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Health Sector wide approach experience in Nicaragua

Health Sector wide approach experience in Nicaragua. Dr. Donald Moncada S. Country Manager PASMO/PSI Nicaragua. MAGNITUDE AND CHARACTERISTICS OF INTERNATIONAL COOPERATION IN NICARAGUA. 2003: 541,380, 000 USD engaged 52% donations, 48% loans

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Health Sector wide approach experience in Nicaragua

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  1. Health Sector wide approach experience in Nicaragua Dr. Donald Moncada S. Country Manager PASMO/PSI Nicaragua

  2. MAGNITUDE AND CHARACTERISTICS OF INTERNATIONAL COOPERATION IN NICARAGUA • 2003: • 541,380, 000 USD engaged • 52% donations, 48% loans • This represents 13.1% of GDP, 32% of public expenditure and 80% public investment. • 80% ring-fence aid • 41 agencies • 553 projects in October 2004 • High degree of uncoordination between Government and agencies This fact leads to high transaction costs and makes the implementation of government policies particularly difficult.

  3. Monterrey Rome SWAPs Mechanism implementation Advisory group in Managua Declaration of Managua Consensus on mechanisms What has been done in Nicaragua ? I Coordination workshop(2002) • Analysis • Need for changes II Coordination workshop (2003) Instruments and Mechanisms were developed Budget support Strengthening of cooperation coordination Creation of sectoral groups OECD-DAC JCLA

  4. HARMONISATION AND MAINSTREAMING PROCESS IN NICARAGUA • Lead by Ministry of Foreign Affairs, with a strong support of donors that promote SWAP: Sweden, The Netherlands and Finland. • Consultation to Global and sectoral group of donors. September 2004 October 2002 February 2003 June 2003 October 2003 PARIS March 2005 Second Forum for the Coordination of the Cooperation Adoption of SWAP Third Forum for the Coordination of the Cooperation(Sept. 2004) Presentation of National Development plan Elaboration of OECD-DAC questionnaire and A&A action plan for NIC. Advisory group Commitment to implement JCLA as a model to monitor the Declaration of Rome Declaration of Managua First Forum for the Coordination of the Cooperation Sectoral groups were set up

  5. HARMONISATION AND MAINSTREAMING PROCESSIN THE HEALTH SECTOR Based on the 5-year Health plan 2005-2009 designed by the MoH in order to implement National Health Policy and Plan • A group of countries and cooperation agencies (Sweden, The Netherlands, Finland, Austria, IDB and WB) decide to carry out joint missions • 1st meeting in April 2004, 10 agencies. Commitments on the date to finalize the Health and the 5-year Plan • 2nd and 3rd meeting in July and September 2004. Commitments on the Code of Conduct and memorandum of understanding . • 4th meeting, November 2004. Presentation of the 5-year Plan, approval of a Code of Conduct and Memorandum of Understanding revision. • 5th meeting, January 2005. Signature of the Code of Conduct. • 6th meeting, June 2005. Approval of the Memorandum of Understanding text. • August 2005. Signature of the Memorandum of Understanding.

  6. NICARAGUA: CODE OF CONDUCT 1 • The parties are the Partners for Development • The results are everybody’s responsibility, and everybody has the same rights. • Transparency commitment in all the decisions concerning the sector. • Support to a single policy and Ministry plan. Consensus on future policies. • All the information will be available for the sectoral group

  7. CODE OF CONDUCT 2 • Promoting: • Use of Government procedures • Adapting of Government budget cycles • Commit to multiannual disbursements • Use the same transparent information mechanisms • Inform on new cooperation activities to the sectoral health group • Give technical assistance according to agreed criteria • Use the same limited follow up indicators

  8. NICARAGUA: MEMORANDUM OF UNDERSTANDING (MoU) • The parties to the MoU must have signed first the Code of Conduct • The annual meeting calendar must respect the national budget cycle of the parties to the MoU • Mechanisms to commit to disbursements • Anti-corruption clauses

  9. COORDINATION MECHANISMS IN THE HEALTH SECTOR • Sectoral Group in the Health sector, comprised of: MoH, Ministry of Foreign Affairs, Ministry of Public Expenditure, Presidency Secretariat, National Social Security Institute and Partners for Development. • Permanent body: Only members of MoH. • Parties to the MoU: Sweden, The Netherlands, Finland, Austria and World Bank • National, Department and Local Health Councils. And Advisory Health Councils for hospitals

  10. CURRENT RESULTS • The MoH, with its own procedures, manages a common fund that represents more than 25% of the total external funds for Health received • The loans from the World Bank and IDB comply with the Government Health policy and Plans. The previous Project Coordination Units will disappear • Formal and organizational instruments are available to advance towards the harmonisation and mainstreaming of all the external aid

  11. PROGRESS • The Health Sectoral Group was reactivated and achieved: • Mainstreaming the Project Portfolio with the 5 year Health Plan • Set up a single package of indicators for the follow up and evaluation of all projects, based on the ones elaborated for National Poverty Reduction Strategy, National Development Plan and the Health plans • Design and implement shared report templates • Elaborate a technical assistance plan that covers all the cooperation • Gradually eliminate all the Project Coordination Units. • Establish mechanisms to meet the needs of the MoH and avoid duplication of studies and diagnosis.

  12. MID-TERM RESULTS Public Treasury Credits Donations Public Treasury Credits Donations National Budget Sector Plan and Budget PCUs Ministry of Health Ministry of Health Discoordiation, multiple plans Multiple management, monitoring and evaluation mechanisms Ministerial Plan and Policies. Single management monitoring and evaluation mechanisms Financing of services and other actions Financing of services and other actions

  13. INTERNATIONAL COOPERATION SITUATION ACCORDING TO THE SWAP AT THE END OF 2006 All the external cooperation organizations Official Development Cooperation (Sectoral Group) Parties to the Code of Conduct SWAP FONSALUD Fuente:

  14. What does it mean for Civil Society? • In the Health sector, it meant joint Strategic Plans. Examples: National Health Plan, Strategic HIV/AIDS Plan • Clear goals • Better donor coordination

  15. What does it mean for Civil Society? • “As a federation, I think this has not affected us directly. However, it has affected the Civil Society organizations as they tried to implement this financing mechanism using Government guidelines”.   Dr. Fernando Campos Ordeñana Deputy Director Federation NicaSalud Network

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