Effective Implementation for Achieving theMDGs

1. Effective Implementation for Achieving theMDGs

2. Overview • Elements of RB/PSM Implementation • Country experiences • Horizontal cross-sectoral • Vertical cross-sectoral • Challenges to implementation

3. Principles for better implementation/service delivery • Horizontal linkage: plan priorities, budget support, and monitoring and evaluation systems and processes are effectively linked between central and sector agencies at the Subnational or local government ; multi-sectoral coordination • Institutional priorities are aligned to budget deliverables. • Policies, people, and processes are oriented to deliver intended results • Service delivery standards are established • Service delivery is aligned to budget with measurable performance indicators to facilitate results monitoring • Vertical linkage: plan priorities, budget support, and monitoring and evaluation processes are effectively linked from National to the Subnational or local government, with diverse options for local implementation

4. Horizontal Implementation • Sector Specific: One entity (agency or ministry) makes all policy and funding decisions • Split responsibility: A Ministry sets policy and sometimes provides core funding to local or regional government, with a separate entity for earmarked funding and partnerships for specific implementation • Split objectives: Two ministries or agencies with mandates for different areas of action set policy and provide funding individually • Multiple actors: Delivery through multiple branches of government, and often also through municipal structures

5. Horizontal Linkages: Multi-sectoral Approaches to Investments in Health • Extreme Poverty • Halve, between 1990 and 2015, the proportion of people whose income is less than $1 a day. • Halve, between 1990 and 2015, the proportion of people who suffer from hunger. • Safe Water & Sanitation • Halve by 2015 the proportion of people without sustainable access to safe drinking water. • By 2020, achieve significant improvement in the proportion of people with access to sanitation. • Child & Maternal Health • Reduce by two thirds, between 1990 and 2015, the under-five mortality rate. • Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio. • Primary & Girls' Education • By 2015, boys and girls everywhere complete a full course of primary schooling. • Eliminate gender disparity in primary and secondary education, preferably by 2005, and in all levels of education no later than 2015. • Communicable Diseases • By 2015, halt and begin to reverse • the spread of: • HIV/AIDS • Malaria & • Other major diseases.

6. Social Funds • Necessarily cross-sectoral mechanisms • Require cooperation of several ministries at the national level • Require coordination between ministries and local governments for implementation

7. Social Funds Kalahi: • National: National Steering Committee • ( DSWD, NAPC, DBM, DOF, NEDA, DILG and three rep. From NGOs, Chairperson- League of Barangays ) National: Project Management Team • Regional : Regional Project Management Team • ( Replication of the national member agencies ) • Provincial : Provincial Inter-Agency Committee ( Replication ) KDP: • National Level ; Government ; Inter- Ministerial Coordination Team; National KDP Secretariat ; consultant/ facilitators ; Management Consultants (NMC)

8. Multi-sectoral: Achieving Change in Health Behavior of Individuals/Households Income Education Water Sanitation Nutrition • Performance of Health System • Clinical Effectiveness • Accessibility and Equity • Quality and Consumer Satisfaction • Economic Efficiency • Health Status Outcomes • Fertility • Mortality • Morbidity • Nutritional Status Macro-economic Environment Health Care System • Institutional Capacity • Regulatory & Legal Framework • Expenditure & Finance • Planning & Budgeting Systems • Client & Service Information/Accountability • Incentives • Delivery Structure • Facilities (public & private) • Staff (public & private) • Information, Education, & communication Governance Projects and Policy Advice

9. People, Policies, processes: enabling breastfeeding in the workplace • Enabling workplace conditions for breastfeeding are important for the health of mother and child. • The Philippines example of multisectoral action: • Key stakeholders involved: • Department of Labour and Employment and DoH • Trade Union Congress of the Philippines (TUCP) • Employers Confederation of the Philippines (ECOP) • NGOs • WHO support • Benefits • health benefits for mother and child, lower cost of infant feeding, improved bonding, • lower absenteeism and higher productivity, enhancement of employer–employee relationship.

10. Service delivery standards • Afghanistan BPHS: focuses on health interventions including child immunizations, nutrition care; TB and malaria control; prenatal, obstetrical, and postpartum care; disability; familyplanning, and other curative services. • MoPH and its international partners to contractwith NGOs to deliver the BPHS in 31 of the 34 provinces • Maintain service delivery standards in difficult environment • Enabled the MoPH to develop key indicators of public health impact and building blocks for monitoring and evaluation of the BPHS including the household surveys, and health facility assessments such as the “Balance Scorecard.

11. Institutional priorities/delivering results Tamil Nadu Health Systems project • The Project has utilized several innovative and effective measures • 80 comprehensive emergency obstetrics and neonatal centers • health education, nutritional support, and HIV/AIDS testing and counseling • 385 ambulances have been provided under the project, managed under a public private partnership, increasing emergency transport services in rural areas. • public private partnerships have also provided mobile out-reach health services as well as other services.

12. Vertical Linkages: Unbundling the sectors & functions

13. Vertical implementation • Governments choose between different mechanisms for implementation • There are trade offs that differ by sector and by context • Decentralized Sectors • Local Government • Community Mechanisms

14. Comparing Approaches • The three approaches share good practices involving common principles • Lack of a clear common language and consistent methods often makes linkages and collaboration among approaches difficult • Tensions among approaches reflect different entry points as well as coordination problems among sectors/organizations promoting them

15. Integrating Approaches to Local Implementation Community Support Approaches Local Government Approaches Linked Approaches Decentralized Sectoral Approaches

16. Examples of Linked Approaches

17. A Framework for Local Implementation • A simple conceptual basis which allows integration of the strategic elements and methods developed by the three complementary approaches Enabling National Policy and Institutional Environment RB-PSM Local Gover-nance Local Public Service Provision Local Non-State Provision Improved human development outcomes Capacity Enhancement and Resource Transfers

18. Challenges to Integrating Local Implementation • Managing complex processes across institutional boundaries • at both local and national levels • Realigning power relations • central-local, state-society, and donor-client • Reconciling different interests & values • Changing attitudes and practices • donor, national, local, community

19. Implementation challenges • Cross-sectoral • Exclusion • MDGs not static • Regional disparities: horizontal • Urbanization: vertical

20. Regional disparities: Horizontal/multi-sectoral approaches • Chittangong • Mindanao • West Papua • Balochistan • Southern Thailand • “Extremist Affected States”

21. Regional disparities

22. Addressing regional disparities We have two worlds of education, two worlds of health, two worlds of transport and two worlds of housing, with a gaping divide in between… In general, the contradiction between the tribal community and the State itself has become sharper, translating itself into open conflict in many areas … people feel a deep sense of exclusion and alienation, which has been manifesting itself in different forms. The failure to provide infrastructure and services … is one of the many discriminatory manifestations of Governance here. (Government of India, 2008, Development in Extremist Affected Areas, Report of An Expert Group to Planning Commission).

23. Urbanization: Vertical Multi-sectoral implementation • Why focus on urban poverty? • Because of population growth, migration and recent increase in urban poverty rate, the number of poor people living in urban areas in the developing world is increasing compared to those in rural areas • The poor in urban areas have different characteristics than the rural poor • People in urban areas face specific covariate and individual risks • There is a gap between the needs of poor people and programs in urban areas

24. Urban Programs • Lack of sufficient poverty alleviation policies and programs that effectively reach the intended beneficiaries • Most of the existing urban programs and policies focus mostly on the improvement of physical infrastructure and delivery of basic services in low income areas and urban slums • CCT experiences • UNDP/Bangladesh studies

25. Concluding issues • Changes/adaptation of policies and procedures to fit multi-sector tasks, programs, and financial instruments; • Enhanced institutional framework to support multi-sector teams such as allocation of staff time and budgets, incentive systems, and accountability mechanisms.; • Learning and teaming practices across departments • Reviewing lessons from experiences in RB-Implementation