Action For Global HealthHealth as a Tracer Sector

Berlin 8 April 2008Elisabeth SANDOR

OECD DCD

Content

1. Background on Health as a tracer sector

2. The challenges and progress

in Aid Effectiveness in Health

3. Health as a Tracer Sector in Accra

Better results are needed !Tracking Health MDGs in SSA:

– HIV prevalence among pregnant women aged 15-24: only 8 out of 36 countries on target

– TB prevalence only 4 countries on target, 27 with worsening trend

– Under-5 Mortality Rate: 2 countries on target, 25 making progress but behind time-bound target, 9 with worsening trend

Source: Global Fund, 2007

Background

• High-Level Fora on Aid Effectiveness and Scaling up for Better Health (2004-2006) focused on AE: lack of aid predictability, alignment and C&H, insufficient ownership and use of country systems + produced best practice for GHPs’ interventions in countries

• Dec.2006: WHO/WB/OECD meeting on “Aid Effectiveness and health”: participants endorsed “Health as a tracer sector”

• Health as a tracer sector to feed the broader agenda on AE (best practice, lessons, keeping public support to financing for development)

Background (2)

• OECD work on AE in health : DCR 2007, DCD EFF coordinates with IHP and other health-related initiatives (HMN, IHME, Global Innovative financing), preparation of HLF3 in Accra

• One Task Team on HaTS to pilot and guide the work up to Accra and beyond (links with IHP and UNSG’ Steering Committee on MDGs in Africa)

• So objective: not only for Accra…but keep Health as a source of lessons for better AE/results and development impact

The challenges in AE in Health: more aid is needed

• Health captured a large part of the ODA increase but more aid is still needed to reach common agreed objectives (also DAH increase brings greater need for accountability)

• The current uncertainties about future increase of aid

• The bulk of the increase in DAH has been going to specific initiatives and few bilateral programs

0.33

0.22

0.26

0.35

0

20

40

60

80

100

120

140

0.00

0.05

0.10

0.15

0.20

0.25

0.30

0.35

0.40

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

ODA

(200

6US

D bi

llion)

% o

f GN

I

ODA as a % of GNI (left scale)

Total ODA(right scale)

0.33

Total ODA (right scale) - excluding debt relief for Iraq and Nigeria

The path to delivering the 2010 promises is getting steeper and what will there be for health ?

DAH has significantly increased and changed

Source: Michaud 2006

Most of the

recent increase:

• focused on Africa

• focused on specific diseases

• was channeled through bilateral (US) and new multilateral agencies (GAVI A, GFTAM)

0

2

4

6

8

10

12

14

16

2000 2005

year

US$ b

illion

s

Private non-profit

Other multilaterals

Development banks

UN agencies

Bilateral agencies

Bilateral ODAH (in constant USD millions)

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,0001

99

7

19

98

19

99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

Axis Title

Bilateral ODA in Health, USD millions

France

Germany

United Kingdom

EC

EU - countries

DAC countries (hors EC)

Bilateral ODAH (in constant USD Millions)

0

100

200

300

400

500

600

700

800

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Bilateral ODA in Health, USD millions

France

Germany

United Kingdom

EC

The challenges in AE in HealthBetter aid is needed

Implementing the 2005 Paris Declaration

Aligning with

partners’ agenda

Using partners’ systems

Alignment(Donors - Partner)

2

Mu

tual a

ccou

nta

bility

Ownership(Partner countries)

Partners set the agenda

1

Harmonisation(Donors - Donors)

Establishing common

arrangements

Simplifying procedures

Sharing information3

Managing for Results 45

The challenges in AE in health: better aid is needed

Improve AE is key in a sector which is:

- complex (large number of actors, multi-sectoral nature of the determinants of health and multiple financing streams, health results require long-term and sustained investments)

- heavily fragmented at global and country levels

Fragmentation in international effort ….

Source; Don De Savigny & COHRED

0.01.02.03.04.05.06.07.08.09.0

10.0

2001 2002 2003 2004 2005

Benin

0.0

2.0

4.0

6.0

8.0

10.0

12.0

2001 2002 2003 2004 2005

Guinea

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

2001 2002 2003 2004 2005

Liberia

0.0

5.0

10.0

15.0

20.0

25.0

2001 2002 2003 2004 2005

Mali

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

2001 2002 2003 2004 2005

Mauritania

0

10

20

30

40

50

60

70

80

2001 2002 2003 2004 2005

Tanzania

Health aid can be very volatile and unpredictableDisbursements from DAC members 2001- 2005

Source: OCDE, 2007

The challenges in AE in Health: Donor aid can be poorly aligned within country systems and priorities

Example from Rwanda (Scaling up for Better Health, 2005): – Donor preference to disburse via NGOs/manage

funds themselves/send them directly to local-level projects . Central Government manages only 14% of donor support to the health sector.

– Inequalities in the distribution of donor funding by strategic objective: $18mn earmarked for malaria (the biggest cause of mortality and morbidity), $1mn for the integrated management of childhood illnesses and $47mn for HIV/AIDS.

MOH MOEC

MOFPMO

PRIVATE SECTORCIVIL SOCIETYLOCAL GVT

NACP

CTUCCAIDS

INT NGO

PEPFAR

Norad

CIDA

RNE

GTZ

Sida WBUNICEF

UNAIDSWHO

CF

GFATM

USAID

NCTP

NCTP

HSSP

HSSP

GFCCP

GFCCP

DAC

CCM

T-MAP

3/5

SWAP

SWAP

UNTG

PRSP

PRSP

Donor collaboration is a challengeDonor collaboration is a challenge

Source: Mbewe, WHO

The progress and remaining challengesin AE in health:

• The current renewed interest for Health Systems has generated a set of interventions which need to be coordinated/harmonised

• Changes in aid modality can have unintended consequences for health

• It’s important to report on progress about the different ongoing initiatives and innovative financing for development

The progress and remaining challenges in AE in Health

• Division of labour and coordination at the global level: informal group of the H8 and IHP

• Global Programs continuous effort to implement the Paris agenda

• Harmonise M&E

• Change behaviour remains key

What is Accra ?• High Level political event on aid, a few months

before Financing for Development in Doha• Mid-term Stock-taking of the Paris Declaration mutual

commitments• Forward looking event : road to 2011.• 100 partner countries, most donors, most international

aid agencies, • 800 to 1000 participants• Strong civil society engagement (consultations +

Advisory Group-CSO contribution + pre Accra meeting)

List of Roundtables• RT 1 : Country ownership• RT 2 : Alignment : country syst, predictability• RT 3 : Harmonisation- complementarity• RT 4 : Results & impacts• RT 5 : Mutual accountability• RT 6 : Civil society & aid effectiveness• RT 7 : Situations of fragility & conflicts• RT 8 : Sector applications (health, education, infrastructure…)

• RT 9 : Aid architecture (incl. Global Health Partnerships)

Core Issues (Partner Countries) for the RTs and the Accra Agenda for

Action• Untying• Conditionality• Predictability• Division of Labour• Incentives• Capacity Development

+ «cross cutting» issues: human rights, environment, gender

Health as a Tracer Sector in Accra• A contribution to the Roundtable on sector

application of the PD (will look at lessons – Sector Wide Approaches and Programme-Based Approaches - across 4 sectors + priority areas and cross-cutting issues)

• One Report on Health and Aid Effectiveness to take stock of progress and remaining challenges

• Other inputs: to other RTs and to the Market place• Concrete recommendations for the Accra Action

Agenda= all prepared by the Task Team on HaTS

Examples of inputs on HaTS in Accra

• Compacts for mutual accountability in a set of partner countries

• Study on donors constraints to provide long-term health aid

• Best practice and lessons from GHPs• Study on Human Rights and AE in health• Monitoring progress in AE in health (country

and global levels)

Thank You !

www.accrahlf.net