EC-Health Sector Budget support in India Involvement of CSOs

1. Working Group 2: Complementarity and coherence within the Accra Agenda for Action (AAA) – Aid effectiveness Agenda EC-Health Sector Budget support in India Involvement of CSOs 1

2. Sector Budget Programme as an Instrument • to reinforce a better understanding between governments at various levels (national, regional and local level) and CSOs of their respective roles, missions and added value; • to promote an enabling environment for CSOs • to enhance public-private dialogue and partnerships for the design, implementation, monitoring and evaluation of public policies. They also offer the opportunity to deploy a ”programmatic” approach towards capacity building, by allowing a more structured intervention, designed in accordance with national social, economic and political challenges, and which makes use of several tools (training, tutoring, organisational, institutional and financial assessments, exchange of information, improved communication, etc). https://webgate.ec.europa.eu/fpfis/mwikis/aidco/index.php/WG2:_T3:_Coherence_and_complementarity_among_EC_instruments_in_support_to_CSOs

3. Role of CSOs in Sector Budget Programmes https://webgate.ec.europa.eu/fpfis/mwikis/aidco/images/9/94/Draft_Study_-_

4. Background to Bilateral Cooperation in Health Sector • HEALTH & FAMILY WELFARE SECTOR PROGRAMME IN INDIA, aSector Investment Programme (SIP) • During1996-2006 • 240 Million Euro • The overall development objective of the EC contribution was to improve the quality and accessibility of health services with particular focus on women and child health status. 4

5. Outcomes of SIP from Final Evaluation Report • Improved community participation: Effective role of Community health volunteers in Chhattisgarh etc. • CSO participation: Provided evidences of enhanced NGO involvement in grass-roots service provision, Behaviour Change Communication (BCC) and reform activities. To name a few • Selected NGOs were trained in Reproductive and Child Health concepts in Himachal Pradesh; • In Rajasthan, 19 NGOs were involved in health-seeking and behavioural change interventions in the 10 targeted districts; • In general NGOs were also involved in securing benchmarks as part of SIP’s performance-linked funding. 5

6. Sector Policy Support Programme • Support to the National Rural Health Mission/ Reproductive and Child Health II Programme in India • Financing Agreement signed in 2008. End in 2013 • 110 Million Euro • The overall objective of the SPSP NRHM/RCH2 is to assist the Government of India in meeting the Millennium Development Goals (MDGs) and, in doing so, to give support to the Ministry of Health and Family Welfare (MOHFW) in the implementation of the RCH II with particular reference to improving institutional, cross cutting aspects of service delivery of RCH II, and to facilitate capacity building to tackle systemic determinants of women’s and children’s health. 6

7. CSO involvement • During Formulation Mission phase two workshops involving all relevant stakeholders including CSOs were organised toincrease aid effectiveness in the health sector and harmonise approaches towards the Millennium Development Goals (target 5,6,7,8) achievement by sharing the EC Identification Mission findings and reviewing proposed strategy for support as well as to seek wider stakeholder insights and opinions in order to improve the EC support.

8. Private sector support including CSO The EU budget support approach aims at: Improving capacity for good governance and decentralisation of the NRHM/RCH II with support from the private sector, including civil society organisations. This will include activities such as: Developing agreements on service delivery modalities between districts’ health societies and the private health sector Comprehensive district planning including public – private partnership in districts Forging innovative initiatives; a catalogue of innovations has been compiled, new innovations are constantly evolving: ambulance systems, nutrition support, micro health financing, RSBY-insurance as PPP and many more

9. Outcomes oriented resource allocation requires all available forces • Focus of activities in EU budget support will take place at central, State and District level with involvement of all relevant and available forces of civil society: • Panchayati Raj Institutions, medical councils, NGOs, and health practitioners in India, institutions • Assessment of capacity needs to be built in the Panchayati Raj Institutions (PRIs), NGOs, Accredited Social Health Activist (ASHA) , Anganwadi Worker (AWW) at district and community level to improve joint monitoring, development of required competencies, promoting equitable access, and health outcomes oriented resource allocation and multisectoral support. • Private firms are auditing the state and district health societies

10. Regulating, auditing and partnering • Key aspects of the NRHM/RCH II are decentralisation and devolution of budgeting and financial management to the State level, with the national government changing its role from service provider to regulator and auditor and promoting a partnership with the private sector. • The NRHM/RCH II aims at better public health outcomes, providing conceptual clarity on organisational structures that allocate resources, manage services, audit results and target health problems. Private sector institutions may contribute from their available data banks, institutional and developmental skills • NRHM/RCHII allows for a flexible standardisation of facilities across the country, irrespective of whether they are managed by public or private providers.

11. Multisectoral cooperation • A multisectoral perspective in NRHM/RCH II is weak and occasional, in spite of available policies, norms and identified chain of responsibilities, especially at the peripheral level, where, for instance, the PRI’s role is still to be clearly addressed by the health sector and measures facilitating convergence, e.g. with nutrition and HIV services, as well as accountability are to be enforced. • CSO are seen to provide the missing link in addressing complex needs (eg. nutrition for improved maternal health and reduced child mortality) and catalyse the drive to connect various inputs required to meet such needs as they are aware of the determinants of gaps.

12. Sector Policy Support Programme at State Level • State Partnership Programme with Chhattisgarh • FA was signed in 2006 till 2013 • 80 Million Euro;32 Million specifically for Health Sector Reforms • purpose of the SPP is “Equitable delivery of and access to quality health and education services as well as improved forest based tribal livelihoods through governance and institutional reform and capacity development at state and decentralized levels”.

13. CSO involvement in SPP Chhattisgarh • During Formulation Mission phase, one workshop involving all relevant stakeholders including CSOs in Chhattisgarh to promote ownership and a consultative framework among the key State stakeholders for the SPP. • During Implementation phase a Programme Steering Committee (PSC) with responsibility for policy guidance and coordination between all institutions and groups involved in the Programme has been set up. PSC also has members from CSOs apart from Government officials. For example Jan Swasthya Sansthan, Bilaspur working on health issues in Chhattisgarh is a member of the PSC; Continue…

14. CSO involvement in SPP Chhattisgarh • The Department of Finance and Planning, Government of Chhattisgarh presents Annual Action Plans and Progress Reports on the SPP to the PSC for review, discussion and endorsement. • Similarly the two external Joint Review Missions present their reports to the PSC for discussion and endorsement. • Once a year, the PSC considers the recommendation for the release of the annual tranche on the basis of JRM recommendations.

15. Thanks • Followed by MAMTA’s Presentation , an EC’s CSO partner