Walter Seidel - European Commission

1. Workshop Towards shared principles for reporting health impacts of development aid; Brussels February 6th, 2012:The aid policy framework - Interntional agreements and aid policy context Walter Seidel - European Commission Directorate General for Development and Cooperation – EuropeAid Unit D4 – Health Sector

2. 1. Introduction: Aid Effectiveness What do we mean by "aid effectiveness"? • The EU citizen's view: Does aid work? Is my money well spent? • The LIC citizen’s view: Does health care get better? • The public health scientist’s view: How can we measure aid effects in terms of health impact [mortality, morbidity]? • The aid professionals' view: Have we progressed on our commitments as stated in the Paris Declaration and the Accra Agenda for Action?

3. 2. Aid Effectiveness (AE) (Paris 2005, Accra 2008, Busan 2011) • Paris and Accra address essentially the problems of “Northern” aid to aid dependent low income countries with emerging institutional capacities; in Busan, the “BRICS” and the issue of South-South- Cooperation have been included into the AE agenda. • 3 key elements relevant for our discussion: • harmonisation (among donor agencies) • alignment (to national policies, mechanisms and systems; respecting national ownership) • managing for results

4. 3. Aid Effectiveness commitments – Practical consequences for EC health aid • Sector Policy Support Programmes (SPSP) => « Sector Reform Contracts » • Wherever possible as predictable budget support • Where criteria not fulfilled: Pooled fund with other donors, aligned forms of project support • Accompanied by a structured sector policy dialogue and sector performance monitoring • EC health aid is currently roughly 600 million EUR p.a.; 4/5th direct bilateral aid; 1/5th global funds and initiatives

5. 4. Reporting Results: Lives saved (LS):(GF web site accessed Nov 9th, 2011)

6. 5. Known problems with LS-Approach • Over-simplification of the model used (one or several of the following not considered) • Quality of care / provider compliance • Patient or user compliance • Drop out • Concurrent mortality • National variability in the above • Double Counting (linked to attribution) – some of the lives saved my have been claimed by other donors, or could be claimed by the Ministry of Health

7. 6. Emerging problems with the LS Approach • Lives saved has become a public accountability issue • As such, it potentially shapes the views and underlying assumptions that are at the basis of funding decisions of the public and the political level: • E.g.: It looks as if it would just need some products to fight the disease • E.g.: It looks, as if the Global Health Initiatives can save lives, whereas comprehensive systems support at country level can’t

8. 7. Aid at the country level: Complicated ...

9. ... nevertheless: Results at country level (1/3) Indicator: Proportion of births attended in health facility There is a slight improvement on the births attended at the health facility from 51% in 2007 to 52% in 2008 ; result for 2009? 2010?

10. ... nevertheless: Results at country level (2/3) Indicator:Percent of TB Treatment success/completionrate Great improvement in treatment success rate from of 84.7% in 2006 to 87.7% in 2008; the achievement surpassed the global target set at 85%.

11. ... nevertheless: Results at country level (3/3) Indicator: Outpatient attendance per capita The Tanzania Mainland OPD per capita is 0.68 in 2008 (below Diagram); it increased to 0.74 in 2009

12. 8. Consequences for results reporting by donor agencies From Global Fund’s High Level Review Panel Report (September 2011): • “… international organizations to refine their methodologies for tracking results as a critical measure of performance." • "In the end, the Global Fund [and indeed any other development agency W.S.] itself cannot be the guarantor of accountable results; the recipient countries, especially their Governments, must be." • Final Recommendations: "Getting serious about results ...Measure outcomes, not inputs: ...v. Coordinate much more closely with other donors on data, including joint analyses to attribute results more precisely, and avoid double-counting"

13. 9. Apply health impact reporting to the country level first – the method Implementing the HLRP recommendation: • Apply the impact algorithm (in analogy to GF / GAVI method) to a broader spectrum of diseases / interventions, • Apply it to the outputs of the entire health system at country level (for countries where output reporting is of reasonable quality, e.g. where there are established SWAps, compacts), • Agree on an attribution key at he country level first (e.g. based on the proportion of financing), • ... and then take home „your“ impacts and report to your constituency.

14. 10. Apply health impact reporting to the country level first – the feasibility Principles: • Build on the achievements of established SWAps, allowing for more comprehensive aid impact reporting • Build on the work already done by done by specialised agencies, partnerships and academia (WHO, Health Metrics Network, International Health Partnership IHP+, GF, GAVI …) Next steps: • Further examine feasibility; agree among major donors • Further develop the method(s) – mobilise resources to get started • get volunteer countries on board for test-run • Cross-check computed impacts against survey data (DHS, etc.)

15. Apply health impact reporting to the country level first – the AE criteria • harmonisation (among donor agencies) • alignment (to national policies, mechanisms and systems; respecting national ownership) • managing for results