COUNTRY EXPERIENCE ON MDG-PRS PROCESSES

1. COUNTRY EXPERIENCE ON MDG-PRS PROCESSES Needs Assessment, Alignment with Poverty Reduction Strategies, Translating into Sector Strategic Plans and Quick Wins. By Eileen Petit-Mshana Health Systems Advisor WHO/MDG Centre

2. Case Studies from four African Countries Tanzania Kenya Ethiopia Senegal

3. Case Study Focus • Similarities in the approach • Best Practices • Comparing findings –health MDGs • Issues for UNCT & Recommendations

4. Similarities in the Approach • Government taking the lead (MOP/MOF/VPO etc. • UNCT providing TA (UNDP coordinating) • Use of local consultants • Additional TA from MP, MDG Centre • Involvement of Bilateral Agencies • Sectoral Focal Points and TWG/Task Forces • Series of stakeholders validation workshops • reports from specific goals consolidated into one document i.e. MDG NA Synthesis Report • Synthesis report feeding into PRS review, MTEF, budgeting processes, etc.

5. Best Practices • Tanzania: a unique approach • Kenya: Health Sector a step ahead • Ethiopia: Positive donor dialogue • Senegal: Strong multisectoral approach and harmonisation efforts

6. Tanzania – a unique approach • Started with reviewing PRSP-1 • Coordinated by VPO • Developed PRSII namely, National Strategy for Growth and Reduction of Poverty (NSGPR 2005-2010) “MKUKUTA” • High involvement of community and civil society • Strong popularization through translation and producing cartoon version • Adjustments (“MDGisation”) made when developing interventions and costing • NSGPR move from “priority sector” to ‘Priority Outcome Approach’ and result-based strategy • NSGPR adapted 3 broad outcome clusters: (i) Growth and reduction of income poverty, for MDG1; (ii) Improvement of quality of life and social well-being, for MDG 2, 3, 4, 5, 6; and (iii) Good governance and accountability.

7. Tz Grasping the Opportunity • The conditions for achieving the outcomes of “Mkukuta” are present: political will, a solid scorecard on governance, a strong development vision, a track record of progress, and a supportive donor community. • As a consequence, Tanzania is well positioned to be one of the fast-track country that will access additional external resources • A well-costed Mkukuta should determine the scale and focus of donor resources over the next 10 years

8. MDG Needs assessment coordinated by Ministry of Planning in three stages Needs assessment; current situation vs. MDG targets + identifying public investment requirements for MDGs 2015 Develop long-term plan for achieving MDG Review medium term strategies (i.e. ERS - the Kenya PRS) to be in line with long-term plan. MDG NA initially parallel to NHSSP review process Needs Assessment eventually fed into NHSSPII process Emergency response plan (Equiv. to QWs) incorporated in NHSSP – giving it a better chance for donor/government funding. Kenya: Health Sector a Step ahead

9. Kenya Health Sector Emergency Response Plan 2005/06 = Quick Wins • Urgent hiring and retaining of critically required HRH (nurses, CO, Lab technicians etc) to scale up MDG interventions. • Increased immunization coverage to 80% by end of 2006, • Expand IMCI to all districts; • Increased access to FP; • Procure equipment and supplies for basic and comprehensive essentials obstetric care (EOC) in 50% of the all health facilities; • 3.4 m LLITNs distributed by end of 2006 to pregnant women and U5 children in high malaria endemic areas, implemented jointly with measles vaccination campaign. • Procure and distribute 12m treatment courses of ACTs;

10. Kenya Health ERP (QWs) cont.. • ARVs scaled up to 100,000 people by end of 2005, • All hospitals and 50% of health centers provide comprehensive HIV health care by 2006, • procurement and distribution of adequate female and male Condoms; • 60% TB detection rate, 83% cure rate and all TB Pts on treatment (DOTs); • establish integrated TB/HIV diagnosis centers in 50% of the rural health facilities; Procurement and distribution of Nutritional supplements;

11. Senegal: Strong Multisectoral approach & harmonisation • Efforts in place to merge MDG NA, MHI, NHA, PRS, etc. • Process well coordinated across sectors through sector FC & working groups • Health MDG component initially under-costed • Need for additional data to guide accurate costing accepted • Consensus reached to use MP costing models • Joint UNCT support observable & well appreciated by Government & partners.

12. Ethiopia: +ve Dialogue with Donors • MDG needs assessment well ahead and on track • Combination of Costing models accepted • The WB/WHO/UNICEF Marginal Budgeting for Bottlenecks (MBB) model used for costing health MDG • Development Partners closely consulted • Direct link with SDPRP (PRSP), MTEF and annual budgeting processes

13. Comparison Health MDGs selected countries

14. Health Systems indicators in selected countries

15. Key Issues for WHO, UNCT and MP Support (1) • Need for early donor involvement • Appreciating different plan horizons • Coordination by Planning Commission, MOF OK, but also consider line ministries as key actors • Urgent need for simple guidelines on MDG/PRS/SSP alignment process • Which costing model (s) to use? • Linking costing of MDG with GFATM, GAVI/FSP, MHI, SWAp etc.

16. Key Issues for WHO, UNCT and MP Support (2) • Need to broaden MDG / PRS knowledge base among indigenous and international staff in countries • MDG / PRS versus “business as usual” –Revisit UN country cooperation Strategies • Accessing resources for meeting MDGs • Continued need for evidence from real situations – MDG NA for evidence based actions & resource mobilisation • Quick wins concept to be properly advocated – link to longer term investment plans.

17. Key Issues for WHO, UNCT and MP Support (3) • Increase involvement of WHO & other UN Technical Agencies at Country and Regional Levels because of comparative advantages • Coordinate relations among HQ/Regions / Country Offices and MP/MDG Center in support of MDG/ PRS processes in countries • Strengthen support to countries • Give special MDG support to African Country Offices (WHO, etc). • WHO, MP, UN agencies collaboration crucial

18. Recommendations for the Way forward • Continue strong advocacy taking the 2015 time-horizon seriously. • Strengthen partnership, mutual trust and joint commitments, including development partners, trade organizations, international agencies, civil society and the private sector • Organise donor assistance around achievement of MDGs • Promote increased financing, while streamlining and harmonizing financial and administrative procedure • UNCT - be in frontline, act jointly as a multisectoral team, assist in establishing synergies, appreciating comparative advantages of each agency.

19. Recommendations for Health Systems • Promote proven cost-effective health interventions as minimum essential health care package • Strengthen health systems to match the required up-scaling of activities to achieve the health MDGs, infrastructure, referral system, drugs, etc. • Urgent Scaling up HRH to meet growing demand due to HIV/AIDS, malaria, TB etc. • Address other HRH issues e.g. motivation, migration, innovative training and flexibility in deployment • Improve required knowledge and information by promoting relevant research and strengthening MDG / Health information management systems, M&E. • Give special attention to sub-Saharan Africa because of its disproportional heavy burden of disease