179. Dr Louisiana Lush; The International Health Partnership.

8/8/2019 179. Dr Louisiana Lush; The International Health Partnership.

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The International Health Partnership

Dr Louisiana Lush

1. Description2. Background and context3. Complex health architecture4. Rationale for IHP

5. IHP Commitments6. Progress to date7. Next steps


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1. Description: What is the IHP?

An accelerated effort to apply the OECD/DAC Paris Principleson aid effectiveness to the health sector in 8 countries,building on existing processes

The specific goals are to:

Better coordinate aid for around national health plans

Provide aid in ways that strengthen health systems

Strengthen planning and accountability at the national level


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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 pooled funding


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Apply Paris Declaration to Health

56 Action-Oriented Commitments


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2. Background context (1) (see annex 1 for detail)

Paris declaration 2005

Post high level forum 2005 - 07

Global Campaign on the HealthMDGs

MDGs 2000

IHP Global Business Planon MDGs 4&5

UNAIDS 3 Ones

Increaseda

ide

ffectiveness

Increas

edr

esources


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Background context (2)

Growth in external aid for health $6-$14bn (2000-2005)

Most aid targets AIDS, TB, Malaria, child vaccination Much aid remains off plan and off budget i.e. not funding

national priorities

Complex and fragmented aid architecture (see next slides)

Use of parallel rather than government systems fordelivering aid

Large transaction costs for governments

The result is limited reach and effectiveness of much aid

(World Bank & AU health strategies)


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3. Complex architecture (see Annex 2 for healthalphabet soup)

MOH MOEC

MOF

PMO

PRIVATE SECTORCIVIL SOCIETYLOCALGVT

NACP

CTUCCAIDS

INT NGO

PEPFAR

Norad

CIDA

RNE

GTZ

SidaWB

UNICEF

UNAIDSWHO

CF

GFATM

USAID

NCTPNCTP

HSSPHSSP

GFCCPGFCCP

DAC

CCM

T-MAP

3/5

SWAPSWAP

UNTG

PRSPPRSP


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Fragmentation ..

Source Don De Savi n & COHRED


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Contra-ceptives and

RHequipment

STIDrugs

EssentialDrugs

Vaccinesand

Vitamin A

TB/Leprosy

BloodSafety

Reagents(inc. HIV

tests)

DFI

D

Kf

W

UNICEF

JIC

A

GOK, WB/IDA

Source of

funds for

commodities

CommodityType

(colour coded) MOHEquip-

ment

Point of first

warehousingKEMSA Central Warehouse

KEMSA

RegionalDepots

Organizationresponsible

for delivery todistrict levels

KEMSA and KEMSA Regional Depots (essential drugs, malaria drugs,

consumable supplies)

Procurement

Agent/BodyCrownAgents

Governmentof Kenya

GOK

GTZ(procurement

implementationunit)

JSI/DELIVER/KEMSA LogisticsManagement Unit (contraceptives,

condoms, STI kits, HIV test kits, TBdrugs, RH equipment etc)

EU

K

fW

UNICEF

KEPI ColdStore

KEPI(vaccines

andvitamin A)

Malaria

U

SA

ID

US

AID

U

NF

PA

EUROP

A

Condomsfor STI/

HIV/AIDSprevention

CID

A

UN

FPA

USGov

CDC

NPHLS store

MEDS(to Missionfacilities)

PrivateDrug

Source

GD

F

Government

NGO/Private

Bilateral Donor

Multilateral Donor

World Bank Loan

Organization Key

JapanesePrivate

Company

WH

O

GAV

I

SID

A

NLTP(TB/

Leprosydrugs

Commodity Logistics System in Kenya (as of April 2004)Constructed and produced by Steve Kinzett, JSI/Kenya - please communicate

any inaccuracies to [email protected] or telephone 2727210

Anti-RetroVirals

(ARVs)

Labor-atorysupp-

lies

GlobalFund forAIDS, TB

and Malaria

The"Consortium"

(Crown Agents,GTZ, JSI and

KEMSA)

BT

C

MEDS

DANI

DA

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

MEDS

Provincial andDistrictHospital

LaboratoryStaff

Organizationresponsible fordelivery to sub-district levels

KNC

V

MSF

MSF

Complex in-country Supply Chains!


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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


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4. Rationale for IHP:

Developing country messages

current aid make it hard to strengthen health systems

need flexible, predictable and long term financing to budget for longterm

high transaction costs of dealing with multiple internationalpartners; who operate outside of national planning & budgetingprocesses & compete for scarce resources, particularly staff;

recognise benefits of targeted investments, but want to see greatercoordination and integration of international support; campaignvertically spend horizontally

suspicious of new donor initiatives over which they have littleinfluence;

limited faith in their international partners performance in deliveringon their commitments


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Rationale for IHP:International messages

Lack of high-level political commitment for health to increaseinvestment in health & overcome policy, implementation &

governance obstacles to progress; Little confidence in quality of many national health plans: divorcedfrom meaningful budgets; often avoid difficult issues; exclude thenon-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;

Need to see support translated into improved health outcomes tomaintain the case for aid to taxpayers


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Rationale for IHP:CSO messages

Generally supportive of principles

Some irritation at the process and non-engagement

Look to structured GFATM-like governance structure

AIDS lobby perceive threat to AIDS exceptionalism

and potential diversion of focus and resources


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Within this architecture, in mid-2007, therewas a political opportunity

New health leaders at WHO, WB, GFATM

Improved coordination of UN, GFATM, GAVI, Gates formation of the H8 Leaders Group now met twice

OECD/DAC focus on health as tracer sector for aideffectiveness High Level Forum

New UK Government convinced of need for moreeffective aid as well as more aid

All this led to the concept note for what became IHP


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Compact: Donor partners will

Better coordinate their support around National Health Plans

Provide aid in ways that strengthens health systems (to meethealth challenges of today and future)

Where possible, provide long term, more flexible support

delivered though national systems


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Compact: Civil society will

Engage in design, implementation and review of national

health plans and the Partnership at global and countrylevel

Support delivery of high quality health services, in line with

national plans

The performance of all parties will be subject to a jointreview at country and global levels


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Launch September 2007 Zambia, Nepal, Kenya, Burundi, Mozambique, Ethiopia,

Cambodia, Mali

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

WHO, UNAIDS, UNICEF, UNFPA, World Bank, GFATM, GAVI,

UNDP, IMF, ILO, AfDB, EC, Gates Foundation


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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 planeffectively and deal with bottlenecks to progress and emergingissues.

All external support is provided in ways that strengthen healthsystems and facilitate the delivery of a coordinated package of

basic services that respond to all major health challenges andachieve results.


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

There is a clear, inclusive, credible monitoring mechanismthat is able to demonstrate progress in improving healthoutputs/outcomes on an annual basis.

International agencies rely on joint appraisal and reportingsystems rather than requiring their own separatearrangements.

What w ill success look like (2)?


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Health system priorities

Financing gaps for health systems strengthening

Human resources for health

Results orientation of health plans

Access to medicines


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6. Progress

Global level:

Multilateral lead via WHO/WB

UK catalytic funding of 3.5 million through WHO/WB

Efforts to engage others eg US and Japan G8

Country level

Country compacts under development for Sept 08

Meeting of first wave countries Lusaka

UK committed catalytic funding to support compactsin first wave countries


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Early results Burundi was the first country to sign a compact, on 22

February. The IHP has helped ensure the national healthstrategy is focused on key outputs such as immunisation

coverage and outpatient numbers.

In Mozambique, the IHP helped facilitate Global Fundresources into the health pooled fund. In future, it is likelyto focus on scaling up of health workers.

In Nepal, the IHP provided important support to the recentannouncement to remove user fees for key health services.

The UK is working with PEPFAR in 4 PEPFAR-IHP overlapcountries to improve and increase resources for health

workers recent funding announcement of $420m fromUK and $1.2b from US.


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179. Dr Louisiana Lush; The International Health Partnership.

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Transcript of 179. Dr Louisiana Lush; The International Health Partnership.