INTERNATIONAL HEALTH PARTNERSHIPS Context, Process, Country Experiences & Expectations

1. INTERNATIONAL HEALTH PARTNERSHIPSContext, Process, Country Experiences & Expectations Mr. Nicholas Chikwenya Deputy Director – Health Planning & Budgeting Ministry of Health Zambia

2. Presentation Layout • Context • Country and Donor Experiences with Aid Architecture • A New Initiative for Aid Harmonisation – IHP • IHP and Process of implementation • Country Expectations • Progress so far

3. Context .... • Better health lies at the centre of the MDGs • Yet at the mid point to 2015 many countries are seriously off track in their efforts to realize the health related MDGs • External resources for health have more than doubled since 2000 and many countries have increased domestic resources • There is still a long way to go in meeting overall financing gaps for health and producing significant results

4. Context ... • There has been minimal progress in maternal and child health, reproductive health, and better coordinated donor support is required to strengthen programmes • Much of the recent increased investments have targeted specific diseases (HIV/AIDS, Malaria, TB) and vaccinations • Achieving better health outcomes requires more and better integrated investments in health systems (including HRH) and new approaches to resource allocation at all levels

5. Country Lamentations on Aid Architecture • Delivering sustainable results requires strengthening the systems that make health services work such as production, training, and retention of health workers • We need greater levels of flexible and predictable financing for health if we are to budget in long terms • We face high transaction costs in dealing with multiple cooperating partners who often operate outside the national planning and budgeting processes

6. Country Lamentations on Aid Architecture ... • We do not need separate multiple plans and budgets. We already have one-sector strategic plan which articulated our public health priorities • Targeted investments can have benefits but we want to see greater coordination and integration • We are suspicious of new donor initiatives over which we have little influence • Efforts to strengthen national health systems need to be country driven

7. Donor Lamentations on Aid Modalities within Recipient Countries • There is a need for partner countries to demonstrate high level political commitment by increasing and sustaining domestic investment in health • There is little confidence in the quality of many national health plans • There is limited capacity to implement the health plan, and inadequate engagement of other sectors • There is little confidence in the accountability mechanisms to citizens and other stakeholders • They need to see their support better translated into improved health outcomes

8. IHP - New Initiative for Aid Harmonisation • The IHP aims to accelerate action to scale up coverage and use of health services and deliver improved outcomes • Partner countries will increase their own resources for health, change policies and practices that are obstacles to efficient use of these resources, strengthen planning and accountability mechanisms • International Partners will better coordinate external support around priorities set in national health strategic plans, provide aid in ways that strengthen health systems

9. IHP - New Initiative for Aid Harmonisation • International Partners will, where possible, provide financial and technical resources in a more long term, predictable and flexible manner, coordinated under the national plan and with a greater proportion through national systems  • Civil society will play an important role in planning and implementation and in holding all parties to account

10. How will it be implemented? • Country-focused and country-led • Builds on existing structures, mechanisms, and country health plans • Provides long term, predictable financing for results-oriented national plans and strategies • Ensures mutual accountability for delivering on compact commitments

11. Development Partners One common M&E and mutual accountability framework H8 Agencies Long-term, predictable financing Fix health Systems bottlenecks Civil Society Donors One costed, results-oriented national health plan and budget Bilaterals/ multilaterals Inter-agency country health sector teams One common review process/ validation Country Compact Scaling Up Effective Coverage The Country Compact Existing country mechanisms Country Ownership Improved Outcomes for MDGs 1b, 4, 5, & 6

12. Country Expectations ... • A shift towards a holistic approach to financing health service delivery and ultimately moving towards more sustainable health system strengthening including HRH and infrastructure as exemplified by GAVI, GF, WB, Sida, CIDA, USAID, EU • A paradigm shift in aid delivery through efforts by development partners to harmonise support to the health sector within our Government-led health systems, plans and procedures.

13. Country Expectations ... • Development partners will commit to investing resources on national priorities as articulated in our respective national health plans. • Strengthened planning and accountability mechanisms • More inclusive and transparent planning and accountability mechanisms that are better linked to external support and improvements in health outcomes.

14. Country Expectations ... • Financing: With the signing of compacts, we expect partners to fill identified resource gaps • More importantly, one single country plan, one single budget, one single policy and results framework, one single M&E framework and process and one single fiduciary process

15. IHP+ Achievements since Sept ‘07 • IHP global compact signed by 8 Countries (Burundi, Cambodia, Ethiopia, Kenya, Mozambique, Nepal Zambia, and Mali) • 9 international organizations (WHO, World Bank, Global Fund, GAVI Alliance, UNFPA, UNAIDs, UNICEF, UNDP, EC) • 5 bilateral donors (UK, Norway, Germany, France, Italy, Portugal and Netherlands) • Other donors (Bill & Melinda Gates Foundation & African Development Bank) • SIDA, Madagascar, and Nigeria signed last week

16. IHP+ Achievements since Sept ‘07 • First Inter-country consultative meeting – February 2008, Lusaka - Zambia • Costing of the National Health Strategic Plan to determine resource required to scale up MDG attainment and gap analysis (Ethiopia, Zambia, Mozambique) • Review of MoU to identify weaknesses and gaps (Zambia)

17. A Costed NHSP in Ethiopia A gap of $2.8 billion needed to scale up!

19. IHP+ Achievements since Sept ‘07 • Country Compacts – first compacts to be agreed by Sept 2008 • Monitoring and Evaluation and External Review – • draft single M&E framework agreed and under discussion • at country level; external review to be completed by Sept 2008. • Growing Civil Society Engagement • IHP+ linked to: • Paris Declaration on Aid Effectiveness • Results-based Financing • Other global partnerships and initiatives • Ouagadougou Declaration on Primary Health Care

20. Conclusion: The Way Forward • Enhance strong political commitments to long-term, predictable financing for health MDGs • There is need to strengthen mutual accountability by all parties • Widen engagement in IHP+ to include more key players • Remove bottlenecks in the global health architecture • The IHP should be incorporated in the UN reforms • The Vision is to harmonize Cooperating Partners at global and country levels towards better health outcomes