synergies and linkages – planning, policy, strategies and · pdf filesynergies and...

1

WHO Western Pacific Region

Synergies and Linkages –Planning, Policy, Strategies

and Programmes

12 May 2010


Significant increase in funding for health

2


New Donors• USA $ 3.636 billion • Japan $ 1.156 billion• Gates Foundation $ 0.895 billion• UK $ 0.729 billion• Germany $ 0.593 billion• France $ 0.394 billion• Canada $ 0.318 billion

But, as with all good and new things….there are some concerns


New foundations: from 2000…

3


High Level Taskforce on Innovative International Financing for Health Systems

Ongoing work 2010

…”Establish a health systems funding platform for the Global Fund, GAVI Alliance, the World Bank and others to coordinate, mobilize, streamline and channel the flow of existing and new international resources to support national health strategies”…

• Taskforce final report -May 2009

•UN General Assembly 2009 side event & Outcome document

•US$1 billion for expanded IFFIm

•Results based buy downs

•Voluntary solidarity contributions

•De-Tax

• The Global Fund, GAVI Alliance, World Bank, and World Health Organization Working Group

• 4 work streams around appraisal, financial management & procurement, a common performance measurement framework and harmonised technical support

• Consultations with Track I and II countries , Jan-June 2010

• Global Fund and GAVI Alliance Governance Committee decisions , April and June

5

“More health for the money”


Planning – renewed interest

4


Agency-based Country-based

Proposal-based National strategy based

Multiple deadlinesFlexible and aligned to country cycles

Outside the budget cycle

Aligned to the budget cycle

Contract drivenAccountable to country's citizens

FromFrom ToTo

The Joint Funding Platform – GFATM/GAVI/WB + WHOMore Health for Money - Implement Paris Declaration

7


Mode of Health Systems Strengthening

TRACK 1

Harmonization of existing Health Systems Strengthening support with existing funding

•3 Agencies (Global Fund, GAVI and World Bank)•Support from WHO•Single performance framework and M&E, financial management and procurement, and program oversight

TRACK 2

Access to new funding for health systems strengthening

• 3 Agencies (Global Fund, GAVI and World Bank)• Support from WHO• Access funding through national health strategies or health systems strengthening strategies

5


Harmonization and alignment of processes and proced ures of HSS programming based on existing portfolio

• Implementation approach– Step 1: Consultations in 3-4 countries (Pre March, 2010)– Step 2: GF/GAVI Board guidance as needed (March/Apr)– Step 3: Piloting H&A in selected countries (following Board

guidance)

Aim To harmonize existing processes and procedures between WB, GF and GAVI, with the facilitation of WHO, where the agencies support HSS programming in order to better align with country processes and timing

FocusHarmonized and aligned M+E frameworks, technical support, joint country missions, financial management and procurement processes


Potential pilot countries for Track 1Criteria for piloting

• Country demand/request• Existing HSS support funded by all 3

funders• Duration of support for at least next two

years (i.e., until 2011)• Regular health sector review process

that includes review of programme and financing elements

• ‘Large enough’ grants or credits with arrayed HSS activities that offer opportunities for reducing fragmentation, improving coordination, and creating positive synergies

• Does not necessarily need to be one of the 49 Least Income Countries

• At least one Francophone country

Countries where we provide existing HSS support and could move quickly to harmonize among three agencies if the country is willing:

• Benin• Cambodia• Ethiopia• Liberia• Sierra Leone• Senegal

6


Track 2 support entails enabling new access to future funding for HSS

TRACK 1

Harmonization of existing Health Systems Strengthening support

•3 Agencies (Global Fund, GAVI and World Bank)•Support from WHO•Single performance framework and M&E, financial management and procurement, and program oversight

TRACK 2

New access to future funding from a health systems funding platform

• 3 Agencies (Global Fund, GAVI and World Bank)• Support from WHO• Access to funding based on national health strategy or health systems strengthening proposal


Track 2 will focus on 4 priority items for funding access

1 Appraisal/assessment processes and procedures

2 Financial management and procurement processes

3 Common performance measurement framework

4 Mechanisms for harmonized technical support

-

�

�

�

�

�

�

�

Track1 Track 2Priority Item

��

7


Access to Future Funding as Part of a Joint HSS Platform

Approach

– Step 1: Global Fund and GAVI improving business models, funding allocation mechanisms, procurement & financial oversight processes, learning from JANS tool pilot countries

– Step 2: Global Fund/GAVI Board guidance and approval– Step 3: Learning from further JANS visits– Step 4: Piloting the platform in selected countries

Aim

To explore ways for jointly supporting HSS through:� HSS funding proposal (Scenario 1)� Support national health strategies, likely with JANS (Joint Assessment of National Strategies) tool (Scenario 2)� Alternative mechanism most convenient for the country


Countries submit joint HSS strategy/application

Coordinated approval by both Boards; Option 1: GFATM and GAVI finance different

components Option 2: GFATM and GAVI provide different % of funds

Joint TRP-IRC assessment and recommendation Option 1: Assessment in GenevaOption 2: In-country assessment

GLOBAL FUND GAVI WORLD BANK

Agreement on HSS ScopeCommon mechanism for tracking resources invested in HSS

Common application form and guidelines; Common funding window with joint funding request

Common performance framework (Countries prepare one report)

Joint review of implementation



No request for proposalsHSS funding based on

CAS

HSS strategy in Project Appraisal Document

Internal WB review and approval of HSS

Approval, signing

Countries may pool funding at the country level

FundingFunding Funding

Scenario 1: Single HSS Funding Request

Definition and

Scope

Access to Funding

Assessment, Approval &

Funding

Program management & country support

M&E

8


Common definition of scopeIndicative resource envelope

Countries develop National Health Strategies, with distinct cross-cutting HSS element

Joint in-country assessment of the National Health Strategies based on IHP+ JANS approach*

WORLD BANKGLOBAL FUND GAVI

Countries with favourable assessment invited to submit funding request

Joint review and recommendation to BoardsBoard approval**

Implementation overseen by lead implementer

Country-led harmonized program implementation Joint annual review (common performance framework)

ContributionContributionContribution

Scenario 2: Funding based on Joint Assessment of National Health Strategies Definition

and Scope

Access to Funding

Assessment, Approval &

Funding

Program management, country support

& M&E


Joint Assessment of

National Health Strategies and Plans

Joint Assessment Tool: the attributes of a sound national strategy

Draft July 2009

A companion set of Joint Assessment Guidelines, FAQ sheet and other materials, are at www.internationalhealthpartnership.net

9


Global Fund Decision Points

• New Prioritisation Criteria – 12 points– Technical merit – 4 points– Disease burden – 4 points– Poverty level – 4 points

• “CCM encouraged to identify opportunities to include MCH issues in Proposals”

• HSS Joint Funding Platform– Track One – pilot 2010 (streamline current $)– Track Two – pilot 2011 (joint platform new $)


Cambodia Strategic Health Sector Plan, 3 Year Rolling Plans and Annual Operational Plans

Source: Dr Lo Veasna Kiry, MoH Cambodia

18

10


What have we learned?

• It is more than the sum of program plans such as MH roadmap, TB plan…

• Blueprints won't work: it is not the "plan" that is important, but the process

• That process is messy; the key is inclusive policy dialogue


HS Framework: Building Blocks

11


HS Framework: Control Knobs(Harvard Group)


Health Outcomes

Fairness of Financing

Responsiveness

GHI investment

Health workforce

Governance

Monitoring and Evaluation

Health Technologies

D

E

L

I

V

E

R

Y

Privateexpenditure

Governmentexpenditure

Financing

Other externalexpenditure

Epidemiological

PoliticalDemographic

Environmental

Technological

Social

Economic

Legal

Communities/Civil Society

HS Framework: Systems

12


Conceptual Framework


Aligning behind country plansCambodia: health plan priorities and donor disbursements (2003-05)

NSDP: Priority Action Plan for Health 2003-05(percent of total)

0 10 20 30 40 50

Pilot health insurance

Staff incentives in remote areas

Communicable diseases ( non-HIVaids)

Communicable diseases HIV Aids

Public private partnership in basichealth

Health education (incl HIV aids)

Contracting in remote areas

Scale up equity funds

Primary health care coverage

Source: 2002 NSDP

NSDP: Priority Action Plan for Health NSDP: Priority Action Plan for Health NSDP: Priority Action Plan for Health NSDP: Priority Action Plan for Health 2003200320032003----05 05 05 05 (percent of total)

Donor disbursements for Health by Purpose 2003-05(percent of total)

0 10 20 30 40 50

Health education

Health personnel development

Basic nutrition

Basic health infrastructure

Population policy and admin. mgmt

Medical services, training and research

Reproductive health care & familyplanning

Basic health care

Health policy & admin. management

Infectious disease control

STD control including HIV/AIDS

Source: OECD, CRS database.

Donor Disbursements for Health by Donor Disbursements for Health by Donor Disbursements for Health by Donor Disbursements for Health by purpose 2003purpose 2003purpose 2003purpose 2003----05 05 05 05 (percent of total)

13


MC

H

MC

H

Service delivery has to be designed within the exis ting capacity

synergies and linkages – planning, policy, strategies and · pdf filesynergies and...

Documents