • A&H being a dynamic agenda • Alignment of agency objectives • Complexity of the health sector • Donor bias • Increased costs • Personalities and politics • Incentive systems (personal, institutional & political)

33. Gracias Thank you