2010 IHP+Results Performance Monitoring Report by ResultsLAB

Strengthening accountability to achieve the health MDGs

+ Related Initiatives

ANNUAL PERFORMANCE REPORT 2010 I

CONTENTS

ACRONYMS AND ABBREVIATIONS

INDEPENDENT ADVISORY GROUP FOREWORD

EXECUTIVE SUMMARY

1. INTRODUCTION

2. HOW THIS PERFORMANCE REVIEW WAS CONDUCTED

3. PROGRESS TOWARDS ACHIEVING THE EXPECTED RESULTS OF THE IHP+

3.1 PROMOTING COUNTRY OWNERSHIP, MUTUAL ACCOUNTABILITY AND MEANINGFUL CIVIL SOCIETY PARTICIPATION 3.2 TRANSPARENT AND RESPONSIBLE HEALTH FINANCING 3.3 USING AND STRENGTHENING COUNTRY SYSTEMS 3.4 MANAGING FOR DEVELOPMENT RESULTS 3.5 STRENGTHENING HEALTH SYSTEMS

14 19 23 27 28

4. DISCUSSION

5. CONCLUSIONS

6. RECOMMENDATIONS

GLOSSARY OF KEY TERMS

TABLE OF IHP+RESULTS STANDARD PERFORMANCE MEASURES & TARGETS

IHP+Results 2010 Performance Report

ACRONYMS AND ABBREVIATIONS CPIA

ountry Policy and InsƟtuƟonal Assessment

CSO

ivil Society KrganisaƟon

DFID

h< Department for InternaƟonal Development

Development Partners

DRC

DemocraƟc Republic of ongo

European Commission

GAVI

The Global Alliance for saccines and ImmuniǌaƟon

GBS

General Budget Support

GFATM

The Global Fund to Fight AIDS, TB and Malaria

HLF4

High Level Forum on aid eīecƟveness

HMIS

Health Management InformaƟon System

HMN

Health Metrics Network

HRH

Human Resources for Health

IHP+

InternaƟonal Health Partnership and related iniƟaƟves

JANS

Joint Assessments of NaƟonal Strategies

MDGs

Millennium Development Goals

MoH

Ministry of Health

OECD

KrganisaƟon for Economic CoͲoperaƟon and Development

OECD/DAC

The Development Assistance CommiƩee

PAF

Performance Assessment Framework

PBAs

Programme Based Approaches

PFM

Public Finance Management

PIUs

Proũect ImplementaƟon hnits

SBS

Sector Budget Support

SPMs

Standard Performance Measures

SuRG

IHP+ Scaling Up Reference Group

TT HATS

The Task Team on Health as a Tracer Sector

United NaƟons

UNAIDS

Joint United NaƟons Programme on HIs and AIDS

UNFPA

United NaƟons PopulaƟon Fund

UNICEF

The United NaƟons Children͛s Fund

World Bank

WHO

World Health KrganisaƟon

WHS

World Health StaƟsƟcs

IHP+Results 2010 Performance Report

INDEPENDENT ADVISORY GROUP FOREWORD As members of the Independent Advisory Group to IHP+Results, we have reviewed the second annual performance report to provide this commentary on the methodology, scope and relevance of the informaƟon it contains. We begin by aĸrming the importance of accountability in improving aid eīecƟveness, both in general and speciĮcally within the health sector. To that end, this report makes a signiĮcant and important contribuƟon ;and one which could be an eǆemplar for tracking Aid EīecƟveness in other sectorsͿ. This report now includes standardiǌed indicators for IHP+ partners to describe and eǆplain their commitments and acƟons to promote greater health aid eīecƟveness. SelfͲreporƟng on these indicators is improving the accountability of IHP+ signatories to their commitments. However, it will be important to improve the degree of independent veriĮcaƟon of the informaƟon provided by signatories in the neǆt accountability round. The methodology and Ƌuality of data provided in this report also shows considerable improvement from the Įrst report. Some methodological challenges remain, and these will need to be resolved in future assessment rounds. For eǆample, some indicators ;in important areas such as civil society engagement and capacity buildingͿ remain open to interpretaƟon, and reƋuire more careful measurement and ƋualitaƟve teǆture. Such reĮnement, the need for which is acknowledged in the report, will further increase the rigour and usefulness of the data in the neǆt accountability eǆercise. These methodological issues do not undermine the present report͛s reasonable assessment of IHP+ signatories͛ performance regarding their commitments under the IHP+. The empirical informaƟon provided in the scorecards is parƟcularly valuable and makes internaƟonal health assistance processes more transparent and accountable. The scorecards should be made widely available, and rendered accessible in terms of presentaƟon and language, to a wide range of interested stakeholders. They represent useful instruments for promoƟng discussion at country and global levels about how procedures and processes could be improved. We are aware that not all Development Partners view all of the measures as applicable to their work. Nonetheless, as IHP+ signatories, they have commiƩed themselves to being accountable for improving health Aid EīecƟveness and harmoniǌaƟon. We thus encourage them to specify how their pracƟces are consistent with the measures and to report on this accordingly. AddiƟonally, to beƩer ensure accountability of both Development Partners and governments with agreed commitments, it is crucial that indigenous organiǌaƟons and insƟtuƟons are allocated resources and assistance to develop their capacity to engage in this monitoring process. It is notable that only half of all IHP+ signatories have parƟcipated in this accountability round. The longͲ term robustness and uƟlity of the accountability eǆercise rests on parƟcipaƟon by a larger proporƟon of reporƟng signatories and we encourage all signatories to parƟcipate in the neǆt accountability round. We believe that this accountability eǆercise provides important opportuniƟes for all signatories to improve their compliance with the spirit of both the IHP+, and the Paris DeclaraƟon on Aid EīecƟveness. Some donors ;notably the USAͿ have not signed up to IHP+. We encourage the SURG and IHP+ EǆecuƟve Team to

IHP+Results 2010 Performance Report

share this report, its methodology and processes with these donors, and to eǆplore points of convergence and ũoint learning with these donors with respect to their own accountability processes for improving aid eīecƟveness. As we noted in the foreword to the 2010 World Health Assembly Update 1, we believe that donor assistance in health should not be viewed in isolaƟon from other aspects of foreign policy covering areas such as trade, investment, security and climate protecƟon. These policies have profound eīects on health outcomes and the challenges faced by health systems in developing countries. We regard the accountability of IHP+ as but one dimension of improving foreign policy coherence, in which improving health Aid EīecƟveness and health system strengthening is one of many important means of achieving beƩer health outcomes. We commend reported IHP+ progress in some areas, such as the increased use of naƟonal planning and review processes by countries and improved alignment of eǆternal Development Partners to those processes and plans. However, this report also gives reasons for concern. There appears to be low use of country systems, notably country led procurement, by eǆternal development partners͖ and only one of the African country signatories parƟcipaƟng in this accountability round has come close to achieving the Abuũa target of commiƫng 15й of its naƟonal budget to the health sector. Five countries appear to have reduced their public health eǆpenditures relaƟve to their overall budget. Moreover, there is no credible way at present to measure whether country reports of naƟonal health eǆpenditures includes, or eǆcludes, transfers of health development assistance. This makes it diĸcult to determine the level of naƟonal commitment to health sector development by aidͲrecipient IHP+ partners. These are issues that need closer aƩenƟon in the neǆt round of the accountability eǆercise in 2011. To conclude: The progress that has been made in establishing this accountability process, and the tools that have been developed for it, provide a uniƋue contribuƟon to the debate on Aid EīecƟveness in health. They are also of substanƟal value for the Aid EīecƟveness debate beyond the health sector. We encourage the IHP+ EǆecuƟve Team, SURG and signatories to: ͻ communicate this development to other sectoral aid groups ͻ eǆplore how the important Įndings in this report can be made more accessible to the increasing number of stakeholders in global health and ͻ ensure that this work conƟnues into the future in response to country and global demands for more accountable support to the health sector. More generally, we encourage the SURG to begin to consider how the momentum for Aid EīecƟveness in health can be sustained and increased beyond the current IHP+ work plan, which comes to an end in 2011.

Advisory Group Members: Prof Ronald Labonte; Prof Gill Walt; Dr David McCoy; Prof David Sanders; Dr Ravi Ram; Prof Adrienne Germain; Dr Lola Dare; Mr Tobias Luppe.

IHP+Results World Health Assembly Update, 2010

IHP+Results 2010 Performance Report

EXECUTIVE SUMMARY The InternaƟonal Health Partnership and Related IniƟaƟves ;IHP+Ϳ was launched in 2007 with a commitment by developing country governments and Development Partners ;DPsͿ to ͞work eīecƟvely together with renewed urgency to build sustainable health systems and improve health outcomes in low and middleͲ income countries.͟ To achieve this, IHP+ signatories speciĮcally commiƩed to delivering and using all available health sector resources to implement ͙͞strong and comprehensive country and governmentͲled naƟonal health plans in a well coordinated way͟. Signatories to the IHP+ Global Compact mandated IHP+Results to annually undertake “…an independent, evidence-based assessment of results at country level and of the performance of each [signatory] ŝŶĚŝǀŝĚƵĂůůǇ ĂƐ ǁĞůů ĂƐ ĐŽůůĞĐƟǀĞůǇ͟ 3 to report on whether these commitments and eǆpectaƟons of the IHP+ are being achieved. This Performance Report reŇects the IHP+Results Įndings for the second annual cycle of monitoring, undertaken in 2010. It builds on the Įndings of previous reviews, and will inform the third annual performance review in 2011 4. Evidence for this report was collected from a subͲset of 25 IHP+ signatories 5 that opted to parƟcipate. Each agency provided data for a set of Standard Performance Measures ;12 for DPs and 10 for country governments, see page 38 for a listͿ. These measures closely reŇect the KECDͬDAC Aid EīecƟveness indicators, which have been applied to the health sector for this purpose. From these selfͲreported data, IHP+Results has produced a credible Development Partner or Country Scorecard for each parƟcipaƟng IHP+ signatory. Their performance has been rated using transparent and obũecƟve criteria 5, against the agreed target for each measure. The data collecƟon and raƟng procedures were implemented in accordance with a review methodology approved by the IHP+ governing body 7. This methodology had been updated through an IHP+ Mutual Accountability Working Group process to address the recommendaƟons and lessons from the Įrst round of IHP+Results performance monitoring 8. Results: This independent review has found that the parƟcipaƟng country governments and Development Partners made some progress in improving how eīecƟvely they were delivering and using health aid by 2009. These Įndings are broadly consistent with those from the KECD 2008 Paris DeclaraƟon monitoring survey, which is conducted at the naƟonal level ;i.e. does not capture sectoral performanceͿ, and covers a larger number of countries and Development Partners. Ethiopia, Mali and MoǌambiƋue have seen the most improvements in Development Partners acƟons to meet their IHP+ targets. Burundi, DũibouƟ, DRC, Niger and Nigeria have beneĮƩed less. However, these results might be eǆpected given the length of Ɵme since each country ũoined the IHP+ ;DũibouƟ only signed up to the IHP+ Global Compact in July 2009, Niger and DRC in May 2009Ϳ and the relaƟve strength of these countries systems and processes.

IHP+Results is an independent consorƟum of research and advocacy organiǌaƟons, led by ReͲAcƟon, working in partnership with the London School of Hygiene and Tropical Medicine, and Kǆfam GB.

hƩp:ͬͬwww.internaƟonalhealthpartnership.netͬCMSͺĮlesͬdocumentsͬihpͺglobalͺcompactͺEN.pdf accessed 19ͬ01ͬ2011

IHP+Results 2011 monitoring will reŇect on how this report, and the tools and Įndings presented here, have been used to take steps towards real mutual accountability.

10 IHP+ country governments: Burkina Faso, Burundi, DũibouƟ, DRC, Ethiopia, Mali, MoǌambiƋue, Nepal, Niger and Nigeria. 15 Development Partners: AusAID, Belgium, EC, GAsI, the Global Fund, Netherlands, Norway, Spain, Sweden, U<, UNAIDS, UNFPA, UNICEF, WHK and World Bank.

More informaƟon about criteria for raƟng can be seen at: www.ihpresults.netͬhowͬmethodologyͬraƟng

The IHP+ Scaling Up Reference Group: hƩp:ͬͬwww.internaƟonalhealthpartnership.netͬCMSͺĮlesͬdocumentsͬihpͺsurgͺͺtermsͺofͺ referenceͺEN.pdf

The details of this were reported in the IHP+Results World Health Assembly Update, 2010

IHP+Results 2010 Performance Report

Partners generally did well to agree on the highͲlevel frameworks and plans for delivering and using resources in the health sector, based on each country͛s own prioriƟes 9. However, performance in strengthening and using country systems to manage these resources is miǆed. For instance, Burkina Faso, Burundi and MoǌambiƋue had strengthened their public Įnancial management systems and in Įve countries with strong country Įnancial management systems 10 DPs overall met the target of a 33й reducƟon in the proporƟon of funds not using these systems. However, the use of country procurement systems by DPs appeared to have declined overall. Civil society appears, overall, to have become more engaged in naƟonal health policy processes in the parƟcipaƟng countries. All DPs reported providing some support to civil society engagement ;although this reƋuires further invesƟgaƟon and discussion with southern civil society organisaƟonsͿ. There has been miǆed progress in securing responsible and predictable Įnancing for the health sector: overall the proporƟon of DP funding through mulƟͲyear commitments fell between the baseline and 2009 period, but 9 of 15 DPs were providing 90й or more of their health aid through mulƟͲyear commitments. Five governments ;Burkina Faso, Burundi, DũibouƟ, Nepal and NigerͿ increased the proporƟon of their naƟonal budget allocated to health. However these increases were widely variable and none of the African governments reviewed had yet met the 15й Abuũa target of naƟonal budget allocated to the health sector 11 . The performance of these governments in disbursing the available health sector budgets on Ɵme also showed a miǆed picture. Countries allocated a lower proporƟon of funding to Human Resources for Health ;HRHͿ, compared to historical levels. This was despite a number of countries having developed more ambiƟous HRH plans and beginning to integrate these into naƟonal health plans and budgets, as promoted by the IHP+. HRH funding is the best proǆy measure that IHP+Results has to assess whether the IHP+ is strengthening health systems, so this raises a concern that the purpose of the IHP+ is not yet being achieved. ŽŶĐůƵƐŝŽŶƐ ĂŶĚ ƌĞĐŽŵŵĞŶĚĂƟŽŶƐ͗ The Įndings in this report can be credibly used to inform ongoing conversaƟons about Aid EīecƟveness in the health sector. These need to be taken up and discussed by IHP+ signatories and other stakeholders ;including civil societyͿ in all relevant forums. These Įndings should also contribute to the 4th HighͲLevel Review of Aid EīecƟveness during 2011, where health is being reported on as a tracer sector 12. Whilst parƟcipants in IHP+Results 2010 survey represent approǆimately half of all IHP+ signatories and some maũor DPs are not included, it is possible to draw some conclusions that may be useful for other country governments and DPs, whether they are IHP+ signatories or not. For the subset of IHP+ signatories parƟcipaƟng in this review, there seems to have been an overall improvement in the eīecƟveness of how aid is being delivered and used in the health sector. But it is too early to state whether these improvements are contribuƟng to stronger health systems or beƩer health outcomes. Kverall, by 2009, progress by signatories fell short of implemenƟng their IHP+ Global Compact commitments to work with renewed urgency to build sustainable health systems and to improve health outcomes. This report and scorecards should prove invaluable for IHP+ stakeholders to use during 2011 to hold themselves and others to account for their commitments, and to strengthen mutual accountability.

NaƟonal strategy, compact, results framework and mutual monitoring process. See IHP+ Compact Guidance note hƩp:ͬͬwww. internaƟonalhealthpartnership.netͬCMSͺĮlesͬdocumentsͬihpͺcompactͺguidanceͺnoteͺEN.pdf.

Burkina Faso, Ethiopia, Mali, MoǌambiƋue and Niger. For more informaƟon see SecƟon 3.3 below.

Although Burkina Faso was closest to the target, having reached 14.6й in 2009.

IHP+Results and the IHP+ are members of the KECD DAC Technical Task Team on Health as a Tracer Sector ;TTHATSͿ that is preparing for the HighͲlevel Forum on Aid EīecƟveness.

IHP+Results 2010 Performance Report

There are inherent limitaƟons to the approach that IHP+Results has used to produce this report: the potenƟal bias of selfͲreporƟng͖ the Įndings cannot be generalised to all IHP+ signatories͖ and there is a Ɵme lag ʹ results reŇect signatories͛ performance in 2009. However, these limitaƟons can be used to the advantage of the IHP+ if further steps are taken towards towards embedding mutual accountability into the ways IHP+ signatories work. Scorecards can be used as tools to promote dialogue, as the basis for stronger accountability. They can inform internal reviews within individual agencies, ũoint reviews between partners, and public review processes. This would increase accountability to the IHP+ commitments, both within countries and at the internaƟonal level. IHP+ Partners are therefore encouraged to review the raƟngs on their own scorecard ;together with their disaggregated raƟngs that are reported online 13 by IHP+ResultsͿ, to ƋuesƟon and plan how to improve their performance and the Ƌuality of their reporƟng. Partners are encouraged to use these scorecards and performance measures within ũoint reviews and other mutual accountability forums to understand the factors behind each other͛s raƟngs, and to ƋuesƟon whether their current performance has changed since 2009. Civil Society and other stakeholders should use these scorecards to demand public accountability for the IHP+ signatories to keep their commitments. However, this needs to be done with care, considering how important the conteǆt is when comparing across countries ʹ even within the same agency. More needs to be done to improve the accessibility of this work to countryͲbased civil society organisaƟons. Future monitoring should aim to increase parƟcipaƟon rates, improve the completeness of data reported, and ensure that the measures are interpreted more consistently. The IHP+ provides credible instruments and mechanisms to promote accountability. For this to contribute more towards ensuring that health sector results are being delivered, IHP+ signatories and stakeholders need to build on their current eīorts to strengthen their individual insƟtuƟonal, mutual and public accountability for these results.

See www.ihpresults.netͬresultsͬdataͬ

IHP+Results 2010 Performance Report

5DPa

Percent of health sector aid that uses country procurement systems.

5DPb

Percent of health sector aid that uses public Įnancial management systems.

5DPc

Number of parallel project implementaƟon units ;piusͿ per country.

6DP

Partner uses the single naƟonal performance assessment framework, where they eǆist, as the primary basis to assess progress ;of support to health sectorͿ.

7DP

Partner has parƟcipated in mutual assessment of progress implemenƟng commitments in the health sector, including on aid eīecƟveness, if a mutual assessment process eǆists.

8DP

Evidence of support for civil society to be acƟvely represented in health sector policy processes Ͳ including health sector planning, coordinaƟon Θ review mechanisms.

World Bank

4DP

Percent of health sector aid disbursements released according to agreed schedules in annual or mulƟͲyear frameworks.

WHO

Percent of health sector aid provided through mulƟͲyear commitments.

UNICEF

3DP

UNFPA

Percent of health sector aid provided as programme based approaches.

UNAIDS

2DPc

Sweden

2DPb

Percent of current capacityͲdevelopment support provided through coordinated programmes consistent with naƟonal plansͬ strategies for the health sector.

Spain

Norway

Netherlands

Belgium

2DPa

Percent of aid Ňows to the health sector that is reported on naƟonal health sector budgets.

GFATM

AusAID

1DP

Partner has signed commitment to ;or documented support forͿ the IHP+ country compact, or equivalent agreement, where they eǆist.

GAVI

STANDARD PERFORMANCE MEASURE

INDICATOR

Overview of Development Partner performance

! ?

A detailed breakdown by Country, for each Development Partner, is available on the IHP+Results website www.ihpresults.net

IHP+Results 2010 Performance Report

2Ga

NaƟonal Health Sector Plansͬ Strategy in place with current targets Θ budgets that have been jointly assessed.

ProporƟon of public funding allocated to health.

ProporƟon of health sector funding disbursed against the approved annual budget.

5Ga

Public Financial Management systems for the health sector either ;aͿ adhere to broadly accepted good pracƟces or ;bͿ have a reform programme in place to achieve these.

5Gb

Country Procurement systems for the health sector either ;aͿ adhere to broadly accepted good pracƟces or ;bͿ have a reform programme in place to achieve these.

An agreed transparent and monitorable performance assessment framework is being used to assess progress in the health sector.

Mutual Assessments, such as Joint Annual Health Sector Reviews, have been made of progress implemenƟng commitments in the health sector, including on aid eīecƟveness.

Evidence that Civil Society is acƟvely represented in health sector policy processes Ͳ including Health Sector planning, coordinaƟon Θ review mechanisms.

target achieved progress made towards achieving target

no progress or regression

data not provided measure not applicable

Nigeria

Niger

Nepal

ũŝďŽƵƟ

Mozambique

NaƟonal Health Sector Plansͬ Strategy in place with current targets Θ budgets.

Mali

2Ga1

DRC

Burundi

IHP+ Compact or equivalent mutual agreement in place.

Ethiopia

STANDARD PERFORMANCE MEASURE

Burkina Faso

INDICATOR

Overview of Country Goverment’s performance

! ! !

A detailed breakdown by Development Partner, for each Country, is available on the IHP+Results website www.ihpresults.net

IHP+Results 2010 Performance Report

1. INTRODUCTION The InternaƟonal Health Partnership and related IniƟaƟves ;IHP+Ϳ was launched in 2007 with the objecƟve of acceleraƟng progress towards achieving the healthͲrelated MDGs. The IHP+ responds to fragmented eīorts to address health system constraints and the unpredictable nature of internaƟonal aid at a Ɵme when there are insuĸcient global and domesƟc investments in health. The ineĸcient ways in which some support is oīered to countries, with duplicaƟon and fragmentaƟon of acƟviƟes carried out by mulƟple agencies through an array of verƟcal iniƟaƟves, have together produced an overly complicated and ineĸcient internaƟonal aid architecture that sƟll fails to show the impacts one would eǆpect relaƟve to the amount of money that is spent on improving health. Since 2007, 25 Development Partners ;DPsͿ and 24 developing country governments14 have signed up to the IHP+ Global Compact, which builds on a number of preͲeǆisƟng processes to promote aid eīecƟveness, based on the Paris DeclaraƟon and Accra Agenda for AcƟon. The IHP+ commits DPs to deliver more eīecƟve development assistance to the health sector of these countries. It also commits parƟcipaƟng country governments to use available domesƟc and eǆternal resources eīecƟvely and for all partners to “...build sustainable health systems ĂŶĚ ŝŵƉƌŽǀĞ ŚĞĂůƚŚ ŽƵƚĐŽŵĞƐ͘͘͘͟ The IHP+ Global Compact calls signatories to report annually on the progress they are making in implemenƟng their IHP+ commitments. It also calls for “…an independent, evidence-based assessment of results at country ůĞǀĞů ĂŶĚ ŽĨ ƚŚĞ ƉĞƌĨŽƌŵĂŶĐĞ ŽĨ ĞĂĐŚ ΀ƐŝŐŶĂƚŽƌǇ΁ ŝŶĚŝǀŝĚƵĂůůǇ ĂƐ ǁĞůů ĂƐ ĐŽůůĞĐƟǀĞůǇ͟. 15 This eǆplicit eǆpectaƟon for partners to be both individually and mutually accountable for the process and results of the IHP+ is a unique feature of this iniƟaƟve. IHP+Results is mandated to undertake this annual independent review of the IHP+. This report presents Įndings from the 2010 IHP+Results Survey and builds on previous reviews carried out in 2009Ͳ10. 16 In response to the Įndings of these previous reviews and the eǆperiences of implemenƟng the Įrst cycle of the IHP+Results process ;in 2009Ϳ, the IHP+ Scaling up Reference Group ;SuRGͿ 17 in July 2010 adopted a set of Standard Performance Measures ;SPMsͿ on which to base this Annual Review and to track progress on the commitments that have been made through the IHP+ Global Compact. 18 These performance measures include 10 indicators and targets for IHP+ country governments, as well as 12 indicators and targets for DPs. A full list of Standard Performance Measures is available on p42 below, and on the IHP+Results website 19. These measures and targets draw directly on the Paris DeclaraƟon indicators and targets, applied to the health sector. 20

hƩp:ͬͬwww.internaƟonalhealthpartnership.netͬenͬpartners accessed 19ͬ01ͬ2011.

hƩp:ͬͬwww.internaƟonalhealthpartnership.netͬCMSͺĮlesͬdocumentsͬihpͺglobalͺcompactͺEN.pdf accessed 19ͬ01ͬ2011

2008 Eǆternal Review of the IHP+, available at hƩp:ͬͬwww.internaƟonalhealthpartnership.netͬCMSͺĮlesͬdocumentsͬihpͺeǆternalͺ reviewͺ2008ͺ1ͺEN.pdf͖ and World Health Assembly IHP+Results Update ;May 2010Ϳ, available at hƩp:ͬͬwww.internaƟonalhealthpartnership. netͬCMSͺĮlesͬdocumentsͬworldͺhealthͺassemblyͺihpresultsͺEN.pdf. 16

IHP+ interͲagency ScalingͲup Reference Group will be responsible for seƫng overall strategic direcƟon and informaƟon sharing for the IHP+. The SuRG includes representaƟves of all IHP+ signatories.

18 Developed by a mulƟͲstakeholder IHP+ Working Group, as detailed in the detailed methodology anneǆ, available at www.ihpresults.netͬhowͬ methodology. A full list of the Standard Performance Measures is available at page 39. 19

www.ihpresults.netͬhowͬmethodologyͬspmͬ

hƩp:ͬͬwww.oecd.orgͬdataoecdͬ57ͬ60ͬ36080258.pdf accessed 19ͬ01ͬ2011

IHP+Results 2010 Performance Report

During September and Kctober 2010, IHP+ signatories reported on these measures ʹ providing data for their baseline year ;using whatever data were available for that point in Ɵme 21Ϳ and for the 2009 period. InformaƟon was collected using a standard set of reporƟng tools and procedures developed by IHP+Results. ParƟcipaƟon in this process was voluntary and parƟcipants included 10 developing country governments ;Burkina Faso, Burundi, DjibouƟ, DRC, Ethiopia, Mali, Moǌambique, Nepal, Niger and NigeriaͿ and 15 of the 25 IHP+ Development Partners ;AusAID, Belgium, EC, GAsI, the Global Fund, Netherlands, Norway, Spain, Sweden, U<, UNAIDS, UNFPA, UNICEF, WHK and World BankͿ. 22 The data collected have been analysed and presented in IHP+Results Partner and Country Scorecards. These provide a simple oneͲpage graphical presentaƟon of the progress of each parƟcipaƟng IHP+ signatory. Progress is reported through a raƟng symbol ; target achieved͖ progress made towards achieving the target͖ no progress, or regressionͿ for each of the agreed Standard Performance Measures. The Scorecards provide an overview of data that can be eǆplored in more detail online ;www.ihpresults.netͿ and in the anneǆes to this report. Partner and Country Scorecards are available on the IHP+Results website 23. !

This report synthesises the key scorecard Įndings for DPs and Country Governments to provide an overall review of progress within Įve Results Areas: ;1Ϳ Kwnership, mutual accountability and engaging civil society͖ ;2Ϳ Transparent and responsible health Įnancing͖ ;3Ϳ Strengthening and using country systems͖ ;4Ϳ Managing for development results͖ and ;5Ϳ Strengthening health systems. These areas align with the KECDͬDAC process for monitoring Aid EīecƟveness and speciĮcally link to the work of the Task Team on Health as a Tracer Sector ;TT HATSͿ. Ensuring alignment between IHP+Results and the TT HATS process should ensure that the eǆperience of implemenƟng the IHP+ contributes to the 2011 KECD High Level Forum review of Aid EīecƟveness. Conclusions have been drawn from this evidence and recommendaƟons are provided to IHP+ signatories on ways in which they could accelerate their progress in implemenƟng the IHP+ commitments. Although these are based on performance data from a subͲset of DPs and countries, and for only two data points in Ɵme, the key messages are likely to be relevant to all IHP+ signatories. IHP+Results is an independent consorƟum of research and advocacy organiǌaƟons, led by ReͲAcƟon͊ ;Responsible AcƟon for Health Θ SustainabilityͿ, working in partnership with the London School of Hygiene and Tropical Medicine, and Kǆfam GB. IHP+Results is informed by an Independent Advisory Group ;IAGͿ, which was established to provide independent advice to IHP+Results on its work to monitor and evaluate the IHP+. The IAG members are internaƟonal eǆperts from civil society and academia 24.

See methodology secƟon and Anneǆ for more detail on baselines: www.ihpresults.netͬhowͬmethodologyͬ

Germany and ILK eǆpressed interest and hope to parƟcipate in future annual surveys.

www.ihpresults.netͬresultsͬscorecardsͬ

For more informaƟon about the Advisory Group membership, see www.ihpresults.netͬaboutͬconsorƟumͬ

IHP+Results 2010 Performance Report

2. HOW THIS PERFORMANCE REVIEW WAS CONDUCTED IHP+Results managed the 2010 survey through a process that started with IHP+ Signatories adopĆ&#x;ng the revised Standard Performance Measures in July Íža full list is available at page 39Íż. A structured survey tool 25 was completed by the representaĆ&#x;ves of country governments and Development Partners over the period September to Kctober. These submissions were analysed by IHP+Results, with gaps and queries clariÄŽed with the reporĆ&#x;ng agencies. The Performance Measures were rated using transparent criteria 26 and Scorecards produced in the ÄŽrst quarter of 2011, to deliver this synthesis Annual Performance Report. AddiĆ&#x;onal details, including disaggregated raĆ&#x;ngs, have been made available online with the release of this report. &Ĺ?Ĺ?ĆľĆ&#x152;Ä&#x17E; ĎŽÍ&#x2DC;ĎÍ&#x2014; WĆ&#x152;Ĺ˝Ä?Ä&#x17E;Ć?Ć? Ĺ&#x2021;Ĺ˝Ç Ä¨Ĺ˝Ć&#x152; /,WĐ˝ZÄ&#x17E;Ć?ĆľĹŻĆ&#x161;Ć? ĎŽĎŹĎĎŹ ĹľĹ˝ĹśĹ?Ć&#x161;Ĺ˝Ć&#x152;Ĺ?ĹśĹ?

MAR - JUL 2010

Developed and/or agreed by IHP+ signatories

SEP - DEC 2010

YĆľÄ&#x17E;Ć?Ć&#x;Ĺ˝ĹśĹśÄ&#x201A;Ĺ?Ć&#x152;Ä&#x17E; Ä?Ä&#x201A;Ć?Ä&#x17E;Ä&#x161; Ĺ˝Ĺś ^Ć&#x161;Ä&#x201A;ĹśÄ&#x161;Ä&#x201A;Ć&#x152;Ä&#x161; Performance Measures. Data Ä?Ĺ˝ĹŻĹŻÄ&#x17E;Ä?Ć&#x161;Ä&#x17E;Ä&#x161; ĆľĆ?Ä&#x17E;Ä&#x161; Ä&#x201A;Ć? Ä?Ä&#x201A;Ć?Ĺ?Ć? Ä¨Ĺ˝Ć&#x152; Ć&#x152;Ä&#x201A;Ć&#x;ĹśĹ?Ć?Í&#x2DC;

JAN - MAR 2011

Ć&#x152;Ä&#x201A;Ĺ&#x152; Ć?Ä?Ĺ˝Ć&#x152;Ä&#x17E;Ä?Ä&#x201A;Ć&#x152;Ä&#x161;Ć? Ä&#x161;Ĺ?Ć?Ä?ĆľĆ?Ć?Ä&#x17E;Ä&#x161; Ç Ĺ?Ć&#x161;Ĺ&#x161; Ć&#x2030;Ä&#x201A;Ć&#x152;Ć&#x;Ä?Ĺ?Ć&#x2030;Ä&#x201A;Ć&#x;ĹśĹ? Ć?Ĺ?Ĺ?ĹśÄ&#x201A;Ć&#x161;Ĺ˝Ć&#x152;Ĺ?Ä&#x17E;Ć?Í&#x2DC;

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Country government surveys were completed by IHP+ focal points in the Ministry of Health 27. DP surveys were completed by representaĆ&#x;ves at the agency headquarters level who collated country oÄ¸ce data where relevant 28. IHP+Results supported data collecĆ&#x;on through providing detailed guidance 29, countryÍ˛based support where requested, and regular internaĆ&#x;onal level support. Ć&#x152;Ĺ?Ć&#x;Ä?Ä&#x201A;ĹŻ Ä&#x201A;Ć?Ć?ĆľĹľĆ&#x2030;Ć&#x;Ĺ˝ĹśĆ? Ä&#x201A;ĹśÄ&#x161; Ć&#x2039;ĆľÄ&#x201A;ĹŻĹ?ÄŽÄ&#x17E;Ć&#x152;Ć? There are inherent limitaĆ&#x;ons to the approach that IHP+Results has used to produce this Performance Report and its accompanying Scorecards. These include: Íť Availability of baseline data and the period that was used. DPs and countries could select baseline in keeping with IHP+ Í&#x161;light touchÍ&#x203A; principle. Baseline data were therefore provided for diÄŤerent years over the period 2005Í˛8 across respondents, depending on what they had available. This report includes data from 2005Í˛2007 as Í&#x161;baselineÍ&#x203A;. Íť WĹ˝Ć?Ć?Ĺ?Ä?Ĺ?ĹŻĹ?Ć&#x161;Ç&#x2021; Ĺ˝Ä¨ Ä&#x161;Ĺ˝ĆľÄ?ĹŻÄ&#x17E; Ä?Ĺ˝ĆľĹśĆ&#x;ĹśĹ?Í&#x2DC; IHP+Results guidance 30 set out that funds should be reported by the agency that completes the ÄŽnal disbursement. Íť General Budget Support (GBS) data has been incorporated for those DPs that reported using this mechanism by impuĆ&#x;ng a percentage for health, to reĹ&#x2021;ect the Đš of government budget for health.

The structured survey tool was available in French and English. An eÇ&#x2020;ample can be found at www.ihpresults.netÍŹhowÍŹdataÍşcollecĆ&#x;onÍŹ

Criteria for raĆ&#x;ng can be found at www.ihpresults.netÍŹhowÍŹmethodologyÍŹraĆ&#x;ngÍŹ

Following discussion with MKH oÄ¸cials, IHP+Results appointed a country researcher in 4 countries ÍžBurkina Faso, Burundi, MoÇ&#x152;ambique, NigeriaÍż to support the data collecĆ&#x;on process.

IHP+Results collected data directly from AusAID Nepal, following agreement with AusAID HY.

Available at www.ihpresults.netÍŹhowÍŹdataÍşcollecĆ&#x;onÍŹ

Available at www.ihpresults.netÍŹhowÍŹmethodologyÍŹlimitaĆ&#x;onsÍŹ Í´ see deÄŽniĆ&#x;on of disbursement Ížeg on pp16Íż.

IHP+Results 2010 Performance Report

ͻ Data were not reported by some DPs. The online methodology anneǆ shows where data were not available ? or the quesƟon is considered not applicable by the respondent. ͻ ^ŽŵĞ ĂŝĚ ĐŽŶĐĞƉƚƐ ĂŶĚ ƚĞƌŵŝŶŽůŽŐǇ ĐĂŶ ďĞ ĐŽŵƉůĞǆ ĂŶĚ ŽƉĞŶ ƚŽ ŝŶƚĞƌƉƌĞƚĂƟŽŶ͕ which might reduce the accuracy of this data 31. For eǆample many respondents stated that they have mutual accountability processes but gave very diīerent eǆamples of what that process involved. ͻ ^ĞůĨͲƐĞůĞĐƟŽŶ ďǇ /,Wн ƐŝŐŶĂƚŽƌŝĞƐ ƚŽ ƉĂƌƟĐŝƉĂƚĞ ŝŶ ƚŚĞ ƐƵƌǀĞǇ means that these Įndings cannot be generalised to all IHP+ signatories. DPs also indicated in which countries they considered their agency to be ͞acƟve͟ in supporƟng health sector development. These points reŇect lessons from IHP+Results eǆperience in implemenƟng this updated methodology for the Įrst Ɵme. The approach has been proven feasible, not least by the signiĮcant amount of data submiƩed from a broad subͲset of IHP+ signatories. However, the data should be interpreted with care ʹ in parƟcular bearing in mind how each country conteǆt diīers from others. The data provide a picture of how the IHP+ is being implemented and a sense of progress over Ɵme, which should prove an invaluable basis for discussions on how to improve performance and accountability. The IHP+Results process provides a set of tools that can support these discussions, and IHP+ stakeholders are encouraged to see this process in this light. An anneǆ with further detailed eǆplanaƟons of the methodology and how the limitaƟons have been addressed can be downloaded from the IHP+Results website 32.

3. PROGRESS TOWARDS ACHIEVING THE EXPECTED RESULTS OF THE IHP+ An evidenceͲbased raƟng of the progress that each partner had made up to 2009 towards achieving the eǆpected results of the IHP+ can be found in the IHP+Results Scorecards that are available with this report 33. Kne Scorecard has been produced for each Country Government and Development Partner that has parƟcipated in the 2010 IHP+Results Survey. The raƟngs in these Scorecards have been made using the data reported by each partner for the set of standard performance measures and targets of the IHP+, based on transparent criteria. This secƟon of the report provides an analysis of the combined progress across all country governments and all Development Partners, within the Įve themaƟc Results Areas. 34

ϯ͘ϭ WƌŽŵŽƟŶŐ ŽƵŶƚƌǇ KǁŶĞƌƐŚŝƉ͕ DƵƚƵĂů ĐĐŽƵŶƚĂďŝůŝƚǇ ĂŶĚ DĞĂŶŝŶŐĨƵů ŝǀŝů ^ŽĐŝĞƚǇ WĂƌƟĐŝƉĂƟŽŶ ƌĞ ĐŽƵŶƚƌŝĞƐ ƚĂŬŝŶŐ ƚŚĞ ůĞĂĚ ĞƐƚĂďůŝƐŚ ŽƵƚ ŶĂƟŽŶĂů ŚĞĂůƚŚ ƐĞĐƚŽƌ ƉůĂŶƐ͕ ƐƚƌĂƚĞŐŝĞƐ ĂŶĚ ďƵĚŐĞƚƐ͍ All of the 10 IHP+ country governments reviewed met the target ;2GaͿ of having a naƟonal health plan in place. This is the basis for DPs aligning their eǆternal support to a country͛s health sector prioriƟes. In most cases, naƟonal governments reported that their plans included performance indicators, as well as a budget that had been approved.

This was a parƟcular concern raised by Development Partners in Burundi, who decided to sit and establish a common understanding of the key terms and to resubmit data. We have not been able to incorporate that revised data in this report, but an analysis of the diīerences between the two sets of data is provided at www.ihpresults.netͬhowͬlessonsͺlearntͬ

www.ihpresults.netͬhowͬmethodologyͬ

Also available online at www.ihpresults.netͬresultsͬscorecardsͬ

Refer to the individual IHP+Results Scorecards to see how each agency or government is progressing overall. Note that DP performance is based only on data from the IHP+ countries in which they were acƟve during 2009 and that parƟcipated in the 2010 IHP+Results survey.

IHP+Results 2010 Performance Report

The IHP+ Global Compact suggests that each country should establish a naƟonal compact or similar agreement as the basis for strengthening partnerships and mutual accountability for results at this level. A compact should be eǆplicit about the commitments that are being made by DPs, the country government and domesƟc civil society to strengthen the country͛s health system and to achieve the health targets ;as set out in the naƟonal health planͿ. Ethiopia, Mali, Moǌambique and Nepal had Country Compacts in place by 2009 and a further two countries ;Burundi and NigerͿ had ͚equivalent country agreements͛. The remaining countries eǆpressed their intenƟon to achieve this in the future. 35 These results might be eǆpected given the length of Ɵme since each country joined the IHP+ ;DjibouƟ only signed up to the IHP+ Global Compact in July 2009, Niger and DRC in May 2009Ϳ. Analysis of the quality of these compacts was not an objecƟve of this review, but Compacts should be evaluated in order to understand whether the global intenƟons of the IHP+ and its level of ambiƟon are being translated into countryͲlevel commitments. More than 70й of Development Partners surveyed reported that they had signed the available compacts in Ethiopia, Mali, Moǌambique and Nepal. 36 In Burkina Faso there appeared to be confusion about whether there was a compact, as the government reported that no compact was in place, but some Development Partners reported that they signed one. The quality of naƟonal plans and budgets is an important consideraƟon in order for DPs to feel conĮdent to align their assistance with these naƟonal frameworks. However the IHP+Results standard performance measures do not give an indicaƟon of this. The new :ŽŝŶƚ ƐƐĞƐƐŵĞŶƚ ŽĨ EĂƟŽŶĂů WůĂŶƐ ĂŶĚ ^ƚƌĂƚĞŐŝĞƐ ;JANSͿ tool developed through the IHP+ might be able to provide addiƟonal informaƟon on the quality of plans for future reviews 37. The JANS was piloted in 2010 in Nepal, Ethiopia, Uganda, Ghana and sietnam.

ŽƵŶƚƌǇ ŐŽǀĞƌŶŵĞŶƚƐ ƉĂƌƟĐŝƉĂƟŶŐ ŝŶ ƚŚĞ /,Wн ŚĂǀĞ ŶĂƟŽŶĂů ŚĞĂůƚŚ ƉůĂŶƐ͘ ^ŽŵĞ ŚĂǀĞ ĂŐƌĞĞĚ ĐŽŵƉĂĐƚƐ ǁŝƚŚ ĞǀĞůŽƉŵĞŶƚ WĂƌƚŶĞƌƐ ĂďŽƵƚ ŚŽǁ ƚŚĞŝƌ ŚĞĂůƚŚ ĂŝĚ ǁŝůů ŇŽǁ͕ ĂŶĚ ŽƚŚĞƌƐ ŝŶƚĞŶĚ ƚŽ ƌĞĂĐŚ ƐŝŵŝůĂƌ ĂŐƌĞĞŵĞŶƚƐ͘

dŚŝƐ ĐŽƵůĚ ďĞ Ă ƉŽƐŝƟǀĞ ŝŶĚŝĐĂƟŽŶ ƚŚĂƚ ƚŚĞ /,Wн ƉƌŽĐĞƐƐ ŝƐ ĐŚĂŶŐŝŶŐ ƚŚĞ ǁĂǇ ƚŚĂƚ ŶĂƟŽŶĂů ŐŽǀĞƌŶŵĞŶƚƐ ĂƌĞ ĞŶŐĂŐŝŶŐ ǁŝƚŚ ƚŚĞŝƌ ĞǀĞůŽƉŵĞŶƚ WĂƌƚŶĞƌƐ ŝŶ ƐŽŵĞ ĐŽƵŶƚƌŝĞƐ͘

ƌĞ ĞǀĞůŽƉŵĞŶƚ WĂƌƚŶĞƌ ĂĐƟŽŶƐ ƉƌŽŵŽƟŶŐ ĐŽƵŶƚƌǇ ŽǁŶĞƌƐŚŝƉ͍ DPs can promote country ownership through a range of the acƟons that they take. The measures used by IHP+Results to indicate whether DPs are taking these acƟons include: informing governments in advance what eǆternal resources they will provide, so this can be recorded on the naƟonal budget ;2DPaͿ͖ providing support for capacity building that is in line with naƟonal prioriƟes ;2DPbͿ͖ and, providing aid for health through programme based approaches ;2DPcͿ.

Nigeria signed a compact in 2010, which is not captured in our 2009 survey. For more details see: hƩp:ͬͬwww.internaƟonalhealthpartnership.netͬCMSͺĮlesͬuserĮlesͬNigerianй20Governmentй20andй20Partnersй20signй20Country й20Compact.pdf

GAsI and GFATM do not sign but send leƩers of support.

Although this might not be possible as the JANS is a diagnosƟc tool to provide the government with an independent ;conducted by internal and eǆternal specialistsͿ assessment of the naƟonal health plan, and is not designed for the purposes of comparison or global reviews.

IHP+Results 2010 Performance Report

ZÄ&#x17E;Ć&#x2030;Ĺ˝Ć&#x152;Ć&#x;ĹśĹ? Ĺ˝Ä¨ Ä&#x17E;Ç&#x2020;Ć&#x161;Ä&#x17E;Ć&#x152;ĹśÄ&#x201A;ĹŻ Ć&#x152;Ä&#x17E;Ć?Ĺ˝ĆľĆ&#x152;Ä?Ä&#x17E;Ć? Ĺ˝Ĺś Ć&#x161;Ĺ&#x161;Ä&#x17E; ĹśÄ&#x201A;Ć&#x;Ĺ˝ĹśÄ&#x201A;ĹŻ Ĺ&#x161;Ä&#x17E;Ä&#x201A;ĹŻĆ&#x161;Ĺ&#x161; Ä?ĆľÄ&#x161;Ĺ?Ä&#x17E;Ć&#x161; The proporĆ&#x;on of health aid reported on the recipient country naĆ&#x;onal health budget increased to 79Đš from a baseline of 52Đš. The most signiÄŽcant progress on this measure was seen in Ethiopia and MoÇ&#x152;ambique, where more than 50Đš of DPs surveyed and acĆ&#x;ve in the health sector in the country met the target.

&Ĺ?Ĺ?ĆľĆ&#x152;Ä&#x17E; ĎŻÍ&#x2DC;ĎÍ&#x2014; Ĺ?Ĺ?Ć&#x152;Ä&#x17E;Ĺ?Ä&#x201A;Ć&#x161;Ä&#x17E; Ć&#x2030;Ć&#x152;Ĺ˝Ć&#x2030;Ĺ˝Ć&#x152;Ć&#x;Ĺ˝Ĺś Ĺ˝Ä¨ Ć&#x2030;Ä&#x201A;Ć&#x152;Ć&#x161;ĹśÄ&#x17E;Ć&#x152; Ć?ĆľĆ&#x2030;Ć&#x2030;Ĺ˝Ć&#x152;Ć&#x161; Ć&#x152;Ä&#x17E;Ć&#x2030;Ĺ˝Ć&#x152;Ć&#x161;Ä&#x17E;Ä&#x161; Ĺ˝Ĺś ĹśÄ&#x201A;Ć&#x;Ĺ˝ĹśÄ&#x201A;ĹŻ Ä?ĆľÄ&#x161;Ĺ?Ä&#x17E;Ć&#x161;Ć?Í&#x2DC; ÍžĎŽ WÄ&#x201A;Íż 100

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The target to increase the proporĆ&#x;on of health aid reported Í&#x161;on budgetÍ&#x203A; requires acĆ&#x;on both by DPs to provide this informaĆ&#x;on and by the country government to record this in the naĆ&#x;onal budget. Netherlands in Burkina Faso and U< and EC in Burundi reported that they provided the data but that it did not appear in the country budget.

dÄ&#x201A;Ä?ĹŻÄ&#x17E; ĎŻÍ&#x2DC;ĎÍ&#x2014; Ä&#x17E;Ç&#x20AC;Ä&#x17E;ĹŻĹ˝Ć&#x2030;ĹľÄ&#x17E;ĹśĆ&#x161; WÄ&#x201A;Ć&#x152;Ć&#x161;ĹśÄ&#x17E;Ć&#x152; Ä&#x201A;Ĺ?Ĺ?Ć&#x152;Ä&#x17E;Ĺ?Ä&#x201A;Ć&#x161;Ä&#x17E; Ć&#x2030;Ä&#x17E;Ć&#x152;Ä¨Ĺ˝Ć&#x152;ĹľÄ&#x201A;ĹśÄ?Ä&#x17E; Ĺ?Ĺś Ć&#x152;Ä&#x17E;Ć&#x2030;Ĺ˝Ć&#x152;Ć&#x;ĹśĹ? Ĺ&#x161;Ä&#x17E;Ä&#x201A;ĹŻĆ&#x161;Ĺ&#x161; Ä&#x201A;Ĺ?Ä&#x161; Ĺ˝Ĺś ĹśÄ&#x201A;Ć&#x;Ĺ˝ĹśÄ&#x201A;ĹŻ Ä?ĆľÄ&#x161;Ĺ?Ä&#x17E;Ć&#x161;Ć?

2DPa I AUS

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GAVI

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dĹ&#x161;Ä&#x17E; Ä&#x17E;Ç&#x2020;Ć&#x161;Ä&#x17E;ĹśĆ&#x161; Ć&#x161;Ĺ˝ Ç Ĺ&#x161;Ĺ?Ä?Ĺ&#x161; Ä&#x17E;Ç&#x2020;Ć&#x161;Ä&#x17E;Ć&#x152;ĹśÄ&#x201A;ĹŻ Ć?ĆľĆ&#x2030;Ć&#x2030;Ĺ˝Ć&#x152;Ć&#x161; Ä¨Ĺ˝Ć&#x152; Ä?Ä&#x201A;Ć&#x2030;Ä&#x201A;Ä?Ĺ?Ć&#x161;Ç&#x2021; Ä&#x161;Ä&#x17E;Ç&#x20AC;Ä&#x17E;ĹŻĹ˝Ć&#x2030;ĹľÄ&#x17E;ĹśĆ&#x161; Ĺ?Ć? Ä?Ä&#x17E;Ä?Ĺ˝ĹľĹ?ĹśĹ? Ä?Ä&#x17E;ĆŠÄ&#x17E;Ć&#x152; Ä?Ĺ˝Ĺ˝Ć&#x152;Ä&#x161;Ĺ?ĹśÄ&#x201A;Ć&#x161;Ä&#x17E;Ä&#x161; Ä&#x201A;ĹśÄ&#x161; Ä&#x201A;ĹŻĹ?Ĺ?ĹśÄ&#x17E;Ä&#x161; Ç Ĺ?Ć&#x161;Ĺ&#x161; ĹśÄ&#x201A;Ć&#x;Ĺ˝ĹśÄ&#x201A;ĹŻ Ć&#x2030;Ć&#x152;Ĺ?Ĺ˝Ć&#x152;Ĺ?Ć&#x;Ä&#x17E;Ć? Capacity building refers to the training and related acĆ&#x;viĆ&#x;es supported by donors to improve the skills of individuals and insĆ&#x;tuĆ&#x;ons in the health system. All DPs that provided data on this measure reported that they had already met the target of 50Đš of capacity building support coordinated and aligned with naĆ&#x;onal prioriĆ&#x;es Ížothers did not report as they do not directly provide capacity development supportÍż.

Progress towards Development Partners using Programme-Based Approaches The KECDÍŹDAC deÄŽnes programme based approaches ÍžPBAÍż as Í&#x17E;a way of engaging in development coÍ˛operaĆ&#x;on based on the principles of coÍ˛ordinated support for a locally owned programme of development, such as a naĆ&#x;onal development strategy, a sector programme, a themaĆ&#x;c programme or a programme of a

IHP+Results 2010 Performance Report

speciÄŽc organisaĆ&#x;on.Í&#x; 38 Eleven of the 15 DPs surveyed reported that they had already met the target of 66Đš of health aid delivered through ProgrammeÍ˛Based Approaches. The collecĆ&#x;ve volume of health aid provided through these approaches eÇ&#x2020;ceeded the target in baseline year and in 2009. Burkina Faso is the only country where all DPs surveyed reported maintaining or improving their use of these approaches.

&Ĺ?Ĺ?ĆľĆ&#x152;Ä&#x17E; ĎŻÍ&#x2DC;ĎŽÍ&#x2014; Ĺ?Ĺ?Ć&#x152;Ä&#x17E;Ĺ?Ä&#x201A;Ć&#x161;Ä&#x17E; Ć&#x2030;Ć&#x152;Ĺ˝Ć&#x2030;Ĺ˝Ć&#x152;Ć&#x;Ĺ˝Ĺś Ĺ˝Ä¨ Ć&#x2030;Ä&#x201A;Ć&#x152;Ć&#x161;ĹśÄ&#x17E;Ć&#x152; Ć?ĆľĆ&#x2030;Ć&#x2030;Ĺ˝Ć&#x152;Ć&#x161; Ć&#x2030;Ć&#x152;Ĺ˝Ç&#x20AC;Ĺ?Ä&#x161;Ä&#x17E;Ä&#x161; Ä&#x201A;Ć? Ć&#x2030;Ć&#x152;Ĺ˝Ĺ?Ć&#x152;Ä&#x201A;ĹľĹľÄ&#x17E; Ä?Ä&#x201A;Ć?Ä&#x17E;Ä&#x161; Ä&#x201A;Ć&#x2030;Ć&#x2030;Ć&#x152;Ĺ˝Ä&#x201A;Ä?Ĺ&#x161;Ä&#x17E;Ć? ÍžĎŽ WÄ?Íż 100

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WĆ? Ĺ&#x161;Ä&#x201A;Ç&#x20AC;Ä&#x17E; Ĺ˝Ç&#x20AC;Ä&#x17E;Ć&#x152;Ä&#x201A;ĹŻĹŻ Ä?Ä&#x17E;Ä?Ĺ˝ĹľÄ&#x17E; ĹľĹ˝Ć&#x152;Ä&#x17E; Ć?ĆľĆ&#x2030;Ć&#x2030;Ĺ˝Ć&#x152;Ć&#x;Ç&#x20AC;Ä&#x17E; Ć&#x161;Ĺ˝Ç Ä&#x201A;Ć&#x152;Ä&#x161;Ć? ĹśÄ&#x201A;Ć&#x;Ĺ˝ĹśÄ&#x201A;ĹŻ Ć&#x2030;Ć&#x152;Ĺ?Ĺ˝Ć&#x152;Ĺ?Ć&#x;Ä&#x17E;Ć? Ä?Ç&#x2021; Ĺ?ĹśÄ?Ć&#x152;Ä&#x17E;Ä&#x201A;Ć?Ĺ?ĹśĹ? Ć&#x161;Ĺ&#x161;Ä&#x17E; Ć&#x2030;Ć&#x152;Ĺ˝Ć&#x2030;Ĺ˝Ć&#x152;Ć&#x;Ĺ˝Ĺś Ĺ˝Ä¨ Ć&#x161;Ĺ&#x161;Ä&#x17E;Ĺ?Ć&#x152; Ĺ&#x161;Ä&#x17E;Ä&#x201A;ĹŻĆ&#x161;Ĺ&#x161; Ä&#x201A;Ĺ?Ä&#x161; Ć&#x161;Ĺ&#x161;Ä&#x201A;Ć&#x161; Ĺ?Ć? Ć&#x152;Ä&#x17E;Ć&#x2030;Ĺ˝Ć&#x152;Ć&#x161;Ä&#x17E;Ä&#x161; Ĺ˝Ĺś ĹśÄ&#x201A;Ć&#x;Ĺ˝ĹśÄ&#x201A;ĹŻ Ä?ĆľÄ&#x161;Ĺ?Ä&#x17E;Ć&#x161;Í&#x2022; Ä&#x161;Ä&#x17E;ĹŻĹ?Ç&#x20AC;Ä&#x17E;Ć&#x152;Ä&#x17E;Ä&#x161; Ć&#x161;Ĺ&#x161;Ć&#x152;Ĺ˝ĆľĹ?Ĺ&#x161; Ć&#x2030;Ć&#x152;Ĺ˝Ĺ?Ć&#x152;Ä&#x201A;ĹľĹľÄ&#x17E;Í˛Ä?Ä&#x201A;Ć?Ä&#x17E;Ä&#x161; Ä&#x201A;Ć&#x2030;Ć&#x2030;Ć&#x152;Ĺ˝Ä&#x201A;Ä?Ĺ&#x161;Ä&#x17E;Ć?Í&#x2022; Ĺ˝Ć&#x152; Ć&#x161;Ĺ&#x161;Ć&#x152;Ĺ˝ĆľĹ?Ĺ&#x161; Ä?Ĺ˝Ĺ˝Ć&#x152;Ä&#x161;Ĺ?ĹśÄ&#x201A;Ć&#x161;Ä&#x17E;Ä&#x161; Ä?Ä&#x201A;Ć&#x2030;Ä&#x201A;Ä?Ĺ?Ć&#x161;Ç&#x2021; Ä?ĆľĹ?ĹŻÄ&#x161;Ĺ?ĹśĹ? Ć?ĆľĆ&#x2030;Ć&#x2030;Ĺ˝Ć&#x152;Ć&#x161; ĹľÄ&#x17E;Ä?Ĺ&#x161;Ä&#x201A;ĹśĹ?Ć?ĹľĆ?Í&#x2DC;

Ć&#x152;Ä&#x17E; ĹśÄ&#x201A;Ć&#x;Ĺ˝ĹśÄ&#x201A;ĹŻ Ĺ?Ĺ˝Ç&#x20AC;Ä&#x17E;Ć&#x152;ĹśĹľÄ&#x17E;ĹśĆ&#x161;Ć? Ä&#x201A;ĹśÄ&#x161; Ä&#x17E;Ç&#x20AC;Ä&#x17E;ĹŻĹ˝Ć&#x2030;ĹľÄ&#x17E;ĹśĆ&#x161; WÄ&#x201A;Ć&#x152;Ć&#x161;ĹśÄ&#x17E;Ć&#x152;Ć? Ä?Ä&#x17E;Ĺ?ĹśĹ? ĹľĹ˝Ć&#x152;Ä&#x17E; ĹľĆľĆ&#x161;ĆľÄ&#x201A;ĹŻĹŻÇ&#x2021; Ä&#x201A;Ä?Ä?Ĺ˝ĆľĹśĆ&#x161;Ä&#x201A;Ä?ĹŻÄ&#x17E; Ä¨Ĺ˝Ć&#x152; Ć&#x152;Ä&#x17E;Ć?ĆľĹŻĆ&#x161;Ć? Ĺ?Ĺś Ć&#x161;Ĺ&#x161;Ä&#x17E; Ĺ&#x161;Ä&#x17E;Ä&#x201A;ĹŻĆ&#x161;Ĺ&#x161; Ć?Ä&#x17E;Ä?Ć&#x161;Ĺ˝Ć&#x152;Í? Mutual accountability is at the heart of the IHP+ and is key to a producĆ&#x;ve and respecĆ&#x17E;ul relaĆ&#x;onship between a country government and its DPs. The IHP+ has recognised that it is necessary to have a mechanism in place 39 for governments to hold DPs accountable for their commitments to provide health aid in a certain way, as well as for DPs to hold government accountable for fulÄŽlling commitments to improve their health system and health outcomes. Mutual accountability also means working jointly together to address obstacles that might be encountered in trying to achieve these shared objecĆ&#x;ves. Seven countries ÍžBurundi, DRC, Ethiopia, Mali, MoÇ&#x152;ambique, Nepal and NigerÍż reported that they conducted a mutual assessment of health sector commitments in 2009 40. DPs reported that there was a high level of parĆ&#x;cipaĆ&#x;on in Ethiopia, MoÇ&#x152;ambique, Mali and Nepal. Some DPs reported that they had parĆ&#x;cipated in mutual accountability processes, even when the governments reported that these were not taking place Ížfor instance in Burkina Faso, DjibouĆ&#x; and NigeriaÍż. It seems that interpretaĆ&#x;on of what consĆ&#x;tutes a mutual accountability process can vary. BeĆŠer guidance is needed on how joint review processes should include a mutual review by NaĆ&#x;onal Governments, DPs and Civil Society KrganisaĆ&#x;ons, of how eÄŤecĆ&#x;vely aid

Programme based approaches share the following features: ÍžiÍż Leadership by the host country or organisaĆ&#x;onÍ&#x2013; ÍžiiÍż A single comprehensive programme and budget frameworkÍ&#x2013; ÍžiiiÍż A formalised process for donor coÍ˛ordinaĆ&#x;on and harmonisaĆ&#x;on of donor procedures for reporĆ&#x;ng, budgeĆ&#x;ng, ÄŽnancial management and procurementÍ&#x2013; ÍživÍż EÄŤorts to increase the use of local systems for programme design and implementaĆ&#x;on, ÄŽnancial management, monitoring and evaluaĆ&#x;on. hĆŠp:ÍŹÍŹwww.oecd.orgÍŹdataoecdÍŹ10ÍŹ46ÍŹ44479916.pdf accessed 20 February 2010

This process could be part of a joint annual review, a regular meeĆ&#x;ng, or producĆ&#x;on of an annual report.

DjibouĆ&#x; reported that a mutual assessmentÍžsÍż had been made in 2005 but not in 2009Í&#x2013; and Burkina Faso and Nigeria reported that a mutual assessmentÍžsÍż had been conducted in 2010.

IHP+Results 2010 Performance Report

is being delivered and used to achieve results in the health sector at the country level. This should build on convenƟonal joint annual review processes that tend to review progress in the health sector from the perspecƟve of health service implementaƟon. The Standard Performance Measures ;SPMsͿ and targets that the IHP+ has adopted through the IHP+Results process can be used by country health teams to review how eīecƟvely DPs are providing support to the health sector and how eīecƟvely governments are managing all the resources available to the health sector. This should promote accountability on both sides ʹ recognising that it is the responsibility of all to achieve health results. Further qualitaƟve research is necessary to review how mutual accountability processes are working in pracƟce, as this has not yet been a focus area of IHP+ acƟvity.

ͻ DŽƐƚ ĐŽƵŶƚƌŝĞƐ ŚĂǀĞ ũŽŝŶƚ ŚĞĂůƚŚ ƐĞĐƚŽƌ ƌĞǀŝĞǁ ƉƌŽĐĞƐƐĞƐ͕ ďƵƚ ƚŚĞƌĞ ŝƐ ĐŽŶƐŝĚĞƌĂďůĞ ǀĂƌŝĂƟŽŶ ŝŶ ŚŽǁ ƚŚĞƐĞ ĂƌĞ ĐŽŶĚƵĐƚĞĚ͘ dŚĞƐĞ ƌĞǀŝĞǁƐ ŚŽůĚ ƚŚĞ ƉŽƚĞŶƟĂů ĨŽƌ ƉĂƌƚŶĞƌƐ Ăƚ ƚŚĞ ĐŽƵŶƚƌǇ ůĞǀĞů ƚŽ ŚŽůĚ ĞĂĐŚ ŽƚŚĞƌ ŵƵƚƵĂůůǇ ƚŽ ĂĐĐŽƵŶƚ ĨŽƌ ƚŚĞŝƌ ĐŽŵŵŝƚŵĞŶƚƐ ƚŽ ĐŽŶƚƌŝďƵƚĞ ƚŽǁĂƌĚƐ ĂĐŚŝĞǀŝŶŐ ŚĞĂůƚŚ ƌĞƐƵůƚƐ͘ dŚŝƐ ĐĂŶ ďĞ ĚŽŶĞ ƵƐŝŶŐ ƚŚĞ ŽďũĞĐƟǀĞ ĐƌŝƚĞƌŝĂ ĂŶĚ ƐƚĂŶĚĂƌĚ ŵĞĂƐƵƌĞƐ ŶŽǁ ĂǀĂŝůĂďůĞ͘

/Ɛ Đŝǀŝů ƐŽĐŝĞƚǇ͛Ɛ ƉĂƌƟĐŝƉĂƟŽŶ ŝŶ ŚĞĂůƚŚ ƉŽůŝĐǇ ƉƌŽĐĞƐƐĞƐ ďĞĐŽŵŝŶŐ ŵŽƌĞ ŵĞĂŶŝŶŐĨƵů͍ Civil society is eǆpected to play a role in bringing the perspecƟves of communiƟes and vulnerable groups into health policy processes. Civil Society advocacy groups can also serve as a watchdog in accountability mechanisms. As an indicaƟon of the eǆtent to which this is happening, IHP+Results reviewed whether civil society has a seat at the health sector coordinaƟon mechanisms within each country ;8GͿ 41 and whether DPs are providing support for civil society to engage with these country mechanisms ;8DPͿ 42.

dĂďůĞ ϯ͘Ϯ͗ ŽƵŶƚƌǇ ŐŽǀĞƌŶŵĞŶƚ ƉĞƌĨŽƌŵĂŶĐĞ ŝŶ ƐƵƉƉŽƌƟŶŐ Đŝǀŝů ƐŽĐŝĞƚǇ ĞŶŐĂŐĞŵĞŶƚ ŝŶ ƉŽůŝĐǇ ƉƌŽĐĞƐƐĞƐ

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DRC

DJI

ETH

MALI

MOZ

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Governments reported that civil society is represented in the health coordinaƟon mechanism in seven of the ten countries ;all eǆcept DjibouƟ, Moǌambique, NigeriaͿ. Civil society representaƟon appeared to be increasing and had reached at least 10й of parƟcipants in siǆ of these countries͛ coordinaƟon mechanisms ;Burundi, DRC, Ethiopia, Mali, Nepal and NigerͿ. In Ethiopia civil society consƟtuted 25й of the membership of the country͛s health sector coordinaƟon mechanism͖ this Įgure was 30й in Mali. In some countries, the process begins with Civil Society representaƟves becoming more engaged in naƟonal health sector planning processes, before they become formally represented in the country͛s health sector coordinaƟon mechanism. All DPs reported that they provide support for civil society to parƟcipate in health policy processes ;see table belowͿ 43. Kther DPs provide support to civil society directly or indirectly. Further work is needed to Ɵghten the deĮniƟon of DP ͚support͛ to civil society. DP reports do not include global level support provided, for eǆample the Civil Society Health Policy AcƟon Fund, supported by IHP+ with donor funding and implemented by Kǆfam.

The health coordinaƟon mechanism is usually a government led body comprising domesƟc and internaƟonal stakeholders in the health sector. It is not the Global Fund Country CoordinaƟon Mechanism, but in some countries it overlaps with this mechanism.

IHP+Results 2011 monitoring should provide a smarter indicator of the quality of civil society engagement in health policy processes.

GAsI ;in EthiopiaͿ, Norway ;in DRC and NepalͿ, U< ;in NigeriaͿ, Sweden ;in Burkina FasoͿ, UNAIDS ;in DjibouƟ and NigeriaͿ, UNFPA ;in BurundiͿ.

IHP+Results 2010 Performance Report

dĂďůĞ ϯ͘ϯ͗ ĞǀĞůŽƉŵĞŶƚ WĂƌƚŶĞƌ ĂŐŐƌĞŐĂƚĞ ƉĞƌĨŽƌŵĂŶĐĞ ŝŶ ƐƵƉƉŽƌƟŶŐ Đŝǀŝů ƐŽĐŝĞƚǇ ĞŶŐĂŐĞŵĞŶƚ ŝŶ ƉŽůŝĐǇ ƉƌŽĐĞƐƐĞƐ

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EVIDENCE OF SUPPORT FOR CIVIL SOCIETY

BEL

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WHO

IHP+Results surveyed a range of Civil Society KrganisaƟons that could be idenƟĮed as being connected in some way to the IHP+, to get an understanding of civil society views of the quality of their engagement in health policy processes. Most of these Civil Society representaƟves reported that they were already parƟcipaƟng in developing naƟonal health plans and mutual accountability mechanisms. They also reported making a contribuƟon to and, to varying eǆtents, inŇuencing the outcomes of naƟonal Joint Annual Health Sector Reviews . 44 A list of interviewed agencies is available on the IHP+Results website 45.

ŝǀŝů ƐŽĐŝĞƚǇ ƌĞƉƌĞƐĞŶƚĂƟǀĞƐ ƌĞƉŽƌƚĞĚ ƚŚĂƚ ƚŚĞǇ ǁĞƌĞ ĞŶŐĂŐŝŶŐ ŵŽƌĞ ŝŶ ƚŚĞ ƐƵƌǀĞǇĞĚ /,Wн ĐŽƵŶƚƌŝĞƐ ŝŶ ƉƌŽĐĞƐƐĞƐ ƚŽ ĚĞǀĞůŽƉ ŶĂƟŽŶĂů ŚĞĂůƚŚ ƉůĂŶƐ͘

dŚĞƌĞ ŝƐ ƐĐŽƉĞ ŝŶ ŵŽƐƚ ĐŽƵŶƚƌŝĞƐ ĨŽƌ ĨƵƌƚŚĞƌ ŐŽǀĞƌŶŵĞŶƚ ĞŶŐĂŐĞŵĞŶƚ ŽĨ ƚŚĞŝƌ Đŝǀŝů ƐŽĐŝĞƚǇ͕ ĂŶĚ ĨŽƌ ŵŽƌĞ W ƐƵƉƉŽƌƚ ĨŽƌ Đŝǀŝů ƐŽĐŝĞƚǇ͕ ƚŽ ďĞĐŽŵĞ ŵŽƌĞ ŵĞĂŶŝŶŐĨƵůůǇ ŝŶǀŽůǀĞĚ ŝŶ ďƌŽĂĚĞƌ ŚĞĂůƚŚ ƉŽůŝĐǇ ƉƌŽĐĞƐƐĞƐ͘

ϯ͘Ϯ dƌĂŶƐƉĂƌĞŶƚ ĂŶĚ ƌĞƐƉŽŶƐŝďůĞ ,ĞĂůƚŚ &ŝŶĂŶĐŝŶŐ The IHP+ encourages governments to make ambiƟous prioriƟsed plans based on need and evidence and to idenƟfy the Įnancing gap that eǆternal resources should Įll. 46 Transparent and responsible Įnancing is crucial because a government needs to know how much money it will have for its health system in order to responsibly manage its health workforce, and budget for salaries, medicines, equipment and other eǆpenses. It is therefore essenƟal for a government to have reliability around DPs aid disbursements within the Ɵme frame promised.

ƌĞ ŐŽǀĞƌŶŵĞŶƚƐ ĂůůŽĐĂƟŶŐ ŵŽƌĞ ĨƵŶĚŝŶŐ ĨŽƌ ŚĞĂůƚŚ͍ A country͛s own Įnancial resources are the most important contribuƟon to operaƟng eīecƟve health systems and improving health outcomes. African heads of state commiƩed to allocaƟng at least 15й of their annual government budgets to the health sector ;3GͿ. 47

Ethiopia and Nigeria, UNICEF ;in EthiopiaͿ and WHK ;in Moǌambique, Burkina Faso, Burundi, DRC and MaliͿ.

www.ihpresults.netͬhowͬmethodologyͬ

See secƟon on developing naƟonal plans in hƩp:ͬͬwww.internaƟonalhealthpartnership.netͬCMSͺĮlesͬdocumentsͬihpͺcompactͺguidanceͺ noteͺEN.pdf accessed 3 February 2011.

Abuja DeclaraƟon, 2001. Nepal commiƩed to allocate 10й of its annual government budget to the health sector.

IHP+Results 2010 Performance Report

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Figure 3.3 above tracks the changes in naƟonal health sector eǆpenditure for each surveyed country. However, this should not be used to compare countries because of how eǆternal sources of funding have been reported by survey parƟcipants 48 49. Burkina Faso, Burundi, DjibouƟ, Nepal and Niger made progress towards allocaƟng 15й ;10й for NepalͿ of naƟonal budget to health. No countries had achieved this target and Įve maintained or decreased their allocaƟon. Burkina Faso was closest to the target, having reached 14.6й in 2009.

dĂďůĞ ϯ͘ϰ͗ ŽƵŶƚƌǇ ŐŽǀĞƌŶŵĞŶƚ ƉĞƌĨŽƌŵĂŶĐĞ ŝŶ ĂůůŽĐĂƟŶŐ Ă ƉƌŽƉŽƌƟŽŶ ŽĨ ƚŚĞ ŶĂƟŽŶĂů ďƵĚŐĞƚ ƚŽ ŚĞĂůƚŚ

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ĨƌŝĐĂŶ ŐŽǀĞƌŶŵĞŶƚƐ ŚĂǀĞ ŶŽƚ ǇĞƚ ŵĞƚ ƚŚĞŝƌ ƚĂƌŐĞƚ ŽĨ ĂůůŽĐĂƟŶŐ ϭϱй ŽĨ ŶĂƟŽŶĂů ďƵĚŐĞƚ ƚŽ ƚŚĞ ŚĞĂůƚŚ ƐĞĐƚŽƌ ;ϭϬй ƚĂƌŐĞƚ ĨŽƌ EĞƉĂůͿ

dƌĞŶĚƐ ĂƌĞ ĚŝĸĐƵůƚ ƚŽ ŝŶƚĞƌƉƌĞƚ ďĞĐĂƵƐĞ ŶĂƟŽŶĂů ŚĞĂůƚŚ ďƵĚŐĞƚƐ ǁĞƌĞ ŶŽƚ ďĞŝŶŐ ƌĞƉŽƌƚĞĚ ŝŶ ƐƚĂŶĚĂƌĚŝƐĞĚ ǁĂǇƐ ;ƚŽ ĞǆĐůƵĚĞ ĞǆƚĞƌŶĂů ĮŶĂŶĐŝĂů ĂƐƐŝƐƚĂŶĐĞͿ

&ŝǀĞ ĐŽƵŶƚƌŝĞƐ ŝŵƉƌŽǀĞĚ͕ ďƵƚ ƚŚƌĞĞ ŚĂĚ Ă ĚĞĐƌĞĂƐĞ ŝŶ ƚŚĞ ƉƌŽƉŽƌƟŽŶ ŽĨ ƚŚĞ ŶĂƟŽŶĂů ďƵĚŐĞƚ ĂůůŽĐĂƚĞĚ ƚŽ ŚĞĂůƚŚ͘

Burkina Faso and Moǌambique eǆcluded eǆternal assistance in their calculaƟons͖ DjibouƟ and Niger included eǆternal assistance. Burundi, Ethiopia, Mali, Nepal and Nigeria did not provide informaƟon on whether they included or eǆcluded eǆternal funding in their reported Įgures.

In view of the variaƟons in reporƟng on domesƟc allocaƟons to health, IHP+Results looked for but was unable to Įnd alternaƟve credible sources of data, such as from iniƟaƟves tracking the implementaƟon of the Abuja DeclaraƟon. A Centre for Health Sciences Training, Research and Development ;CHESTRADͿ survey on stewardship for Įnancial management showed that no country has a health care Įnancing process or system other than the annual budgeƟng cycle based on ceilings established by the Ministry of Finance. Ministries of health have no mechanism for tracking and delinking eǆternal resources in any credible way to ensure addiƟonality and reduce both subsƟtuƟon and duplicaƟon. A copy of this survey will be available in May, enƟtled ͞Aligning KDA to budgeƟng cycles and appropriaƟon processes in Africa: A case study in Nigeria͟.

IHP+Results 2010 Performance Report

Ć&#x152;Ä&#x17E; Ä&#x17E;Ç&#x20AC;Ä&#x17E;ĹŻĹ˝Ć&#x2030;ĹľÄ&#x17E;ĹśĆ&#x161; WÄ&#x201A;Ć&#x152;Ć&#x161;ĹśÄ&#x17E;Ć&#x152;Ć? ĹľÄ&#x201A;ĹŹĹ?ĹśĹ? ĹŻĹ˝ĹśĹ?Í˛Ć&#x161;Ä&#x17E;Ć&#x152;Ĺľ Ä¨ĆľĹśÄ&#x161;Ĺ?ĹśĹ? Ä?Ĺ˝ĹľĹľĹ?Ć&#x161;ĹľÄ&#x17E;ĹśĆ&#x161;Ć? Ć&#x161;Ĺ˝ Ć&#x161;Ĺ&#x161;Ä&#x17E; Ĺ&#x161;Ä&#x17E;Ä&#x201A;ĹŻĆ&#x161;Ĺ&#x161; Ć?Ä&#x17E;Ä?Ć&#x161;Ĺ˝Ć&#x152;Í? The measure of longÍ˛term predictability of eÇ&#x2020;ternal resources is the proporĆ&#x;on of funding made through mulĆ&#x;Í˛ year commitments. A mulĆ&#x;Í˛year commitment is one where the donor outlines to the government its ÄŽnancial commitment for at least the neÇ&#x2020;t three years for the health sector Íž3DPÍż.

dÄ&#x201A;Ä?ĹŻÄ&#x17E; ĎŻÍ&#x2DC;ĎąÍ&#x2014; Ä&#x17E;Ç&#x20AC;Ä&#x17E;ĹŻĹ˝Ć&#x2030;ĹľÄ&#x17E;ĹśĆ&#x161; WÄ&#x201A;Ć&#x152;Ć&#x161;ĹśÄ&#x17E;Ć&#x152; Ä&#x201A;Ĺ?Ĺ?Ć&#x152;Ä&#x17E;Ĺ?Ä&#x201A;Ć&#x161;Ä&#x17E; Ć&#x2030;Ä&#x17E;Ć&#x152;Ä¨Ĺ˝Ć&#x152;ĹľÄ&#x201A;ĹśÄ?Ä&#x17E; Ĺ?Ĺś Ć&#x2030;Ć&#x152;Ĺ˝Ç&#x20AC;Ĺ?Ä&#x161;Ĺ?ĹśĹ? ĹľĆľĹŻĆ&#x;Í˛Ç&#x2021;Ä&#x17E;Ä&#x201A;Ć&#x152; ÍžĹľĹ?ĹśÍ&#x2DC; ĎŻ Ç&#x2021;Ä&#x17E;Ä&#x201A;Ć&#x152;Ć?Íż Ä¨ĆľĹśÄ&#x161;Ĺ?ĹśĹ? Ä?Ĺ˝ĹľĹľĹ?Ć&#x161;ĹľÄ&#x17E;ĹśĆ&#x161;Ć?

3DP I AUS

PROPORTION OF HEALTH SECTOR AID PROVIDED THROUGH MULTI-YEAR COMMITMENTS

BEL

GAVI

GFATM

NOR

ESP

SWE

UNAIDS UNFPA

UNICEF

WHO

CollecĆ&#x;vely, DPs are not meeĆ&#x;ng the target of 90Đš of their health aid provided through mulĆ&#x;Í˛year commitments Í˛ overall the proporĆ&#x;on of mulĆ&#x;Í˛year commitments fell from 75Đš to 70Đš between baseline and 2009. But nine of the 15 Development Partners surveyed met the target of 90Đš of their health aid provided through mulĆ&#x;Í˛ year comments in 2009 ÍžTable 3.5Íż. 50

&Ĺ?Ĺ?ĆľĆ&#x152;Ä&#x17E; ĎŻÍ&#x2DC;Ď°Í&#x2014; Ĺ?Ĺ?Ć&#x152;Ä&#x17E;Ĺ?Ä&#x201A;Ć&#x161;Ä&#x17E; Ć&#x2030;Ć&#x152;Ĺ˝Ć&#x2030;Ĺ˝Ć&#x152;Ć&#x;Ĺ˝Ĺś Ć&#x2030;Ä&#x201A;Ć&#x152;Ć&#x161;ĹśÄ&#x17E;Ć&#x152; Ć?ĆľĆ&#x2030;Ć&#x2030;Ĺ˝Ć&#x152;Ć&#x161; Ć&#x2030;Ć&#x152;Ĺ˝Ç&#x20AC;Ĺ?Ä&#x161;Ä&#x17E;Ä&#x161; Ć&#x161;Ĺ&#x161;Ć&#x152;Ĺ˝ĆľĹ?Ĺ&#x161; ĹľĆľĹŻĆ&#x;Í˛Ç&#x2021;Ä&#x17E;Ä&#x201A;Ć&#x152; Ä?Ĺ˝ĹľĹľĹ?Ć&#x161;ĹľÄ&#x17E;ĹśĆ&#x161;Ć? ÍžĎŻ WÍż 100

Đš

%DVHOLQH BASELINE

'DWD ZLWK EDVHOLQH YDOXHV IURP DUH QRW LQFOXGHG

2009

+LJKFKDUWV FRP

Íť

dÄ&#x17E;Ĺś Ĺ˝Ä¨ Ć&#x161;Ĺ&#x161;Ä&#x17E; ĎĎą Ä&#x17E;Ç&#x20AC;Ä&#x17E;ĹŻĹ˝Ć&#x2030;ĹľÄ&#x17E;ĹśĆ&#x161; WÄ&#x201A;Ć&#x152;Ć&#x161;ĹśÄ&#x17E;Ć&#x152;Ć? Ć?ĆľĆ&#x152;Ç&#x20AC;Ä&#x17E;Ç&#x2021;Ä&#x17E;Ä&#x161; Ĺ&#x161;Ä&#x201A;Ç&#x20AC;Ä&#x17E; Ĺ?ĹľĆ&#x2030;Ć&#x152;Ĺ˝Ç&#x20AC;Ä&#x17E;Ä&#x161; Ć&#x161;Ĺ&#x161;Ä&#x17E; Ć&#x2030;Ć&#x152;Ä&#x17E;Ä&#x161;Ĺ?Ä?Ć&#x161;Ä&#x201A;Ä?Ĺ?ĹŻĹ?Ć&#x161;Ç&#x2021; Ĺ˝Ä¨ Ć&#x161;Ĺ&#x161;Ä&#x17E;Ĺ?Ć&#x152; Ä&#x201A;Ĺ?Ä&#x161; Ä?Ç&#x2021; Ĺ?ĹśÄ?Ć&#x152;Ä&#x17E;Ä&#x201A;Ć?Ĺ?ĹśĹ? ĹľĆľĹŻĆ&#x;Í˛Ç&#x2021;Ä&#x17E;Ä&#x201A;Ć&#x152; Ä?Ĺ˝ĹľĹľĹ?Ć&#x161;ĹľÄ&#x17E;ĹśĆ&#x161;Ć?Í&#x2022; Ä&#x201A;ĹśÄ&#x161; ĹśĹ?ĹśÄ&#x17E; Ĺ&#x161;Ä&#x201A;Ç&#x20AC;Ä&#x17E; ĹľÄ&#x17E;Ć&#x161; Ć&#x161;Ĺ&#x161;Ä&#x17E; Ć&#x161;Ä&#x201A;Ć&#x152;Ĺ?Ä&#x17E;Ć&#x161; Ĺ˝Ä¨ ĎľĎŹĐš Ĺ˝Ä¨ Ä¨ĆľĹśÄ&#x161;Ĺ?ĹśĹ? Ä?Ä&#x17E;Ĺ?ĹśĹ? Ć&#x2030;Ć&#x152;Ĺ˝Ç&#x20AC;Ĺ?Ä&#x161;Ä&#x17E;Ä&#x161; Ć&#x161;Ĺ&#x161;Ć&#x152;Ĺ˝ĆľĹ?Ĺ&#x161; ĹľĆľĹŻĆ&#x;Í˛Ç&#x2021;Ä&#x17E;Ä&#x201A;Ć&#x152; Ä?Ĺ˝ĹľĹľĹ?Ć&#x161;ĹľÄ&#x17E;ĹśĆ&#x161;Ć?

Íť

,Ĺ˝Ç Ä&#x17E;Ç&#x20AC;Ä&#x17E;Ć&#x152;Í&#x2022; Ĺ˝Ç&#x20AC;Ä&#x17E;Ć&#x152;Ä&#x201A;ĹŻĹŻ Ć&#x161;Ĺ&#x161;Ä&#x17E; Ć&#x2030;Ć&#x152;Ĺ˝Ć&#x2030;Ĺ˝Ć&#x152;Ć&#x;Ĺ˝Ĺś Ĺ˝Ä¨ Ä&#x17E;Ç&#x20AC;Ä&#x17E;ĹŻĹ˝Ć&#x2030;ĹľÄ&#x17E;ĹśĆ&#x161; WÄ&#x201A;Ć&#x152;Ć&#x161;ĹśÄ&#x17E;Ć&#x152; Ä&#x201A;Ĺ?Ä&#x161; Ć&#x2030;Ć&#x152;Ĺ˝Ç&#x20AC;Ĺ?Ä&#x161;Ä&#x17E;Ä&#x161; Ć&#x161;Ĺ&#x161;Ć&#x152;Ĺ˝ĆľĹ?Ĺ&#x161; ĹľĆľĹŻĆ&#x;Í˛Ç&#x2021;Ä&#x17E;Ä&#x201A;Ć&#x152; Ä?Ĺ˝ĹľĹľĹ?Ć&#x161;ĹľÄ&#x17E;ĹśĆ&#x161;Ć? Ä¨Ä&#x17E;ĹŻĹŻ Ä?Ä&#x17E;Ć&#x161;Ç Ä&#x17E;Ä&#x17E;Ĺś Ä?Ä&#x201A;Ć?Ä&#x17E;ĹŻĹ?ĹśÄ&#x17E; Ä&#x201A;ĹśÄ&#x161; ĎŽĎŹĎŹĎľ

WHK, UNAIDS and GFATM cannot make 3 year mulĆ&#x;Í˛year commitments because of their budgeĆ&#x;ng cycles ÍžWHK, UNAIDSÍż and grant making rules ÍžGFATMÍż.

IHP+Results 2010 Performance Report

Ž ĐŽƵŶƚƌǇ ŐŽǀĞƌŶŵĞŶƚƐ ƐƉĞŶĚ ƚŚĞ ƚŽƚĂů ĂŶŶƵĂů ďƵĚŐĞƚ ƚŚĂƚ ƚŚĞǇ ĂůůŽĐĂƚĞ ƚŽ ŚĞĂůƚŚ͍ Country governments are ulƟmately responsible for allocaƟng suĸcient resources for health in their annual budgets, but they also have a responsibility to spend ;disburseͿ those Įnancial resources in the course of the planned year. The target for this is a reducƟon by 50й of funds that are not disbursed in the intended year, over previous levels.

&ŝŐƵƌĞ ϯ͘ϱ͗ ĐƚƵĂů ĚŝƐďƵƌƐĞŵĞŶƚ ŽĨ ŐŽǀĞƌŶŵĞŶƚ ŚĞĂůƚŚ ďƵĚŐĞƚƐ ;dĂƌŐĞƚ͗ ZĞĚƵĐĞĚ ďǇ ϱϬйͿ

%DVHOLQH Baseline

1LJHULD

1LJHU

1HSDO

0DOL

(WKLRSLD

'MLERXWL

'5&

%XUXQGL

%XUNLQD )DVR

0R]DPELTXH

2009 +LJKFKDUWV FRP

Five of the ten countries surveyed increased the disbursement of their health budget and three actually decreased the disbursement of their health budget. It is not clear why these changes have occurred.

dĂďůĞ ϯ͘ϲ͗ ŽƵŶƚƌǇ ŐŽǀĞƌŶŵĞŶƚ ƉĞƌĨŽƌŵĂŶĐĞ ŝŶ ĚŝƐďƵƌƐŝŶŐ ŚĞĂůƚŚ ƐĞĐƚŽƌ ďƵĚŐĞƚƐ

4G I BF

HALVE THE AMOUNT OF HEALTH BUDGET NOT SPENT IN THE PLANNED YEAR BUR

DRC

DJI

ETH

MALI

MOZ

NEP

NIGER NIGERIA

KŶůǇ ĨŽƵƌ ĐŽƵŶƚƌŝĞƐ ĚŝƐďƵƌƐĞĚ Ă ŐƌĞĂƚĞƌ ƉƌŽƉŽƌƟŽŶ ŽĨ ƚŚĞ ĨƵŶĚƐ ĂǀĂŝůĂďůĞ ǁŝƚŚŝŶ ƚŚĞŝƌ ĂŶŶƵĂů ŚĞĂůƚŚ ďƵĚŐĞƚƐ͕ ĐŽŵƉĂƌĞĚ ƚŽ ƚŚĞŝƌ ďĂƐĞůŝŶĞƐ͘

Ž ĞǀĞůŽƉŵĞŶƚ WĂƌƚŶĞƌƐ ƚƌĂŶƐĨĞƌ ĨƵŶĚƐ ƚŽ ĐŽƵŶƚƌŝĞƐ ŽŶ ƟŵĞ͍ This is an important measure because country governments can only disburse the funds that they receive within any budgeted period if these are delivered on Ɵme, as commiƩed by their development partners. This was measured by IHP+Results using the proporƟon of actual disbursements in a year that were planned for that year ;this idenƟĮes disbursements that were carried over from a previous year or brought forward from the neǆt yearͿ. The measure diīers from KECDͬDAC indicator for aid predictability, which uses the proporƟon of disbursements planned for a given year that were actually made in that year. Both of these approaches provide interesƟng, but slightly diīerent, pictures of the predictability of eǆternal funding for health. 51

IHP+Results will collect data for both quesƟons in 2011 to ensure consistency with KECDͬDAC.

IHP+Results 2010 Performance Report

dĂďůĞ ϯ͘ϳ͗ ĞǀĞůŽƉŵĞŶƚ ƉĂƌƚŶĞƌ ĂŐŐƌĞŐĂƚĞ ƉĞƌĨŽƌŵĂŶĐĞ ŝŶ ƚŚĞ ƉƌŽƉŽƌƟŽŶ ŽĨ ĂĐƚƵĂů ĚŝƐďƵƌƐĞŵĞŶƚƐ ŝŶ Ă ǇĞĂƌ ƚŚĂƚ ǁĞƌĞ ƉůĂŶŶĞĚ ĨŽƌ ƚŚĂƚ ǇĞĂƌ

4DP I AUS

PROPORTION OF HEALTH SECTOR AID DISBURSED ACCORDING TO SCHEDULE

BEL

GAVI

GFATM

NOR

ESP

SWE

UNAIDS UNFPA

UNICEF

WHO

IHP+Results found that 12 of 15 DPs surveyed reported that more than 90й of their health spending in 2009 was actually planned to take place 2009. Although there are no data from this measure to indicate the percentage of DP planned eǆpenditure that was actually disbursed, this will be included in the neǆt round of monitoring.

dŚĞ ŵĂũŽƌŝƚǇ ŽĨ ĨƵŶĚŝŶŐ ƉƌŽǀŝĚĞĚ ďǇ ĞǀĞůŽƉŵĞŶƚ WĂƌƚŶĞƌƐ ǁĂƐ ďĞŝŶŐ ĚŝƐďƵƌƐĞĚ ĚƵƌŝŶŐ ƚŚĞ ǇĞĂƌ ĨŽƌ ǁŚŝĐŚ ƚŚŝƐ ŚĂĚ ďĞĞŶ ĐŽŵŵŝƩĞĚ ƚŽ ƚŚĞ ĐŽƵŶƚƌǇ͘

ϯ͘ϯ hƐŝŶŐ ĂŶĚ ƐƚƌĞŶŐƚŚĞŶŝŶŐ ŽƵŶƚƌǇ ^ǇƐƚĞŵƐ The IHP+ eǆpects that health service delivery will be sustained over the longerͲterm through countries invesƟng in stronger health systems. To make these investments, countries need to have sound Įnancial management systems that can reliably spend the available health resources. When DPs use parallel systems and fragmented projects to provide resources to the health sector, this can undermine the country͛s own systems. This also loses opportuniƟes to help countries build systems that are more eīecƟve, eĸcient, and equitable in meeƟng the needs of their ciƟǌens. Kn the other hand, DPs require naƟonal governments to have procurement and public Įnancial management systems that are reliable enough before conĮdently commiƫng Įnancial resources to be managed through these systems. This can result in a ͚stalemate͛ unless DPs take approaches that build this capacity with the eǆpectaƟon to incrementally transiƟon to using the country͛s systems.

ƌĞ ĐŽƵŶƚƌŝĞƐ ŝŵƉƌŽǀŝŶŐ ŚŽǁ ƚŚĞǇ ŵĂŶĂŐĞ ƚŚĞŝƌ ŚĞĂůƚŚ ĮŶĂŶĐĞƐ͍ Governments have commiƩed to improve their country systems for procurement ;5GaͿ and for public Įnancial management ;5GbͿ. 52 A health system requires a reliable supply of high quality equipment, medicines and diagnosƟcs at an aīordable price. This requires a strong procurement system that obtains value for money and does not waste resources. A health system also requires strong Įnancial management to ensure that money is spent on the right acƟviƟes, and that eǆpenditure is accurately recorded and accounted for. It is challenging to measure the strength of a procurement or public Įnancial management system and IHP+Results has used the same measures as the Paris DeclaraƟon Survey to get an indicaƟon of whether these systems are improving. There was insuĸcient informaƟon to assess whether the ten surveyed countries had strengthened their country procurement systems using the KCEDͬDAC fourͲpoint scale. Niger was the only country to have completed this type of procurement systems assessment. Niger scored ͚B͛ ;on a scale from A to D, where A indicates the best raƟngͿ. It was not possible to assess whether Niger͛s raƟng was an improvement, as there was no baseline Įgure.

See also the indicators in the Paris DeclaraƟon hƩp:ͬͬwww.oecd.orgͬdataoecdͬ57ͬ60ͬ36080258.pdf accessed on 23 January 2011.

IHP+Results 2010 Performance Report

The strength of Public Financial Management Systems was measured using the World Bank Country Policy and InsƟtuƟonal Assessment ;CPIAͿͬPFM raƟngs. This is a broad crossͲgovernment assessment that is not health sector speciĮc. NaƟonal systems are scored on a scale of 1 ;lowest scoreͿ to 6 ;highest scoreͿ. 53

dĂďůĞ ϯ͘ϴ͗ W/ ͬW&D ƐĐŽƌĞƐ ƐŚŽǁŝŶŐ ĂƐƐĞƐƐŵĞŶƚƐ ŽĨ ƐƚƌĞŶŐƚŚ ŽĨ ŶĂƟŽŶĂů WƵďůŝĐ &ŝŶĂŶĐŝĂů DĂŶĂŐĞŵĞŶƚ ƐǇƐƚĞŵƐ ĨŽƌ ƚŚĞ ϭϬ ƉĂƌƟĐŝƉĂƟŶŐ /,Wн ĐŽƵŶƚƌŝĞƐ

Country

2005

2009

Change

4.5

0.5

Burundi

2.5

0.5

DRC

2.5

DjibouƟ

Ethiopia

3.5

Ͳ0.5

Moǌambique

3.5

0.5

Nepal

3.5

Ͳ0.5

Niger

3.5

Burkina Faso

Mali

Nigeria

Three countries ;Burkina Faso, Burundi and MoǌambiqueͿ registered an increase in their CPIAͬPFM scores between 2005 and 2009. Mali and Nepal registered a decrease and the remaining 5 countries ;DRC, DjibouƟ, Ethiopia, Niger and NigeriaͿ showed no change from their baselines.

dŚĞƌĞ ŝƐ ŝŶƐƵĸĐŝĞŶƚ ĞǀŝĚĞŶĐĞ ƚŽ ƐƚĂƚĞ ǁŚĞƚŚĞƌ ĐŽƵŶƚƌǇ ƉƌŽĐƵƌĞŵĞŶƚ ƐǇƐƚĞŵƐ ĂƌĞ ŝŵƉƌŽǀŝŶŐ͘

YƵĂůŝƚĂƟǀĞ ƌĞƐĞĂƌĐŚ Žƌ ĐŽƵŶƚƌǇ ƐƚƵĚŝĞƐ ǁŽƵůĚ ďĞ ƌĞƋƵŝƌĞĚ ƚŽ ĂƐƐĞƐƐ ŝĨ ĐŽƵŶƚƌǇ ƉƌŽĐƵƌĞŵĞŶƚ ƐǇƐƚĞŵƐ ŚĂǀĞ ŝŵƉƌŽǀĞĚ ŝŶ ƌĞĐĞŶƚ ǇĞĂƌƐ͘ ǆŝƐƟŶŐ ĞǀŝĚĞŶĐĞ ŝƐ ŝŶĐŽŶĐůƵƐŝǀĞ͘

dŚƌĞĞ ĐŽƵŶƚƌǇ ŐŽǀĞƌŶŵĞŶƚƐ ; ƵƌŬŝŶĂ &ĂƐŽ͕ ƵƌƵŶĚŝ ĂŶĚ DŽǌĂŵďŝƋƵĞͿ ŚĂĚ ŝŵƉƌŽǀĞĚ ƚŚĞŝƌ ƉƵďůŝĐ ĮŶĂŶĐŝĂů ŵĂŶĂŐĞŵĞŶƚ ƐǇƐƚĞŵƐ͘ /Ŷ DĂůŝ ĂŶĚ EĞƉĂů ƚŚĞƐĞ ƐǇƐƚĞŵƐ ǁĞƌĞ ĂƐƐĞƐƐĞĚ ĂƐ ŚĂǀŝŶŐ ďĞĐŽŵĞ ǁĞĂŬĞƌ͘

ƌĞ ĞǀĞůŽƉŵĞŶƚ WĂƌƚŶĞƌƐ ĐŚĂŶŶĞůůŝŶŐ ĨƵŶĚƐ ƚŚƌŽƵŐŚ ĐŽƵŶƚƌǇ ƉƌŽĐƵƌĞŵĞŶƚ ƐǇƐƚĞŵƐ͍ Knly 53й of the total amount of development partner funding for procurement reported in this survey used country procurement systems in 2009. 54 This was a decrease from baseline of 60й. Siǆ of the 14 DPs surveyed ;for whom procurement is applicableͿ had met the target proporƟon of funding that used country procurement systems 55. This measure is not applicable for the GAsI Alliance whose funds for procurement Ňow through a global pooled procurement mechanism that is managed by UNICEF. This is a technically diĸcult measure for some DPs to report on, so it is possible that the results for procurement are underesƟmated and that in pracƟce a higher proporƟon of funds were Ňowing through country procurement systems. For instance, some DPs ;including the U<, EC, Netherlands, Norway and SwedenͿ provide General Budget or Sector Budget Support that is not easy to disaggregate to determine what proporƟon is used for procurement 56. A higher 53

CPIA raƟngs are produced annually by the World Bank. For more informaƟon see hƩp:ͬͬwww.oecd.orgͬdataoecdͬ45ͬ46ͬ35230756.pdf ;accessed 24 January 2011Ϳ and hƩp:ͬͬsiteresources.worldbank.orgͬIDAͬResourcesͬCPIA2004quesƟonnaire.pdf ;accessed 24 January 2011Ϳ.

This is a diīerent denominator to the Paris indicator ʹ which shows procurement spend over total spend.

The target for this measure is: 66й reducƟon in the proporƟon of funding not going through country procurement systems ;with at least 80й using country procurement systemsͿ.

IHP+Results 2010 Performance Report

proporĆ&#x;on of DPs provide aid through country systems to Ethiopia and Mali than to other countries, but it is not clear to what eÇ&#x2020;tent DP performance on this measure is inĹ&#x2021;uenced by assessments of the strength of country procurement systems Ížbecause data is not rouĆ&#x;nely available for indicator 5Ga, see aboveÍż.

dÄ&#x201A;Ä?ĹŻÄ&#x17E; ĎŻÍ&#x2DC;ĎľÍ&#x2014; Ä&#x17E;Ç&#x20AC;Ä&#x17E;ĹŻĹ˝Ć&#x2030;ĹľÄ&#x17E;ĹśĆ&#x161; WÄ&#x201A;Ć&#x152;Ć&#x161;ĹśÄ&#x17E;Ć&#x152; Ä&#x201A;Ĺ?Ĺ?Ć&#x152;Ä&#x17E;Ĺ?Ä&#x201A;Ć&#x161;Ä&#x17E; Ć&#x2030;Ä&#x17E;Ć&#x152;Ä¨Ĺ˝Ć&#x152;ĹľÄ&#x201A;ĹśÄ?Ä&#x17E; Ĺ˝Ĺś ĆľĆ?Ĺ?ĹśĹ? ĹśÄ&#x201A;Ć&#x;Ĺ˝ĹśÄ&#x201A;ĹŻ Ć&#x2030;Ć&#x152;Ĺ˝Ä?ĆľĆ&#x152;Ä&#x17E;ĹľÄ&#x17E;ĹśĆ&#x161; Ć?Ç&#x2021;Ć?Ć&#x161;Ä&#x17E;ĹľĆ?Í&#x2DC;

5DPa I AUS

PROPORTION OF HEALTH SECTOR AID USING COUNTRY PROCUREMENT SYSTEMS

BEL

GAVI

GFATM

NOR

ESP

SWE

UNAIDS UNFPA

UNICEF

WHO

&Ĺ?Ĺ?ĆľĆ&#x152;Ä&#x17E; ĎŻÍ&#x2DC;Ď˛Í&#x2014; Ĺ?Ĺ?Ć&#x152;Ä&#x17E;Ĺ?Ä&#x201A;Ć&#x161;Ä&#x17E; Ć&#x2030;Ä&#x201A;Ć&#x152;Ć&#x161;ĹśÄ&#x17E;Ć&#x152; ĆľĆ?Ä&#x17E; Ĺ˝Ä¨ Ä?Ĺ˝ĆľĹśĆ&#x161;Ć&#x152;Ç&#x2021; Ć&#x2030;Ć&#x152;Ĺ˝Ä?ĆľĆ&#x152;Ä&#x17E;ĹľÄ&#x17E;ĹśĆ&#x161; Ć?Ç&#x2021;Ć?Ć&#x161;Ä&#x17E;ĹľĆ?Í&#x2DC; ÍžĎą WÄ&#x201A;Íż 100

Đš 40

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Ć&#x152;Ä&#x17E; Ä&#x17E;Ç&#x20AC;Ä&#x17E;ĹŻĹ˝Ć&#x2030;ĹľÄ&#x17E;ĹśĆ&#x161; WÄ&#x201A;Ć&#x152;Ć&#x161;ĹśÄ&#x17E;Ć&#x152;Ć? Ä?Ĺ&#x161;Ä&#x201A;ĹśĹśÄ&#x17E;ĹŻĹŻĹ?ĹśĹ? Ä¨ĆľĹśÄ&#x161;Ć? Ć&#x161;Ĺ&#x161;Ć&#x152;Ĺ˝ĆľĹ?Ĺ&#x161; Ä?Ĺ˝ĆľĹśĆ&#x161;Ć&#x152;Ç&#x2021; Ć&#x2030;ĆľÄ?ĹŻĹ?Ä? ÄŽĹśÄ&#x201A;ĹśÄ?Ĺ?Ä&#x201A;ĹŻ ĹľÄ&#x201A;ĹśÄ&#x201A;Ĺ?Ä&#x17E;ĹľÄ&#x17E;ĹśĆ&#x161; Ć?Ç&#x2021;Ć?Ć&#x161;Ä&#x17E;ĹľĆ?Í? &Ĺ?Ĺ?ĆľĆ&#x152;Ä&#x17E; ĎŻÍ&#x2DC;ĎłÍ&#x2014; Ĺ?Ĺ?Ć&#x152;Ä&#x17E;Ĺ?Ä&#x201A;Ć&#x161;Ä&#x17E; Ć&#x2030;Ä&#x201A;Ć&#x152;Ć&#x161;ĹśÄ&#x17E;Ć&#x152; ĆľĆ?Ä&#x17E; Ĺ˝Ä¨ Ä?Ĺ˝ĆľĹśĆ&#x161;Ć&#x152;Ç&#x2021; Ć&#x2030;ĆľÄ?ĹŻĹ?Ä? ÄŽĹśÄ&#x201A;ĹśÄ?Ĺ?Ä&#x201A;ĹŻ ĹľÄ&#x201A;ĹśÄ&#x201A;Ĺ?Ä&#x17E;ĹľÄ&#x17E;ĹśĆ&#x161; Ć?Ç&#x2021;Ć?Ć&#x161;Ä&#x17E;ĹľĆ? ÍžĎą WÄ?Íż 100

Đš 40

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Kf the total amount of Development Partner funding for health that was reported in this survey Ížin the ÄŽve countries whose country ÄŽnancial management systems ÍžPFMÍż were considered to adhere to broadly accepted good pracĆ&#x;ces 57Íż, 63Đš used country ÄŽnancial management ÍžPFMÍż systems in 2009. This was an increase of 18Đš over the baseline years Ížsee ÄŽg. 3.7 aboveÍż, and represents a collecĆ&#x;ve achievement of the target 58 by DPs in the ÄŽve countries with suÄ¸ciently strong systems. Eight of the 15 DPs surveyed achieved

A descripĆ&#x;on of the approach used to count procurement funding through SBS is provided in the methodology anneÇ&#x2020;.

PFM systems in Burkina Faso, Ethiopia, Mali, MoÇ&#x152;ambique and Niger were scored with 3.5 or above on the CPIAÍŹPFM raĆ&#x;ng Í˛ 3.5 is the point at which DPs are eÇ&#x2020;pected to start using country PFM systems.

IHP+Results 2010 Performance Report

the target for using country PFM systems in the ÄŽve countries with suÄ¸ciently strong systems. A higher proporĆ&#x;on of DPs provided aid through the country systems of Ethiopia and Mali, followed by MoÇ&#x152;ambique, Nepal and Burkina Faso, in comparison with the remaining countries. Burundi, DjibouĆ&#x;, Nigeria, DRC and Niger had seen liĆŠle improvement in the use of their country systems for both procurement and public ÄŽnancial management, over the baseline. Table 3.10 below shows the variable progress that Development Partners were making in using country public ÄŽnancial management systems.

dÄ&#x201A;Ä?ĹŻÄ&#x17E; ĎŻÍ&#x2DC;ĎĎŹÍ&#x2014; Ä&#x17E;Ç&#x20AC;Ä&#x17E;ĹŻĹ˝Ć&#x2030;ĹľÄ&#x17E;ĹśĆ&#x161; WÄ&#x201A;Ć&#x152;Ć&#x161;ĹśÄ&#x17E;Ć&#x152; Ä&#x201A;Ĺ?Ĺ?Ć&#x152;Ä&#x17E;Ĺ?Ä&#x201A;Ć&#x161;Ä&#x17E; Ć&#x2030;Ä&#x17E;Ć&#x152;Ä¨Ĺ˝Ć&#x152;ĹľÄ&#x201A;ĹśÄ?Ä&#x17E; Ĺ˝Ĺś ĆľĆ?Ä&#x17E; Ĺ˝Ä¨ ĹśÄ&#x201A;Ć&#x;Ĺ˝ĹśÄ&#x201A;ĹŻ WĆľÄ?ĹŻĹ?Ä? &Ĺ?ĹśÄ&#x201A;ĹśÄ?Ĺ?Ä&#x201A;ĹŻ DÄ&#x201A;ĹśÄ&#x201A;Ĺ?Ä&#x17E;ĹľÄ&#x17E;ĹśĆ&#x161; Ć?Ç&#x2021;Ć?Ć&#x161;Ä&#x17E;ĹľĆ?

5DPb I AUS

PROPORTION OF HEALTH SECTOR AID USING PUBLIC FINANCIAL MANAGEMENT SYSTEMS

BEL

GAVI

GFATM

NOR

ESP

SWE

UNAIDS UNFPA

UNICEF

WHO

Ć&#x152;Ä&#x17E; Ä?Ĺ˝ĆľĹśĆ&#x161;Ć&#x152;Ĺ?Ä&#x17E;Ć? Ç Ĺ?Ć&#x161;Ĺ&#x161; Ć&#x152;Ĺ˝Ä?ĆľĆ?Ć&#x161; Ć?Ç&#x2021;Ć?Ć&#x161;Ä&#x17E;ĹľĆ? ĹľĹ˝Ć&#x152;Ä&#x17E; ĹŻĹ?ĹŹÄ&#x17E;ĹŻÇ&#x2021; Ć&#x161;Ĺ˝ Ć&#x152;Ä&#x17E;Ä?Ä&#x17E;Ĺ?Ç&#x20AC;Ä&#x17E; Ä&#x17E;Ç&#x20AC;Ä&#x17E;ĹŻĹ˝Ć&#x2030;ĹľÄ&#x17E;ĹśĆ&#x161; WÄ&#x201A;Ć&#x152;Ć&#x161;ĹśÄ&#x17E;Ć&#x152; Ä&#x201A;Ć?Ć?Ĺ?Ć?Ć&#x161;Ä&#x201A;ĹśÄ?Ä&#x17E;Í? Burkina Faso, Ethiopia, Mali, MoÇ&#x152;ambique and Niger had PFM systems with scores of 3.5 or above in 2009 Íž3.5 is the point at which DPs are eÇ&#x2020;pected to start using country PFM systemsÍż. 60 These countries appeared to have a higher proporĆ&#x;on of DPs providing health aid through their country systems. However, Niger and Burkina Faso Ížtwo countries with the strongest PFM systemsÍż did not appear to have received more ÄŽnancial support through their country systems in comparison with Ethiopia, Mali and MoÇ&#x152;ambique.

,Ä&#x201A;Ç&#x20AC;Ä&#x17E; Ä&#x17E;Ç&#x20AC;Ä&#x17E;ĹŻĹ˝Ć&#x2030;ĹľÄ&#x17E;ĹśĆ&#x161; WÄ&#x201A;Ć&#x152;Ć&#x161;ĹśÄ&#x17E;Ć&#x152;Ć? Ć&#x152;Ä&#x17E;Ä&#x161;ĆľÄ?Ä&#x17E;Ä&#x161; Ć&#x161;Ĺ&#x161;Ä&#x17E; ĹśĆľĹľÄ?Ä&#x17E;Ć&#x152; Ĺ˝Ä¨ Ć?Ć&#x161;Ä&#x201A;ĹśÄ&#x161;Ä&#x201A;ĹŻĹ˝ĹśÄ&#x17E; Ć&#x2030;Ć&#x152;Ĺ˝ĹŠÄ&#x17E;Ä?Ć&#x161; Ĺ?ĹľĆ&#x2030;ĹŻÄ&#x17E;ĹľÄ&#x17E;ĹśĆ&#x161;Ä&#x201A;Ć&#x;Ĺ˝Ĺś ĆľĹśĹ?Ć&#x161;Ć?Í? &Ĺ?Ĺ?ĆľĆ&#x152;Ä&#x17E; ĎŻÍ&#x2DC;Ď´Í&#x2014; Ĺ?Ĺ?Ć&#x152;Ä&#x17E;Ĺ?Ä&#x201A;Ć&#x161;Ä&#x17E; ĹśĆľĹľÄ?Ä&#x17E;Ć&#x152; Ĺ˝Ä¨ Ć&#x2030;Ä&#x201A;Ć&#x152;Ä&#x201A;ĹŻĹŻÄ&#x17E;ĹŻ WĆ&#x152;Ĺ˝ĹŠÄ&#x17E;Ä?Ć&#x161; /ĹľĆ&#x2030;ĹŻÄ&#x17E;ĹľÄ&#x17E;ĹśĆ&#x161;Ä&#x201A;Ć&#x;Ĺ˝Ĺś hĹśĹ?Ć&#x161;Ć? ÍžW/hĆ?Íż 60

Total number of PIUs Total number of PIUs

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There had been a 29Đš reducĆ&#x;on in the number of standalone project implementaĆ&#x;on units ÍžPIUsÍż supported by DPs in the ten countries and this represents progress towards achieving the target of a twoÍ˛thirds reducĆ&#x;on Ížalthough it has to be acknowledged that country governments sĆ&#x;ll request some DPs to establish or maintain PIUs for strategic or operaĆ&#x;onal reasonsÍż. UNFPA reported the greatest reducĆ&#x;on in the numbers of PIUs that it was involved with in the surveyed countries. Most other DPs reported that their agency strategy is to conĆ&#x;nue reducing their use of PIUs to deliver support to the health sector. 58

The target for this measure is: 33Đš reducĆ&#x;on in the proporĆ&#x;on of health aid not using country PFM systems Ížwith at least 80Đš using country PFM systemsÍż

This benchmark is set in the Paris DeclaraĆ&#x;on targets: hĆŠp:ÍŹÍŹwww.oecd.orgÍŹdataoecdÍŹ57ÍŹ60ÍŹ36080258.pdf

Not applicable because DRC does not have a performance framework yet. This also applies to Nigeria.

IHP+Results 2010 Performance Report

/Ŷ ĮǀĞ ĐŽƵŶƚƌŝĞƐ ǁŝƚŚ ƐƚƌŽŶŐ ĐŽƵŶƚƌǇ ĮŶĂŶĐŝĂů ŵĂŶĂŐĞŵĞŶƚ ƐǇƐƚĞŵƐ͕ ĞǀĞůŽƉŵĞŶƚ WĂƌƚŶĞƌƐ ŽǀĞƌĂůů ŵĞƚ ƚŚĞ ƚĂƌŐĞƚ ŽĨ Ă ϯϯй ƌĞĚƵĐƟŽŶ ŝŶ ƚŚĞ ƉƌŽƉŽƌƟŽŶ ŽĨ ĨƵŶĚƐ ŶŽƚ ƵƐŝŶŐ ƚŚĞƐĞ ƐǇƐƚĞŵƐ͘

dŚĞ ƚŽƚĂů ĂŵŽƵŶƚ ŽĨ ĚĞǀĞůŽƉŵĞŶƚ ƉĂƌƚŶĞƌ ĨƵŶĚŝŶŐ ƵƐŝŶŐ ĐŽƵŶƚƌǇ ƉƌŽĐƵƌĞŵĞŶƚ ƐǇƐƚĞŵƐ ŝŶ ϮϬϬϵ ĂƉƉĞĂƌƐ ƚŽ ŚĂǀĞ ĚĞĐůŝŶĞĚ ƐŝŶĐĞ ƚŚĞ ďĂƐĞůŝŶĞ͘

dŚĞ ŶƵŵďĞƌ ŽĨ W/hƐ ǁĂƐ ĚĞĐůŝŶŝŶŐ͕ ďƵƚ ŶŽƚ ĞŶŽƵŐŚ ƚŽ ŵĞĞƚ ƚŚĞ ƚĂƌŐĞƚƐ ƚŚĂƚ ŚĂǀĞ ďĞĞŶ ĂŐƌĞĞĚ͘

dŚĞƌĞ ŝƐ ŝŶƐƵĸĐŝĞŶƚ ŝŶĨŽƌŵĂƟŽŶ ƚŽ ĐŽŶĐůƵĚĞ ǁŚǇ ƌĞůĂƟǀĞůǇ ůŝƩůĞ ƉƌŽŐƌĞƐƐ ǁĂƐ ďĞŝŶŐ ŵĂĚĞ ŝŶ ZĞƐƵůƚƐ ƌĞĂ͕ ƚŚŽƵŐŚ ŝƚ ŝƐ ǁŽƌƚŚ ŶŽƟŶŐ ƚŚĂƚ ƚŚŝƐ ŝƐ ĂŶ ĂƌĞĂ ŝŶ ǁŚŝĐŚ ƉƌŽŐƌĞƐƐ ďǇ ĞǀĞůŽƉŵĞŶƚ WĂƌƚŶĞƌ ŝƐ ĐŽŶƟŶŐĞŶƚ ŽŶ ŐŽǀĞƌŶŵĞŶƚƐ ŵĂŬŝŶŐ ƉƌŽŐƌĞƐƐ ƚŽ ƐƚƌĞŶŐƚŚĞŶ ƚŚĞŝƌ ĐŽƵŶƚƌǇ ƐǇƐƚĞŵƐ͘

/ƚ ŝƐ ĞŶĐŽƵƌĂŐŝŶŐ ƚŚĂƚ͕ ŽŶ ƚŚĞ ǁŚŽůĞ͕ ĐŽƵŶƚƌŝĞƐ ǁŝƚŚ ƐƚƌŽŶŐĞƌ ƐǇƐƚĞŵƐ ĂƌĞ ƌĞĐĞŝǀŝŶŐ ŵŽƌĞ ƐƵƉƉŽƌƚ ƚŚƌŽƵŐŚ ƚŚŽƐĞ ƐǇƐƚĞŵƐ͘

ϯ͘ϰ DĂŶĂŐŝŶŐ ĨŽƌ ĞǀĞůŽƉŵĞŶƚ ZĞƐƵůƚƐ A single performance assessment framework is central to a government͛s eīorts to measure health outcomes, monitor progress and idenƟfy areas of underͲperformance. Fragmented performance frameworks, informaƟon systems, and project based monitoring can hinder a government͛s eīorts to have a comprehensive overview of progress in their country. Managing mulƟple performance monitoring and reporƟng requirements to meet the demands of diīerent Development Partners also incurs high transacƟon costs to the government. Each IHP+ country government has commiƩed to develop a transparent and monitorable performance assessment framework ;PAFͿ that includes a comprehensive set of health and health systems indicators that all partners can use ;6GͿ. DPs have commiƩed to using these frameworks as the primary basis to assess progress of their health aid ;6DPͿ.

dĂďůĞ ϯ͘ϭϭ͗ ŽƵŶƚƌǇ ŐŽǀĞƌŶŵĞŶƚ ƉĞƌĨŽƌŵĂŶĐĞ ŝŶ ĞƐƚĂďůŝƐŚŝŶŐ ƐŝŶŐůĞ WĞƌĨŽƌŵĂŶĐĞ ƐƐĞƐƐŵĞŶƚ &ƌĂŵĞǁŽƌŬƐ

6G I BF

COUNTRIES USING SINGLE PERFORMANCE FRAMEWORK BUR

DRC

DJI

ETH

MALI

MOZ

NEP

NIGER NIGERIA

Seven of ten countries surveyed reported that they had a single performance framework in place ;see table 3.11 aboveͿ. 62 More than 60й of the DPs that were acƟve in these countries claimed to use the naƟonal framework as the primary basis to assess the performance of their health aid, although this varies across countries ;see table 3.11 aboveͿ. It is not evident whether DPs use the naƟonal framework as the primary basis to assess the performance of their health aid to the country. DPs indicated that they required reporƟng on addiƟonal indicators ;beyond the naƟonal performance assessment frameworkͿ in four countries ;DRC, Ethiopia, Mali and NigerͿ. It is not clear whether these addiƟonal indicators are required to meet the needs of DPs parƟcipaƟng in this survey, or the needs of other DPs providing health sector support to the country. Nevertheless the outcome is the same: the eǆistence of a single performance framework does not completely reduce the requests for countries to report on addiƟonal indicators.

DRC reports not having a performance framework, but a number of DPs reported that there is one that they use as their primary basis of assessing progress.

IHP+Results 2010 Performance Report

dĂďůĞ ϯ͘ϭϮ͗ ĞǀĞůŽƉŵĞŶƚ WĂƌƚŶĞƌ ĂŐŐƌĞŐĂƚĞ ƉĞƌĨŽƌŵĂŶĐĞ ŝŶ ƵƐŝŶŐ ŶĂƟŽŶĂů WĞƌĨŽƌŵĂŶĐĞ ƐƐĞƐƐŵĞŶƚ &ƌĂŵĞǁŽƌŬƐ ĂƐ ƚŚĞ ƉƌŝŵĂƌǇ ďĂƐŝƐ ƚŽ ĂƐƐĞƐƐ ƉƌŽŐƌĞƐƐ

6DP I AUS

PARTNERS USING SINGLE NATIONAL PERFORMANCE ASSESSMENT FRAMEWORK

BEL

GAVI

GFATM

NOR

ESP

SWE

UNAIDS UNFPA

UNICEF

WHO

! IHP+Results did not collect evidence of the quality of these country performance frameworks. These also depend on each country having a good Health Management InformaƟon System ;HMISͿ in place to collect and summarise reliable, Ɵmely data so that all partners can use these as indicaƟons of performance. Recent assessments suggest that Burkina Faso and Mali have an ͚adequate͛ HMIS in place and that Ethiopia, Moǌambique and Burundi each have a funcƟoning, but inadequate HMIS. 63 Other countries have not yet had recent HMIS assessments. Ethiopia is an eǆample amongst these countries of having made considerable investments into strengthening the HMIS since the IHP+ was launched.

ŽƵŶƚƌŝĞƐ ĂƌĞ ŽǀĞƌĂůů ďĞƩĞƌ ƉůĂĐĞĚ ƚŽ ŵŽŶŝƚŽƌ ƚŚĞ ƉĞƌĨŽƌŵĂŶĐĞ ŽĨ ƚŚĞŝƌ ŚĞĂůƚŚ ƐĞĐƚŽƌ͕ ƐŝŶĐĞ ƚŚĞ ƐƚĂƌƚ ŽĨ ƚŚĞ /,Wн͘ DŽƌĞ ŽƵŶƚƌŝĞƐ ŚĂǀĞ ŝŵƉůĞŵĞŶƚĞĚ ŶĂƟŽŶĂů ƉĞƌĨŽƌŵĂŶĐĞ ĂƐƐĞƐƐŵĞŶƚ ĨƌĂŵĞǁŽƌŬƐ ĂŶĚ ƚŚĞ ŵĂũŽƌŝƚǇ ŽĨ ĞǀĞůŽƉŵĞŶƚ WĂƌƚŶĞƌƐ ĂƌĞ ŵĂŬŝŶŐ ŐƌĞĂƚĞƌ ƵƐĞ ŽĨ ƚŚĞƐĞ͕ ǁŚĞƌĞ ƚŚĞǇ ĞǆŝƐƚ͘

/ƚ ŝƐ ŶŽƚ ĐůĞĂƌ ŚŽǁ ŵƵĐŚ ƚŚŝƐ ƌĞĚƵĐĞƐ ƚƌĂŶƐĂĐƟŽŶ ĐŽƐƚƐ͕ ĂƐ ƐŽŵĞ WƐ ƐƟůů ƌĞƋƵŝƌĞ ĂĚĚŝƟŽŶĂů ƌĞƉŽƌƟŶŐ͕ ƵƐŝŶŐ ŝŶĚŝĐĂƚŽƌƐ ƚŚĂƚ ĂƌĞ ŶŽƚ ƉĂƌƚ ŽĨ ƚŚĞ ŶĂƟŽŶĂů ĨƌĂŵĞǁŽƌŬ͘

ϯ͘ϱ ^ƚƌĞŶŐƚŚĞŶŝŶŐ ,ĞĂůƚŚ ^ǇƐƚĞŵƐ The main intenƟon of the IHP+ was to invest, with countries, in strengthening health systems so that health aid could produce more eīecƟve health results. It is too early to eǆpect IHP+ to have had a signiĮcant impact on strengthening health systems, and aƩribuƟng any improvements to the eǆistence of the IHP+ would in any case be diĸcult. IHP+Results is tracking a few key health systems indicators to provide a starƟng point for future monitoring of health systems strengthening. The eǆtent to which naƟonal governments are prioriƟsing Human Resources for Health ;HRHͿ and developing more ambiƟous naƟonal HRH plans ;2GbͿ provides an iniƟal proǆy measure of this. This has been supplemented with data on the number of health workers per populaƟon and resources allocated to HRH to get a view of whether each country government is allocaƟng resources according to its HRH plan. Countries͛ ability to implement these plans is linked to progress on more eĸcient aid to the health sector ;as reviewed in the previous secƟons of this reportͿ. Responsible and predictable eǆternal assistance places Ministries of Health in a beƩer posiƟon to plan, train, recruit and retain health workers.

The Health Metrics Network has provided assistance to some IHP+ countries to assess the quality of the HMIS and develop plans to improve them. Country assessments available at hƩp:ͬͬwww.who.intͬhealthmetricsͬsupportͬenͬ accessed 20 February 2011.

IHP+Results 2010 Performance Report

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Seven of the ten surveyed countries had an HRH plan in place, but only Burundi, Mali and MoÇ&#x152;ambique had fully integrated this with the naĆ&#x;onal health plan Ížsee table 3.13 aboveÍż.64 However, there appears to be a miÇ&#x2020;ed picture of how this aÄŤects the resources allocated to HRH: 3 countries showed an increase in the absolute volume of funding for HRH, but all countries showed a decrease in the proporĆ&#x;on of funding allocated to HRH Ížsee ÄŽgure 3.9 belowÍż. The Global Health Workforce Alliance ÍžGHWAÍż has recently published a progress report on the <ampala DeclaraĆ&#x;on, which found that 86Đš of high priority countries had an HRH plan, but that not all were costed.65 Future GHWA progress reports should provide useful informaĆ&#x;on to supplement the ÄŽndings of the IHP+Results surveys.

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A more posiĆ&#x;ve ÄŽnding was that eight of the ten countries surveyed had increased the proporĆ&#x;on of skilled health workers per 10,000 populaĆ&#x;on Ížsee ÄŽgure 3.9 aboveÍż, although all countries sĆ&#x;ll fell short of the recommended criĆ&#x;cal threshold of 23 skilled health workers per 10,000 populaĆ&#x;ons 66.

DRC reported that it plans to develop an HRH plan.

hĆŠp:ÍŹÍŹwww.who.intÍŹworkforceallianceÍŹknowledgeÍŹresourcesÍŹkdagaprogressreportÍŹenÍŹindeÇ&#x2020;.html accessed 3 February 2011.

2006, World Health Report, threshold at 2.28 ÍŹ1,000 populaĆ&#x;on Í´ hĆŠp:ÍŹÍŹwww.who.intÍŹwhrÍŹ2006ÍŹenÍŹindeÇ&#x2020;.html accessed 4 February 2011

IHP+Results 2010 Performance Report

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Future IHP+Results annual performance monitoring will aĆŠempt to collect evidence of health services changes and the eÇ&#x2020;tent to which the IHP+ has contributed to these changes. Four of the ten countries in the survey reported increasing numbers of outpaĆ&#x;ent visits per 10,000 of the populaĆ&#x;on, which could provide an indicaĆ&#x;on of increasing access to health services in these countries Ížalthough the proporĆ&#x;on of births aĆŠended by skilled health personnel might be considered a more sensiĆ&#x;ve measure and could be included in subsequent performance reviewsÍż.

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Íť

^Ĺ˝ĹľÄ&#x17E; Ĺ?Ĺ˝Ç&#x20AC;Ä&#x17E;Ć&#x152;ĹśĹľÄ&#x17E;ĹśĆ&#x161;Ć? Ĺ&#x161;Ä&#x201A;Ç&#x20AC;Ä&#x17E; Ä&#x161;Ä&#x17E;Ç&#x20AC;Ä&#x17E;ĹŻĹ˝Ć&#x2030;Ä&#x17E;Ä&#x161; ĹľĹ˝Ć&#x152;Ä&#x17E; Ä&#x201A;ĹľÄ?Ĺ?Ć&#x;Ĺ˝ĆľĆ? Ć&#x2030;ĹŻÄ&#x201A;ĹśĆ? Ć&#x161;Ĺ˝ Ĺ?ĹśÇ&#x20AC;Ä&#x17E;Ć?Ć&#x161; Ĺ?Ĺś ,ĆľĹľÄ&#x201A;Ĺś ZÄ&#x17E;Ć?Ĺ˝ĆľĆ&#x152;Ä?Ä&#x17E;Ć? Ä¨Ĺ˝Ć&#x152; ,Ä&#x17E;Ä&#x201A;ĹŻĆ&#x161;Ĺ&#x161;Í&#x2022; Ä?ĆľĆ&#x161; Ć&#x161;Ĺ&#x161;Ä&#x17E;Ć&#x152;Ä&#x17E; Ĺ?Ć? ĹŻĹ?ĆŠĹŻÄ&#x17E; Ä&#x17E;Ç&#x20AC;Ĺ?Ä&#x161;Ä&#x17E;ĹśÄ?Ä&#x17E; Ć&#x161;Ĺ&#x161;Ä&#x201A;Ć&#x161; ĹľĹ˝Ć&#x152;Ä&#x17E; Ć&#x152;Ä&#x17E;Ć?Ĺ˝ĆľĆ&#x152;Ä?Ä&#x17E;Ć? Ç Ä&#x17E;Ć&#x152;Ä&#x17E; Ä?Ä&#x17E;Ä?Ĺ˝ĹľĹ?ĹśĹ? Ä&#x201A;Ç&#x20AC;Ä&#x201A;Ĺ?ĹŻÄ&#x201A;Ä?ĹŻÄ&#x17E; Ć&#x161;Ĺ˝ Ä¨ĆľĹśÄ&#x161; Ć&#x161;Ĺ&#x161;Ä&#x17E;Ć?Ä&#x17E;Í&#x2DC;

Íť

&ĆľĆ&#x161;ĆľĆ&#x152;Ä&#x17E; /,WĐ˝ZÄ&#x17E;Ć?ĆľĹŻĆ&#x161;Ć? Ć&#x2030;Ä&#x17E;Ć&#x152;Ä¨Ĺ˝Ć&#x152;ĹľÄ&#x201A;ĹśÄ?Ä&#x17E; Ć&#x152;Ä&#x17E;Ç&#x20AC;Ĺ?Ä&#x17E;Ç Ć? Ć?Ĺ&#x161;Ĺ˝ĆľĹŻÄ&#x161; Ć&#x2030;Ć&#x152;Ĺ˝Ç&#x20AC;Ĺ?Ä&#x161;Ä&#x17E; Ć?Ć&#x161;Ć&#x152;Ĺ˝ĹśĹ?Ä&#x17E;Ć&#x152; Ä&#x17E;Ç&#x20AC;Ĺ?Ä&#x161;Ä&#x17E;ĹśÄ?Ä&#x17E; Ĺ˝Ä¨ Ç Ĺ&#x161;Ä&#x17E;Ć&#x161;Ĺ&#x161;Ä&#x17E;Ć&#x152; Ĺ&#x161;Ä&#x17E;Ä&#x201A;ĹŻĆ&#x161;Ĺ&#x161; Ć?Ç&#x2021;Ć?Ć&#x161;Ä&#x17E;ĹľĆ? Ä&#x201A;Ć&#x152;Ä&#x17E; Ĺ?ĹľĆ&#x2030;Ć&#x152;Ĺ˝Ç&#x20AC;Ĺ?ĹśĹ? Ć&#x161;Ĺ˝ Ä&#x161;Ä&#x17E;ĹŻĹ?Ç&#x20AC;Ä&#x17E;Ć&#x152; Ĺ&#x161;Ä&#x17E;Ä&#x201A;ĹŻĆ&#x161;Ĺ&#x161; Ć&#x152;Ä&#x17E;Ć?ĆľĹŻĆ&#x161;Ć? Ĺ?Ĺś Ć&#x161;Ĺ&#x161;Ä&#x17E; /,WĐ˝ Ä?Ĺ˝ĆľĹśĆ&#x161;Ć&#x152;Ĺ?Ä&#x17E;Ć?Í&#x2DC;

IHP+Results 2010 Performance Report

4. DISCUSSION ƌĞĚŝďůĞ ŐĞŶĐǇͲƐƉĞĐŝĮĐ WĞƌĨŽƌŵĂŶĐĞ ^ĐŽƌĞĐĂƌĚƐ ĂƌĞ ŶŽǁ ĂǀĂŝůĂďůĞ This third IHP+ independent review presents the Įrst complete set of standardised reports by country governments and their Development Partners on how they are delivering and using resources in the health sector. ƌĞĚŝďůĞ ĂŐĞŶĐǇͲƐƉĞĐŝĮĐ ƉĞƌĨŽƌŵĂŶĐĞ ƐĐŽƌĞĐĂƌĚƐ ĂƌĞ ŶŽǁ ĂǀĂŝůĂďůĞ ĨŽƌ ĮŌĞĞŶ ĞǀĞůŽƉŵĞŶƚ WĂƌƚŶĞƌƐ and ten developing country governments. These scorecards provide visual summaries of how well each agency and country government is performing overall 67 against their IHP+ commitments, and demonstrate how eīecƟvely they are delivering and using health aid. Disaggregated results by country are also available online for each parƟcipaƟng country. Together with the performance measures and targets, IHP+Results provides a set of tools that can be used by all parƟes within countries, as part of joint annual reviews, to monitor progress in improving the eīecƟveness of support to the health sector. Although the raƟngs in these scorecards are based on selfͲreported progress in 2009, these can be used as a starƟng point to discuss whether progress is viewed in the same way by all partners and to reŇect on what has changed since 2009. This would form an important neǆt step towards achieving real mutual accountability in countryͲlevel reviews. These discussions were started in early 2011 in Burundi and Nepal. IHP+Results provided data for discussion by country health sector teams in these countries and the potenƟal for these tools to enhance ongoing discussions on mutual accountability was acknowledged 68. IHP+Results will work with country teams and others who eǆpress an interest, to support the adaptaƟon and use of these tools in ongoing countryͲlevel discussions and review processes. Agencies and governments that have volunteered to parƟcipate in the IHP+Results process during 2010 have demonstrated their leadership and willingness to become more transparent and accountable ;see Įgure 4.1 belowͿ. This should encourage remaining IHP+ signatories to parƟcipate in future monitoring, in line with the IHP+ Global Compact commitment to “…an independent, evidence-based assessment of results at country level ĂŶĚ ŽĨ ƚŚĞ ƉĞƌĨŽƌŵĂŶĐĞ ŽĨ ĞĂĐŚ ΀ƐŝŐŶĂƚŽƌǇ΁ ŝŶĚŝǀŝĚƵĂůůǇ ĂƐ ǁĞůů ĂƐ ĐŽůůĞĐƟǀĞůǇ͟ 69.

&ŝŐƵƌĞ ϰ͘ϭ͗ WĂƌƟĐŝƉĂƟŽŶ ŝŶ /,WнZĞƐƵůƚƐ ĨŽƌ ŶŶƵĂů WĞƌĨŽƌŵĂŶĐĞ ZĞƉŽƌƟŶŐ Θ ĐĐŽƵŶƚĂďŝůŝƚǇ

NOT YET PARTICIPATING IN IHP+RESULTS FOR ANNUAL PERFORMANCE REPORTING OR SELF REPORTING & ACCOUNTABILITY

GOVERNMENTS OF: Cambodia, <enya, ambia, Benin, Cameroon, Madagascar, Mauritania, Pakistan, Rwanda, Senegal, SierraͲLeone, Togo, Uganda and sietnam. DEVELOPMENT PARTNERS: Canada, Finland, France, Germany, Italy, Portugal, African Development Bank ;AFDBͿ, InternaƟonal Labour OrganisaƟon ;ILOͿ, Bill and Melinda Gates FoundaƟon.

ENSURING HEALTH SECTOR AID EFFECTIVENESS COMMITMENTS ARE SYSTEMATICALLY AND ROUTINELY MONITORED

PARTICIPATING IN IHP+RESULTS

GOVERNMENTS OF:

DEVELOPMENT PARTNERS:

TAKING STEPS TO USE IHP+RESULTS REPORTING TO STRENGTHEN MUTUAL ACCOUNTABILITY

This represents the end goal of a virtuous cycle. No IHP+ signatories have yet reached this stage of the cycle.

In the 10 survey countries where they are acƟve.

Although in Burundi, DPs raised concerns about the consistency of interpretaƟon of key terms used in the survey, and so reconvened as partners and establish a common understanding and to resubmit data. We have not been able to incorporate that revised data in this report, but an analysis of the diīerences between the two sets of data is provided at www.ihpresults.netͬhowͬlessonsͺlearntͬ

hƩp:ͬͬwww.internaƟonalhealthpartnership.netͬCMSͺĮlesͬdocumentsͬihpͺglobalͺcompactͺEN.pdf accessed 19ͬ01ͬ2011

IHP+Results 2010 Performance Report

A number of parƟcipants have seen the IHP+Results 2010 monitoring process as a construcƟve eǆercise. Some Development Partners ;such as Spain and UNFPAͿ have reŇected on how it has been useful to strengthen their own internal performance monitoring. The IHP+ has helped to reĮne and apply these ͚Paris Indicators͛ to the health sector in a way that should contribute useful lessons to the highͲlevel review of Aid EīecƟveness towards the end of 2011. ConducƟng this eǆercise does raise some quesƟons about the validity of measuring Aid EīecƟveness in the health sector using the types of performance measures that the IHP+ has adopted. The concepts and terminology involved are compleǆ and open to mulƟple interpretaƟons. It is a challenging eǆercise to collect valid data for the more conceptual measures ;such as ͚use of country systems͛Ϳ. Each country conteǆt is uniquely challenging, so Development Partners and governments cannot deliver and use health sector resources in an idealised way but have to respond to the diīerent and changing risk environments in which they operate operate, so comparisons between DP country oĸce results should be made with cauƟon. DP country oĸce scorecards present a simpliĮed view of the world and therefore need to be interpreted with an understanding of the conteǆt of each agency and country, especially when comparing performance across agencies and countries. For instance the scorecards for AusAID ;providing health aid to NepalͿ and the Global Fund ;providing health aid to all ten survey countriesͿ are not directly comparable. IHP+Results is commiƩed to learning and implemenƟng lessons from each monitoring round. The challenge of measuring Aid EīecƟveness should not be a barrier to aƩempƟng to measure and learn. As neǆt steps in this evolving, incremental process further debate is needed 70 on what these performance monitoring results demonstrate and how they can be pracƟcally used to promote more eīecƟve, responsible resourcing of the health sector. There is a growing movement towards greater transparency and accountability for internaƟonal development assistance. This is eǆempliĮed by iniƟaƟves such as the UN Commission on InformaƟon and Accountability for Women͛s and Children͛s Health, the InternaƟonal Aid Transparency IniƟaƟve, Publish What zou Fund and others. The IHP+Results process contributes to this by making data available in the public domain on the implementaƟon of IHP+ commitments to health sector aid eīecƟveness.

/ƚ ŝƐ ŶŽǁ ĞǀŝĚĞŶƚ ŚŽǁ ŚĞĂůƚŚ ĂŝĚ ŝƐ ďĞŝŶŐ ƵƐĞĚ ĂŶĚ ǁŚĞƌĞ ŝƚ ŝƐ ďĞŝŶŐ ĚĞůŝǀĞƌĞĚ ŵŽƌĞ ĞīĞĐƟǀĞůǇ͘ There is also evidence of where there are speciĮc gaps. This survey does not include all IHP+ signatories, or all health aid, but it does reŇect how the major health donors are operaƟng in 10 countries. This can infrom agency and countryͲbased agendas for further discussion and acƟon. In the face of this informaƟon ongoing failure to address these gaps cannot be eǆcused and could eǆpose IHP+ signatories to quesƟons on their commitment. InacƟon will present an obstacle to acceleraƟng progress towards achieving the healthͲ related MDGs. Our Įndings suggest that progress has been made in key areas: ͻ

The majority of governments and Development Partners have put in place the four policy pillars outlined in the IHP+ Compact Guidance note 71 ;naƟonal strategy, a compact, a results framework and a mutual monitoring processͿ.

Through the IHP+Results website ;www.ihpresults.netͿ and in followͲup consultaƟons.

IHP+ Compact Guidance note hƩp:ͬͬwww.internaƟonalhealthpartnership.netͬCMSͺĮlesͬdocumentsͬihpͺcompactͺguidanceͺnoteͺEN.pdf accessed 2 February 2011.

IHP+Results 2010 Performance Report

DPs have made progress in aligning their health aid ;Įnancial aid and capacity buildingͿ with naƟonal prioriƟes.

Five governments ;Burkina Faso, Burundi, DjibouƟ, Nepal and NigerͿ have increased the proporƟon of their naƟonal budget allocated to health.

Three governments ;Burkina Faso, Burundi and MoǌambiqueͿ have strengthened their public Įnancial management systems.

DPs are increasing their use of public Įnancial management systems for their health aid, and in Įve countries with strong country Įnancial management systems 72 DPs overall met the target of a 33й reducƟon in the proporƟon of funds not using these systems.

Civil society is seen to be engaging more in naƟonal health policy processes͖ governments appear to be involving them more ;although the eǆtent to which this engagement is considered to be meaningful needs to be further discussed with the organisaƟons involvedͿ.

Less progress has been reported on targets for responsible health Įnancing and for strengthening and using country systems. The IHP+Results survey has shown: ͻ

No African government had met the 15й Abuja target ;although Burkina Faso had reached 14.6йͿ.

DP performance in providing predictable Įnancing for the health sector has been miǆed: overall the proporƟon funding through mulƟͲyear commitments fell͖ but 9 out of 15 DPs are providing 90й of their health aid through mulƟͲyear commitments.

Government performance in disbursing their health budgets was miǆed.

DP use of country procurement systems appeared to have declined.

Civil society engagement in health sector policy processes could increase much further, and could be supported much more.

Countries allocated a lower proporƟon of funding to human resources for health, despite developing HRH plans and beginning to integrate them into naƟonal health plans.

Overall, the IHP+Results Įndings are broadly consistent with the OECD 2008 Survey on Monitoring the Paris DeclaraƟon 73. It is not clear that this miǆed picture of progress will translate into stronger health systems and ulƟmately to beƩer health outcomes and impacts. IHP+Results has collected and presented some data on health systems indicators, but it is too soon to eǆpect to see posiƟve trends in most of these measures that can be linked to the IHP+ or to recent changes in Aid EīecƟveness behaviour by IHP+ signatories.

,Žǁ ƚŽ ďƵŝůĚ ŽŶ ƚŚĞ ŐĂŝŶƐ ƚŚĂƚ ŚĂǀĞ ďĞĞŶ ŵĂĚĞ ĂŶĚ ƉƌŽŵŽƚĞ ƉƌŽŐƌĞƐƐ ǁŚĞƌĞ ƚŚŝƐ ŚĂƐ ďĞĞŶ ƐůŽǁ͍ The Įndings of this survey suggest a number of enablers for building on progress where this has been made and to promote further change where this is needed: ƐƚĂďůŝƐŚŝŶŐ ŶĂƟŽŶĂů ƉŽůŝĐǇ ĨƌĂŵĞǁŽƌŬƐ seems to be criƟcally important. Burkina Faso, Ethiopia, Mali, Moǌambique and Nepal have all invested in strengthening these frameworks since joining the IHP+ and have beneĮted from receiving a greater proporƟon of their health aid in ways that align with Aid EīecƟveness

Burkina Faso, Ethiopia, Mali, Moǌambique and Niger. For more informaƟon, see secƟon 3.3 above.

hƩp:ͬͬwww.oecd.orgͬdocumentͬ0ͬ0,3746,enͺ21571361ͺ39494699ͺ41203264ͺ1ͺ1ͺ1ͺ1,00.html accessed 2 February 2011. OECD survey includes a much larger set of countries and development partners, and was last conducted in 2008.

IHP+Results 2010 Performance Report

commitments. All ;with the eǆcepƟon of Burkina FasoͿ have put in place the four key pillars of a naƟonal plan, compact, performance assessment framework and mutual accountability process. This suggests a tentaƟve correlaƟon between the eǆistence of key policy frameworks and beƩer aid. These four pillars are a criƟcal starƟng point for leadership and ownership by naƟonal governments over how resources are allocated in the health sector. DŽƌĞ ĞŵƉŚĂƐŝƐ ƐŚŽƵůĚ ďĞ ƉůĂĐĞĚ ŽŶ ƉƵƫŶŐ ƚŚĞ ĨŽƵƌ ƉŝůůĂƌƐ ŽĨ ƚŚĞ ƉŽůŝĐǇ ĨƌĂŵĞǁŽƌŬ ŝŶ ƉůĂĐĞ in the other IHP+ countries. The policy framework needs to be robust enough to aƩract support from DPs, so that it can be used as the basis for coordinated support and reduce the transacƟon costs of aid for governments. 74 IHP+ signatories ;with the IHP+ Core TeamͿ have developed tools and frameworks to help countries put in place these four pillars and to support country compact development. The Joint Assessment of NaƟonal Strategies ;JANSͿ tool can provide countries with an independent assessment of their emerging naƟonal health plans. 75 The IHP+ Working Group on Monitoring and EvaluaƟon has developed guidance for comprehensive performance frameworks. 76 It can be argued that many of the policy improvements uncovered by the IHP+Results survey would have happened anyway, without the IHP+, but there is no counterͲfactual. Important progress has been made in other areas since 2009 that is not captured by this survey, such as the rollout of JANS in 6 countries and the signing of Nigeria͛s compact in December 2010. The results of this should be apparent in the neǆt annual Performance Report. &ƵƌƚŚĞƌ ĂƉƉůŝĐĂƟŽŶ ŽĨ ƚŚĞƐĞ ŐůŽďĂů ůĞǀĞů ƚŽŽůƐ Ăƚ ƚŚĞ ĐŽƵŶƚƌǇ ůĞǀĞů ƐŚŽƵůĚ ďĞ supported and encouraged by the IHP+ Core team and IHP+ working groups. SupporƟng sustainable implementaƟon of naƟonal health plans requires ƌĞŶĞǁĞĚ ĂŶĚ ĂĚĚŝƟŽŶĂů ĨŽĐƵƐ ďǇ ƚŚĞ /,Wн ƐŝŐŶĂƚŽƌŝĞƐ ĐŽůůĞĐƟǀĞůǇ ĂŶĚ ŝŶĚŝǀŝĚƵĂůůǇ ŝŶ ƚŚĞ ĨŽůůŽǁŝŶŐ ƚŚƌĞĞ ĂƌĞĂƐ͗ 1.

DŽƌĞ ƉƌĞĚŝĐƚĂďůĞ ĂŶĚ ƌĞƐƉŽŶƐŝďůĞ ŚĞĂůƚŚ ĮŶĂŶĐŝŶŐ͘ Governments need to increase domesƟc allocaƟons to health, in order to meet agreed targets ;15й Abuja target for African governmentsͿ. DPs need to increase the predictability of their health Įnancing and conƟnue to act on High Level Task Force recommendaƟons to increase the volume of health Įnancing.

Governments and DPs need to make joint investments into improving country systems, and to increase their use of country public Įnancial management and procurement systems. Progress on this is compleǆ to measure ;for both IHP+Results and through the OECD Paris DeclaraƟon Survey processͿ, as the measurement is of general country systems, and in some countries the acƟons required lie outside the health sector. IdenƟfying joint acƟons to strengthen country systems should be a priority for country health teams and the IHP+ core team. IHP+ signatories and the core team should bring these issue to the forthcoming High Level Forum on Aid EīecƟveness in Busan in November 2011

The IHP+ needs to evaluate in more depth the factors that have contributed to the targets met and targets missed to inform future planning, in order to learn from this iniƟaƟve. The third year of IHP+Results monitoring in 2011 should provide opportunity for this.

Without sustained eīort to address these three criƟcal areas, faster progress on achieving the goals of the IHP+ seems a long way oī.

An eǆcepƟon is Burundi which reports having the four pillars in place but development partners do not recognise all of them.

hƩp:ͬͬwww.internaƟonalhealthpartnership.netͬenͬaboutͬjͺ1253621551 accessed 27 January 2011.

hƩp:ͬͬwww.internaƟonalhealthpartnership.netͬenͬworkingͺgroupsͬmonitoringͺandͺevaluaƟon accessed 27 January 2011.

IHP+Results 2010 Performance Report

/,Wн ƐŝŐŶĂƚŽƌŝĞƐ ŶŽǁ ŚĂǀĞ ƚŚĞ ƚŽŽůƐ ĂŶĚ ŝŶĨŽƌŵĂƟŽŶ ƚŽ ŚŽůĚ ĞĂĐŚ ŽƚŚĞƌ ŵƵƚƵĂůůǇ ĂĐĐŽƵŶƚĂďůĞ ĨŽƌ ŝŵƉƌŽǀŝŶŐ ƚŚĞ ƉĞƌĨŽƌŵĂŶĐĞ ŽĨ ƉƵďůŝĐ ŝŶǀĞƐƚŵĞŶƚƐ ŝŶƚŽ ŚĞĂůƚŚ Implicit in the IHP+ Global Compact͛s commitment to greater accountability is the promise of a shiŌ in power to so that the accountability for results is shared between Development Partners and country governments. Although there are some signs of this happening in a few countries, the IHP+ is sƟll a long way oī from achieving mutual accountability at the countryͲlevel, where there is most potenƟal for this to make the diīerence. It seems that the IHP+ is contribuƟng to change in this direcƟon, but this survey suggests that country level mutual accountability processes are not performing to their full potenƟal. At the global level a forum or space for a highͲlevel mutual accountability review process needs to be found, as the HighͲlevel Ministerial Review of the IHP+ was last held in February 2009 was originally intended to be an annual event. This report, together with its Performance Scorecards and online evidence are an invaluable resource for mutual accountability in the IHP+. Interpreted with care, IHP+ signatories can use these to hold each other mutually accountable for improving the performance of public investments into health, to achieve health results and value for the scarce resources available. Individual agencies can use these results and the framework that has been established, to internally review their own performance Ͳ looking criƟcally at where the IHP+Results scorecards indicate there are gaps to be addressed. Mutual accountability can drive improvement when reviews of the eīecƟveness of health aid are incorporated into country level joint annual reviews ;JARͿ of the health sector. If compacts and performance assessment frameworks are in place the JAR can annually take stock of progress, idenƟfy issues arising from this and undertake beƩer planning for the year ahead. The IHP+ Core Team should develop guidance and good pracƟce for country level mutual accountability processes as a resource to help countries share lessons in this pioneering area. The conteǆt of each country is criƟcal to appreciate, so opportuniƟes to locate this review process at the country level and for this to be led by countryͲlevel partners and the naƟonal government should be acƟvely eǆplored in 2011. This report will contribute to improving Aid EīecƟveness if it is used by country health teams to idenƟfy problems and develop soluƟons. Even greater value will come if countries take ownership and leadership of the survey, adapƟng it to their annual Ɵmelines and needs, and using the tools developed by IHP+Results in their conteǆt. This would provide Ɵmely data owned by the country but with global comparability.

IHP+Results 2010 Performance Report

5. CONCLUSIONS ,Žǁ ĐƌĞĚŝďůĞ ĂƌĞ ƚŚĞ ĮŶĚŝŶŐƐ͍ The IHP+Results 2010 survey demonstrates that it is possible to measure Aid EīecƟveness in the health sector. The Įndings in this report can be credibly used to understand the current state of play with regards to this. They are broadly consistent with the OECD 2008 Survey monitoring implementaƟon of the Paris DeclaraƟon. There are limits to the generalisability of the Įndings because the IHP+Results Survey parƟcipants were a subset of approǆimately half of all IHP+ signatories, and that in turn is a subset of all country governments and development partners. Other major development partners, most notably the US Government, are not included. It is possible to draw some conclusions about this subset of IHP+ signatories that may be useful for other country governments and development partners, whether IHP+ signatories or not. Some methodological challenges to collecƟng and analysing data have been idenƟĮed for a number of the Aid EīecƟveness measures from which the IHP+Results measures are derived. These could be, in some cases, addressed in future surveys, whilst others require broader discussion as part of the HighͲLevel review of Aid EīecƟveness. Some of these can aīect the comparability of raƟngs, so Scorecards and online disaggregated anneǆes should be interpreted with care.

dŽ ǁŚĂƚ ĞǆƚĞŶƚ ŚĂƐ ƚŚĞ /,Wн ŝŵƉƌŽǀĞĚ ŝĚ īĞĐƟǀĞŶĞƐƐ ǁŝƚŚŝŶ ĐŽƵŶƚƌŝĞƐ͍ The Įndings suggest that for the subset of IHP+ signatories parƟcipaƟng in this review, there has been an overall improvement in the eīecƟveness of aid delivery in the health sector. In these IHP+ countries, governments and Development Partners are puƫng in place the foundaƟons ;compacts, performance frameworks, results frameworksͿ for increasing progress, which has been supported in most cases by the IHP+. A few countries have strengthened their public Įnancial management systems. Some, but not all, governments and Development Partners have increased health Įnancing and made it more predictable. Ethiopia, Mali, and Moǌambique saw greatest progress in eīecƟveness of the health aid they received, followed by Nepal and Burkina Faso. All these countries, eǆcept Burkina Faso, have compacts with their development partners. Evidence is inconclusive on whether compacts result in improved health aid eīecƟveness, but there is a possible correlaƟon. There has been less progress on eīecƟveness of health aid to Burundi, DjibouƟ, DRC, Niger and Nigeria. However, these results might be eǆpected given the length of Ɵme since each country joined the IHP+ ;DjibouƟ only signed up to the IHP+ Global Compact in July 2009, Niger and DRC in May 2009Ϳ and the relaƟve strength of these countries systems and processes. All Development Partners have improved health Aid EīecƟveness but most could do more. Civil Society is engaging more in country health processes. There is scope for more government engagement with civil society, and more development partner support for civil society. It is too early to state whether Aid EīecƟveness and the IHP+ is contribuƟng to stronger health systems or improved health outcomes.

IHP+Results 2010 Performance Report

,Žǁ ĐĂŶ /,Wн ƐƚĂŬĞŚŽůĚĞƌƐ ƵƐĞ ƚŚĞ ĮŶĚŝŶŐƐ͍ The report and scorecards provide an invaluable source of data for IHP+ signatories to hold themselves and others to account for their commitments. The scorecards for each country and agency provide an aggregate raƟng for each of the measures that give a high level view of performance. The online anneǆes provide disaggregated data that enable a more nuanced view of a development partner performance across diīerent countries and conteǆts. Mutual accountability and monitoring IHP+ commitments and Aid EīecƟveness must take place at the country level, led by countries. Global monitoring should bring together the results of countryͲbased monitoring, to provide a global synthesis and to compare progress across countries and between partners. The IHP+Results team is ready to work with any IHP+ country government and development partner that would like to take ownership and leadership in applying these tools to support the monitoring process in their country or organisaƟon. As an important neǆt step towards real mutual accountability in this evolving, incremental process ʹ IHP+ signatories and civil society organisaƟons are encouraged to use the data and Įndings here as the basis for discussion in order to move towards a shared analysis of performance and agreement on priority acƟons to improve performance.

IHP+Results 2010 Performance Report

6. RECOMMENDATIONS Each development partner and country government signing up to the InternaƟonal Health Partnership Global Compact agrees to parƟcipate in ͞an independent evidenceͲbased assessment of results at country level and of the performance of each of us individually as well as collecƟvely.͟ Accountability is at the heart of the IHP+, in the spirit of solidarity and partnership between country governments, Development Partners and civil society. With the support of IHP+Results, the IHP+ provides both the instruments and mechanisms to promote this individual, mutual and public accountability. However, for the IHP+ to become really eīecƟve, we recommend that its signatories and stakeholders should build on current eīorts to strengthen this accountability, in both the spirit and leƩer of the IHP+ Global Compact, using this report as an input to conversaƟons about how to achieve this.

ϭ͘

^ƚƌĞŶŐƚŚĞŶŝŶŐ ŝŶĚŝǀŝĚƵĂů ĂĐĐŽƵŶƚĂďŝůŝƚǇ ŽĨ ĚĞǀĞůŽƉŵĞŶƚ ĂŐĞŶĐŝĞƐ ĂŶĚ ŶĂƟŽŶĂů ŐŽǀĞƌŶŵĞŶƚƐ I.

IHP+ Development Partners should use this report and scorecard to review the Aid EīecƟveness of their health aid. They should develop a prioriƟsed set of acƟons to improve their aid eīecƟveness, and they should review and report on their own progress regularly. To this end they could adapt and incorporate the IHP+Results survey tool in their own internal monitoring and accountability.

II. The same IHP+ signatories ;as parƟcipated in 2010 reviewͿ should parƟcipate in IHP+Results 2011 monitoring. All other IHP+ signatories should be encouraged to parƟcipate in the IHP+Results 2011 performance review process.

Strengthening mutual accountability between IHP+ signatories

At the country level: I.

IHP+ country governments, Development Partners and civil society should use this report and scorecards to jointly review their collecƟve progress towards improving how eǆternal aid and naƟonal resources are eīecƟvely delivered and used to deliver results in the health sector. This review should result in an agreed set of individual and collecƟve acƟons to improve how all available resources are used in the health sector. Progress on these acƟons should be reviewed regularly and within Joint Annual Reviews.

II. Standard performance measures, such as the ones reported in the IHP+Results Scorecards, should be incorporated into annual health sector reviews. These should become rouƟnely reported on by all partners and the naƟonal government. At the global level: III. IHP+ SuRG and EǆecuƟve team should take responsibility for ensuring that the leaders of naƟonal governments, donors and internaƟonal agencies together with civil society review what progress has been made in delivering on their IHP+ commitments. The IHP+ Global Compact stated that ͞the signatories to this compact will meet each year to review progress against the commitments.͟ Is. This IHP+Results report and scorecards should be used in this global review of progress and it should result in an agreed set of prioriƟsed acƟons to improve the Aid EīecƟveness of health aid. s. Progress on these acƟons should be reviewed regularly. sI.

The IHP+ Core Team should facilitate the producƟon of technical guidance and standards for countryͲ

IHP+Results 2010 Performance Report

level mutual accountability processes. This can be achieved through reconvening the IHP+ working group on mutual accountability. Eǆperiences can be shared on how to incorporate the standard performance measures into county health sector review processes and for using these reviews to promote mutual accountability for health sector results. WHO country oĸces should facilitate inͲ country consultaƟon to ensure that the standards are relevant and implemented at country level. sII. The IHP+ working group on mutual accountability should review the eǆperience of the 2010 IHP+Results process, gain feedback from parƟcipants, and make recommendaƟons for improving the process. This should parƟcularly focus on how to ensure that these processes can become more sustainable and countryͲdriven.

Strengthening public accountability I.

The IHP+ SuRG and EǆecuƟve Team should make this report and scorecards widely available, including at eǆisƟng meeƟngs such as the World Health Assembly. sersions of the report should be made available that are more accessible to a wider audience in countries, amongst civil society and for researchers.

II. IHP+ signatories should ensure that the Įndings of this report and its scorecards are used to inform preparaƟon for and discussion at the 2011 High Level Forum on Aid EīecƟveness in Busan. This should reŇect the posiƟve lessons learned about the feasibility of monitoring Aid EīecƟveness at the sector level͖ and how progress can be made through establishing mechanisms for mutual accountability and transparency in aid delivery and use. III. IHP+Results will provide online public access to the detailed Įndings that have been used to develop this report and scorecards, by agency and by country. We encourage civil society, researchers and others interested in Aid EīecƟveness and health aid to use the Įndings in this report to hold governments and Development Partners to account for improving the eīecƟveness of their health aid.

IHP+Results 2010 Performance Report

GLOSSARY OF KEY TERMS AID EFFECTIVENESS

Aid eīecƟveness is the eīecƟveness of development aid in achieving economic or human development ;or development targetsͿ.

APPROVED ANNUAL BUDGET FOR THE HEALTH SECTOR

Is the annual budget as it was originally approved by the legislature. In order to support discipline and credibility of the budget preparaƟon process, subsequent revisions to the original annual budget Ͷ even when approved by the legislature Ͷ should NOT be recorded here. This is because it is the credibility of the original, approved budget that is important to measure and because revisions to the annual budget in many cases are retroacƟve.

CAPACITY DEVELOPMENT

The process whereby people, organisaƟons and society as a whole unleash, strengthen, create, adapt and maintain capacity over Ɵme.

COUNTRY POLICY AND INSTITUTIONAL ASSESSMENT (CPIA)

The Country Policy and InsƟtuƟonal Assessment ;CPIAͿ assess the quality of a country͛s present policy and insƟtuƟonal framework. ͞Yuality͟ refers to how conducive that framework is to fostering poverty reducƟon, sustainable growth, and the eīecƟve use of development assistance. ;World BankͿ

COUNTRY PROCUREMENT SYSTEMS

Donors use naƟonal procurement procedures when the funds they provide for the implementaƟon of projects and programmes are managed according to the naƟonal procurement procedures as they were established in the general legislaƟon and implemented by government. The use of naƟonal procurement procedures means that donors do not make addiƟonal, or special, requirements on governments for the procurement of works, goods and services.

DEVELOPMENT PARTNER

Includes bilateral and mulƟlateral donors, e.g. country aid agencies, and internaƟonal organisaƟons.

4-POINT SCALE USED TO ASSESS PERFORMANCE IN THE PROCUREMENT SECTOR

The OCED has outlined a procedure to produce an indicaƟve picture of the quality of procurement systems, based on a 4Ͳpoint scale. Detailed informaƟon can be found on the OECD website.

GENERAL BUDGET SUPPORT

General budget support is a subͲcategory of direct budget support. In the case of general budget support, the dialogue between donors and partner governments focuses on overall policy and budget prioriƟes ;OECD 2006Ϳ.

HEALTH AID REPORTED ON NATIONAL HEALTH SECTOR BUDGET

This should include all health sector aid recorded in the annual budget as grants, revenue or loans.

HUMAN RESOURCES FOR HEALTH (HRH) PLAN

Human Resources for Health ;HRHͿ plans should address the key constraints that need to be addressed to achieve agreed objecƟves on HRH. A HRH plan includes three main elements: it is costed, evidenceͲbased and comprehensive.

HEALTH SECTOR COORDINATION MECHANISM

MulƟͲstakeholder body that meets regularly ;usually monthly or quarterlyͿ to provide the main forum for dialogue on health sector policy and planning.

HEALTH SECTOR AID

ODA contributed to the health sector. ODA includes all transacƟons deĮned in OECDͬDAC staƟsƟcal direcƟves paragraph 35, including oĸcial transacƟons that are administered with the promoƟon of economic development and welfare of developing countries as its main objecƟve͖ and are concessional in character and convey a grant element of at least 25й.

IHP+

A global partnership that puts the Paris and Accra principles on Aid EīecƟveness into pracƟce, with the aim of improving health services and health outcomes, parƟcularly for the poor and vulnerable.

IHP+ COUNTRY COMPACT

The IHP+ is open to all countries and partners willing to sign up to the commitments of the Global Compact. IHP+ Global Compact deĮnes commitments following Paris principles on naƟonal ownership, alignment with naƟonal systems, harmoniǌaƟon between agencies, managing for results and mutual accountability.

JOINT ASSESSMENTS OF NATIONAL STRATEGIES (JANS)

Joint assessment is a shared approach to assessing the strengths and weaknesses of a naƟonal strategy. IHP+ partners have developed a process for the Joint Assessment of NaƟonal Strategies ;JANSͿ with the intenƟon that a JANS assessment is accepted by mulƟple stakeholders, and can be used as the basis for technical and Įnancial support. In this deĮniƟon, a plan has been jointly assessed if the JANS process, or a similar joint assessment, has been completed ;please provide details in the ͞Answers and addiƟonal informaƟon column of the survey toolͿ.

IHP+Results 2010 Performance Report

MUTUAL ACCOUNTABILITY

Two or more parƟes have shared development goals, in which each has legiƟmate claims the other is responsible for fulĮlling and where each may be required to eǆplain how they have discharged their responsibiliƟes, and be sancƟoned if they fail to deliver. ;DFIDͿ

NATIONAL PERFORMANCE ASSESSMENT FRAMEWORKS

The basis of a government͛s policy to make informaƟon about the quality and performance of health care services available to the public and partners. NaƟonal Performance Assessment Frameworks should be comprehensive ;i.e. cover all areas of health sector performanceͿ.

ODA

Grants and concessional loans for development and welfare purposes from the government sector of a donor country to a developing country or mulƟlateral agency acƟve in development. ODA includes the costs to the donor of project or programme aid, technical cooperaƟon, debt forgiveness, food and emergency aid, and associated administraƟon costs. ;OECDͬDACͿ

PARALLEL PROJECT IMPLEMENTATION UNIT (PIU)

When providing development assistance in a country, some donors establish Project ImplementaƟon Units ;They are also commonly referred to as project management units, project management consultants, project management oĸces, project coͲordinaƟon oĸces etc.Ϳ. These are designed to support the implementaƟon and administraƟon of projects or programmes.

PARIS DECLARATION

The Paris DeclaraƟon, endorsed on 2 March 2005, is an internaƟonal agreement to which over one hundred Ministers, Heads of Agencies and other Senior Oĸcials adhered and commiƩed their countries and organisaƟons to conƟnue to increase eīorts in harmonisaƟon, alignment and managing aid for results with a set of monitorable acƟons and indicators. ;OECDͿ

PERFORMANCE ASSESSMENT FRAMEWORK

POOLED FUNDING MECHANISM

A funding mechanism which receives contribuƟons from more than one donor which are then pooled and disbursed upon instrucƟons from the Fund͛s decisionͲmaking structure by an AdministraƟve Agent ;or Fund ManagerͿ to a number of recipients. SomeƟmes known as a MulƟ Donor Trust Fund. Taken from hƩp:ͬͬwww.undg.orgͬindeǆ.cfm͍Pс152

PROGRAMME BASED APPROACHES (PBAS)

PBAs are a way of engaging in development coͲoperaƟon based on the principles of coordinated support for a locally owned programme of development, such as a naƟonal development strategy, a sector programme, a themaƟc programme or a programme of a speciĮc organisaƟon.

PUBLIC FINANCIAL MANAGEMENT SYSTEMS (PFM)

LegislaƟve frameworks normally provide for speciĮc types of Įnancial reports to be produced as well as periodicity of such reporƟng. The use of naƟonal Įnancial reporƟng means that donors do not impose addiƟonal requirements on governments for Įnancial reporƟng.

RESULTS AREAS

IHP+Results uses the following Įve themaƟc areas that IHP+Results to track IHP+ performance. These areas are chosen to align with the OECDͬDAC process for monitoring Aid EīecƟveness: Ownership Θ Accountability͖ Transparent Θ responsible health Įnancing͖ Using Θ strengthening country systems͖ Strengthening health systems͖ Managing for Development Results.

SECTOR BUDGET SUPPORT

Sector budget support is a subͲcategory of direct budget support. Sector budget support means that dialogue between donors and partner governments focuses on sectorͲspeciĮc concerns rather than on overall policy and budget prioriƟes ;OECD 2006Ϳ.

STANDARD PERFORMANCE MEASURES (SPMS)

Indicators developed and agreed by the IHP+ Working Group on Mutual Accountability. SPM were designed to track the implementaƟon of development partners͛ and country governments͛ commitments as set out in the IHP+ Global Compact. They are based as closely as possible on the Paris DeclaraƟon indicators.

TECHNICAL COOPERATION (ALSO REFERRED TO AS TECHNICAL ASSISTANCE)

Is the provision of knowͲhow in the form of personnel, training, research and associated costs. Technical coͲoperaƟon includes both free standing technical coͲoperaƟon and technical coͲ operaƟon that is embedded in investment programmes ;or included in programmeͲbased approachesͿ.

IHP+Results 2010 Performance Report

/,WнZ ^h>d^ ^d E Z W Z&KZD E D ^hZ ^ Έ^WDsΉ d, d , s BEEN AGREED BY IHP+ SIGNATORIES

PD3 PD4

IHP+ GOVERNMENTS

IHP+ DEVELOPMENT PARTNERS

Standard Performance Measures

Target

Standard Performance Measures

Target

1G: IHP+ Compact or equivalent mutual agreement in place.

An IHP+ Compact or equivalent mutual agreement is in place.

1DP: ProporƟon of IHP+ countries in which the partner has signed commitment to ;or documented support forͿ the IHP+ Country Compact, or equivalent agreement.

100й of IHP+ countries where the signatory operates have support forͬcommitment to the IHP+ compact ;or equivalentͿ mutually agreed and documented.

2Ga: NaƟonal Health Sector PlansͬStrategy in place with current targets Θ budgets that have been jointly assessed.

A NaƟonal Health Sector PlanͬStrategy is in place with current targets Θ budgets that have been jointly assessed.

2DPa: Percent of aid Ňows to the health sector that is reported on naƟonal health sector budgets.

Halve the proporƟon of aid Ňows to the health sector not reported on government͛s budget;sͿ ;with ш 85й reported on budgetͿ.

2Gb: Costed and evidenceͲ based HRH plan in place that is integrated with the naƟonal health plan.

A costed, comprehensive naƟonal HRH plan ;integrated with the health planͿ is being implemented or developed.

2DPb: Percent of current capacityͲdevelopment support provided through coordinated programmes consistent with naƟonal plansͬstrategies for the health sector.

50й or more of capacity development support to each IHP+ country in which the signatory operates are based on naƟonal health sector plansͬstrategies

2DPc: Percent of health sector aid provided as programme based approaches.

66й of health sector aid Ňows are provided in the conteǆt of programme based approaches

LINKED TO PARIS TARGETS

PD9

PD7 PD5a PD5b

PD11 PD12

3G: ProporƟon of public funding allocated to health.

15й ;or an equivalent published targetͿ of the naƟonal budget is allocated to health.

3DP: Percent of health sector aid provided through mulƟͲ year commitments.

90й ;or an equivalent published targetͿ of health sector funding provided through mulƟͲyear commitments ;min. 3 yearsͿ.

4G: ProporƟon of health sector funding disbursed against the approved annual budget.

Halve the proporƟon of health sector funding not disbursed against the approved annual budget.

4DP: Percent of health sector aid disbursements released according to agreed schedules in annual or mulƟͲyear frameworks.

90й of health sector aid disbursed within the Įscal year for which it was scheduled.

5Ga: Country procurement systems either ;aͿ adhere to broadly accepted good pracƟces or ;bͿ have a reform programme in place to achieve these.

Improvement of at least one measure ;ie 0.5 pointsͿ on the PFMͬCPIA scale of performance.

5DPa: Percent of health sector aid that uses country procurement systems.

Reduce by oneͲthird the aid not using public Įnancial management systems ;with ш 80й using country systemsͿ.

5Gb: Country public Įnancial management either ;aͿ adhere to broadly accepted good pracƟces or ;bͿ have a reform programme in place to achieve these.

Improvement of at least one measure on the fourͲ point scale used to assess performance for this sector.

5DPb: Percent of health sector aid that uses public Įnancial management systems.

Reduce by oneͲthird the aid not using procurement systems ;with ш 80й using country systemsͿ.

5DPc: Number of parallel Project ImplementaƟon Units ;PIUsͿ per country.

Reduce by twoͲthirds the stock of parallel project implementaƟon units ;PIUsͿ.

6G: An agreed transparent and monitorable performance assessment framework is being used to assess progress in the health sector.

A transparent and monitorable performance assessment framework is in place to assess progress in the health sector.

6DP: ProporƟon of countries in which agreed, transparent and monitorable performance assessment frameworks are being used to assess progress in the health sector.

Single naƟonal performance assessment frameworks are used, where they eǆist, as the primary basis to assess progress in all countries where the signatory operates.

7G: Mutual assessments, such as joint annual health sector reviews, have been made of progress implemenƟng commitments in the health sector, including on aid eīecƟveness.

Mutual assessments ;such as a joint annual health sector reviewͿ are being made of progress implemenƟng commitments in the health sector, including on aid eīecƟveness.

7DP: ProporƟon of countries where mutual assessments have been made of progress implemenƟng commitments in the health sector, including on aid eīecƟveness.

Annual mutual assessment of progress in implemenƟng health sector commitments Θ agreements ;such as the IHP+ country compact and on aid eīecƟveness in the health sectorͿ is being made in all the countries where the signatory operates.

8G: Evidence that civil society is acƟvely represented in health sector policy processes Ͳ including health sector planning, coordinaƟon Θ review mechanisms.

At least 10й of seats in the country͛s health sector coordinaƟon mechanisms are allocated to civil society representaƟves.

8DP: Evidence of support for Civil Society to be acƟvely represented in health sector policy processes Ͳ including health sector planning, coordinaƟon Θ review mechanisms.

All signatories can provide some evidence of supporƟng acƟve civil society engagement in 100й of IHP+ countries in which they are acƟve.

These Standard Performance Measures from the basis of IHP+Results reporƟng framework in 2010. For more informaƟon on these Measures, see www.ihpresults.netͬhowͬmethodologyͬspmͬ

PARIS INDICATOR The boǆ is indicaƟng a connecƟon the the Paris DeclaraƟon Indicator. For more informaƟon, please visit www.oecd.orgͬdataoecdͬ57ͬ60ͬ36080258.pdf

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