The International Health Partnership

December 2007

Dr Stewart Tyson, DFID

IHP What is it?

A high level agreement to apply the Paris Principles on aid effectiveness to the health sector –building on SWAP experience in many countries

Commitments by all parties to • Back country led national health plans• Include all parties in the plan (non-state providers, CSO) • Better coordinate efforts• Provide assistance in ways that build sustainable health

systems• Mutual accountability for delivery of results • Deliver more effective aid

What it is not

• A new Institution

• A new plan

• A new funding stream

• A new global fund for health

• An exclusive initiative

• About only budget support or pool funding

Apply Paris Declaration to Health

• 56 Action-Oriented Commitments

ContextParis declaration 2005

Post high level forum 2005 - 07

Global Campaign on the Health MDGs

MDGs 2000

IHP Global Business Plan on MDGs 4&5

UNAIDS 3 Ones

Incr

ease

d a

id e

ffec

tive

nes

s

Incr

ease

d r

eso

urc

es

Context (2)

• More aid for health $6-$14bn (2000-2005)• But limited reach of much investment: AIDS, TB,

Malaria ,childhood vaccination• Much aid is off plan-not funding national

priorities • Complex and fragmented architecture • Use of parallel systems rather than government • Large transaction costs for governments • “The result is limited reach and effectiveness of

much aid”(World Bank & AU health strategies)

Complex architecture …..

MOH MOEC

MOFPMO

PRIVATE SECTORCIVIL SOCIETYLOCALGVT

NACP

CTUCCAIDS

INT NGO

PEPFAR

Norad

CIDA

RNE

GTZ

Sida WBUNICEF

UNAIDSWHO

CF

GFATM

USAID

NCTPNCTP

HSSP HSSP

GFCCP

GFCCP

DAC

CCM

T-MAP

3/5

SWAPSWAP

UNTG

PRSP PRSP

Fragmentation…..

Source; Don De Savigny & COHRED

Contra-ceptives and

RHequipment

STIDrugs

EssentialDrugs

Vaccinesand

Vitamin ATB/Leprosy

BloodSafety

Reagents(inc. HIV

tests)

DFID

KfW

UNICEF

JICA

GOK, W B/IDA

Source offunds for

commodities

CommodityType

(colour coded) M OHEquip-ment

Point of firstwarehousing

KEM SA Central W arehouse

KEM SARegionalDepots

Organizationresponsible

for delivery todistrict levels

KEM SA and KEM SA Regional Depots (essential drugs, m alaria drugs,

consum able supplies)

ProcurementAgent/Body

Crow nAgents

Governmentof Kenya

GOK

GTZ(p rocurem ent

im plem entationunit)

JSI/DELIVER/KEM SA LogisticsM anagement Unit (contraceptives,

condom s, STI kits, HIV test kits, TBdrugs, RH equipm ent etc)

EU

KfW

UNICEF

KEPI ColdStore

KEPI(vaccines

andvitam in A)

M alaria

USAID

USAID

UNFPA

EUROPA

Condomsfor STI/

HIV/AIDSprevention

CIDA

UNFPA

USGov

CDC

NPHLS store

M EDS(to M issionfacilities)

PrivateDrug

Source

GDF

Governm ent

NGO/Private

Bilateral Donor

M ultilateral Donor

W orld Bank Loan

Organization Key

JapanesePrivate

Com pany

WHO

GAVI

SIDA

NLTP(TB/

Leprosydrugs

Com modity Logistics System in Kenya (as of April 2004) Constructed and produced by Steve Kinzett, JSI/Kenya - please communicateany inaccuracies to skinzett@ cb.jsikenya.com or telephone 2727210

Anti-RetroVirals

(ARVs)

Labor-atorysupp-

lies

GlobalFund forAIDS, TB

and M alaria

The"Consortium"

(Crow n Agents,GTZ, JSI and

KEMSA)

BTC

M EDS

DANIDA

M ainly District level staff: DPHO, DPHN, DTLP, DASCO, DPHO, etc or staff from the Health Centres,Dispensaries come up and collect from the District level

M EDS

Provincial andDistrict

HospitalLaboratory

Staff

Organizationresponsible fordelivery to sub-

district levels

KNCV

M SF

M SF

Complex in-country Supply Chains!

Transaction costs..

800

750

700

650

600

550

450

Vietnam (791)

Cambodia (568)

Honduras (521)

Mongolia (479) Uganda (456)

10 453 missions in 34 countries in 2005

Number of donor missions in 2005

Developing country messages• current aid make it hard to strengthen health systems• need flexible, predictable and long term financing to budget for long term• high transaction costs of dealing with multiple international partners; who

operate outside of national planning & budgeting processes & compete for scarce resources, particularly staff;

• recognise benefits of targeted investments, but want to see greater coordination and integration of international support; ‘campaign vertically spend horizontally’

• suspicious of new donor initiatives over which they have little influence; • limited faith in their international partner’s performance in delivering on

their commitments

International messages• High-level political commitment for health lacking ; increase & sustain

investment in health; overcome policy, implementation & governance obstacles to progress;

• Little confidence in quality of many national health plans: divorced from meaningful budgets; avoid difficult issues (eg gender, SRHR); exclude the non-state sector;

• Concern over limited capacity to implement health plans; inadequate engagement of supporting sectors such as water, education and transportation;

• Little confidence in accountability mechanisms to citizens;• Must see support translated into improved health outcomes to maintain the

case for aid to taxpayers

CSO messages

• Some irritation at the process and non-engagement

• Look to structured GFATM-like governance structure

• Generally supportive of principles

• AIDS lobby perceive threat to ‘AIDS exceptionalism’ and potential diversion of focus and resources

Mid -2007…a political opportunity

• New health leaders WHO, WB, GFATM• Coordination H8 Group (UN, Major GHI, Gates)• New UK Government-convinced of need for

more effective aid and more aid • Concept note for what became IHP• High level compact-signed by 8 first wave

countries, H8 group, UNDP, EC, IMF, and 8 bilaterals at launch September 2007

Developing countries will…

• Invest more in health• Address policy constraints• Strengthen planning & accountability

mechanisms• Link aid to demonstrable improvements in

outcomes (MDGs, HSS)

Donor partners will…

• Better coordinate their support around National Health Plans

• Provide aid in ways that strengthens health systems

• Where possible, provide long term, more flexible support delivered though national systems

Civil society will

• Engage in design, implementation and review of National Health Plans and the Partnership at global and country level

• Deliver high quality health services, in line with national plans

• The performance of all parties will be subject to a joint review at country and global levels

What will success look like (1)?• All partners work to achieve national health objectives as laid out in

robust national plans that include the contributions of public, private and civil society providers.

• All share a collective commitment to help implement the plan effectively and deal with bottlenecks to progress and emerging issues.

• All external support is provided in ways that strengthen health systems and facilitate the delivery of a coordinated package of basic services that respond to all major health challenges and achieve results.

• More resources are provided as long term, flexible aid with a greater proportion delivered through national systems.

• There is a clear, inclusive, credible monitoring mechanism that is able to demonstrate progress in improving health outputs/outcomes on an annual basis.

• International agencies are encouraged to rely on joint appraisal and reporting systems rather than requiring their own separate arrangements.

What will success look like (2)?

Signatories… so far• Zambia, Nepal, Kenya, Burundi, Mozambique,

Ethiopia, Kenya, Mali

• UK, Norway, Netherlands, Germany, France, Italy, Portugal, Canada

• WHO, UNAIDS, UNICEF, UNFPA, World Bank, GFATM, GAVI, UNDP, IMF, ILO, AfDB, EC, Gates

Next steps

• Multilateral lead WHO/WB

• Develop country level compacts

• UK resources for process via WHO/WB and to first wave countries

• Engage US and Japan –G8

• Meeting of first wave countries in 01/08

• Ministerial meeting -margins WHA 05/08

Lessons from DFID SWAp Review

• Takes time to get processes working – IHP to build on these and not start again

• SWAp structures help coordination, allocation – IHP to encourage discipline

• Staff or minister changes – anticipate them, coordinate response, contingency plans

Lessons from DFID SWAp Review

• Mix of aid instruments is desirable – plan across donors – IHP role in this?

• Participation – neglected early on, IHP to address and learn lessons?

• Mutual accountability – often poor EDP performance, IHP to push accountability