Guggi Laryea Civil Society Focal Point World Bank The International Health Partnership and related initiatives (IHP+) Presentation for the Action for Global

Guggi LaryeaCivil Society Focal PointWorld Bank

The International Health Partnership and related initiatives (IHP+)

Presentation for the Action for Global Health Conference

MadridMay 26, 2008

What is the IHP+?

• Country-focused and country-led

• Builds on existing structures, mechanisms, and country health plans

• Provides long term, predictable financing for results-oriented national plans and strategies

• Ensures mutual accountability for delivering on compact commitments

• A renewed effort to support countries in achieving their health MDGs (1b, 4, 5, 6)

• Through a single harmonized in-country implementation effort

• With scaled-up financial, technical and institutional support for health MDGs

How will it be implemented?

IHP+ Signatories• As of 23 May 2008, the IHP global compact has been signed by:

• Ten Ministers from developing country governments (Burundi, Cambodia, Ethiopia, Kenya, Madagascar, Mali, Mozambique, Nepal, Nigeria, Zambia),

• Nine international organizations (WHO, World Bank, Global Fund, GAVI Alliance, UNFPA, UNAIDS, UNICEF, UNDP, EC),

• Eleven bilateral donors (Australia, Finland, Sweden, UK, Norway, Germany, France, Italy, Portugal, Canada and Netherlands), and

• Other donors (Bill & Melinda Gates Foundation & African

Development Bank).

InternationalHealth

Partnership

Catalytic Initiative to

Save a Million Lives

UN SGMDG Africa Initiative

InnovativeResults-Based

Financing

Providing for Health Initiative

Deliver NowFor women and children

Global FundNationalStrategy

Applications

GAVIHealth

SystemsStrengthening

HealthMetricsNetwork

Global HealthWorkforceAlliance

IHP+ Related Initiatives

Objectives of the IHP+Four main objectives consistent with the Paris Declaration on Aid

Effectiveness: 1. Developing results-focused, country-led compacts that

rally all development partners around one national health plan; one M&E framework; and one review process, thus improving harmonization, alignment, focus on results and mutual accountability

2. Generating and disseminating relevant knowledge, guidance and tools

3. Enhancing coordination and efficiency at country, regional and global levels

4. Ensuring mutual accountability and monitoring of performance

Why now?

Progress towards MDGs: inadequateTrend in Under-Five Deaths, 1960-2015 (Millions deaths per year)

2.9 3.2 3.5 4.1 4.6 4.9

2

5.1

13.510.9

8.3 75.1 4.1

2.2

3

4.1

3.6

2.7

1.8

1.41.1

0.8

0.1

0

5

10

15

20

25

1960 1970 1980 1990 2000 2005 2015 withachievement of

MDGs

2015 withcurrent Trend

Africa Asia Other

Progress towards MDGs: inadequateNo region is on track to reduce maternal mortality by three-quarters by 2015.

Health system constraints: unaddressed

• Human resources Production, retention and migration

• Infrastructure

Logistics, procurement, physical infrastructure

• Catastrophic health spending Reduction of out-of-pocket expenditure, social protection

• Ineffective delivery Integration and coordination, primary care, community engagement, non-state providers, management

Investment in health: insufficient

International funding: unpredictable

0

5

10

15

20

25

30

35

40

2000 2001 2002 2003 2004

Benin

Burundi

Ethiopia

Mali

Niger

MOH MOEC

MOFPMO

PRIVATE SECTORCIVIL SOCIETYLOCALGVT

NACP

CTUCCAIDS

INT NGO

PEPFAR

Norad

CIDA

RNE

GTZ

Sida WBUNICEF

UNAIDSWHO

CF

GFATM

USAID

NCTP

NCTP

HSSP

HSSP

GFCCPGFCCPDAC

CCM

T-MAP

3/5

SWAPSWAP

UNTG

PRSP PRSP

Support to countries: inefficient

The challenge to put an end to deaths from preventable and

treatable illnesses needs ALL of us to join forces.

Value-Added of the IHP+• Country-focused and country-led activities

• ONE costed, results-oriented national health plan

• Build consensus and inclusion of all stakeholders through Country Compacts

• Long-term predictable financing for strengthening health systems which addresses volatility, fiduciary and procurement issues

• Improved harmonization and alignment of aid which reduces fragmentation and transaction costs

• Improved coordination between country governments and development partners

• Strengthened mutual accountability and transparency

Strengthening Health Systems• The fragmentation of donor assistance to health, including fragmented financing of

health systems strengthening, generates serious constraints to the delivery and sustainability of results in health, including:

– Funding distortions– Increased transaction costs– Unpredictable donor financing;– Lack of fungibility of donor financing (earmarked/vertical programs);– Poor donor coordination/harmonization;– Lack of absorptive capacity (HRH, health systems);– Insufficient cross-sectoral coordination/investment

• IHP+ aims to facilitate better coordination and increased financing for health based on country-led processes for improved results by rallying partners to support and take forward one costed, validated, results-oriented national health plan through the signing of country compacts, which will contribute to broader goals of overall health systems strengthening.

Empowering Women• The IHP+ seeks to improve results for achieving the health MDGs – 1b, 4, 5, and 6, however

progress against these MDGs will have positive spill-over effects and may lead to advances in other areas, such as improving gender equality and empowering women (MDG 3).

• Gender inequalities contribute to poor progress against MDG 5.

– Due to lack of access to information and family planning services, 108 million married women in developing countries have an unmet need for contraception.

– 66% of unintended pregnancies occur among women who are not using any method of contraception.

• Access and availability of high-quality contraceptive information and services would prevent many unintended pregnancies and reduce induced abortions.

– If contraception were provided to all women who lack access, maternal mortality would decline by 25%–35%.

By delivering on health MDGs through the IHP+, other positive results, such as women’s empowerment and improved gender equality,

should be achieved.

Possible Elements of a Country Compact

• ONE single country health plan• ONE single results framework• ONE single policy matrix • ONE single budget that will be the basis for funding• ONE single mutual monitoring and reporting process • ONE single country-based appraisal and validation process for the country health plan• Benchmarks for government performance • Benchmarks for development partner performance• Agreement on aid modalities • Process for resolution of non-performance and disputes

ONE National Health PlanCentral to the compact is the national health plan and how

it will be used in the new aid environment:

Common Monitoring & Evaluation Framework

IHP+ Management Structure

Inter-agencyworking groups

Inter-agency country health

sector teams

• Ministry of Health• Ministry of Finance• Civil Society• Bilaterals/Multilaterals• International health agencies

Regular partner forums

(inc civil society)



sector teams



(inc civil society)


sector teams



(inc civil society)

Scaling-up Reference Group (SuRG)

1) Business: Gates, GAVI, GF, UNAIDS, UNFPA, UNICEF, WHO, WB2) Steering: Above, plus development

Partners and Civil Society


Scaling-up Reference Group (SuRG)

1) Business: Gates, GAVI, GF, UNAIDS, UNFPA, UNICEF, WHO, WB2) Steering: Above, plus development

Partners and Civil Society


Political AdvocacyH8, SG

Inter- agency Core Team

• Washington DC• Geneva• Brazzaville (HHA)

Inter- agency Core Team

• Washington DC• Geneva• Brazzaville (HHA)

The role of the IHP+, country level

Improved Outcomes for MDGs 1b, 4, 5, & 6

Scaling Up Effective CoverageScaling Up Effective Coverage

One costed, results-oriented national health plan and budget

Inter-agencycountry healthsector teams

Long-term,predictable

financing

One commonM&E and mutualaccountability

framework

Country Compact

Fix healthSystems

bottlenecks

One commonreview process/

validation




financing


framework

Country Compact

Fix healthSystems

bottlenecks


validation

Existing country

mechanisms

Development Partners

Bilaterals/multilaterals

CivilSociety

Donors

H8 Agencies

Existing country

mechanisms



CivilSociety

Donors

H8 Agencies



CivilSociety

Donors

H8 Agencies




financing


framework

Country Compact

Fix healthSystems

bottlenecks


validation

Civil Society’s involvement in the IHP+– Concept note on CS Engagement drafted and commented

on; currently being revised

– Consultation on mode of engagement has taken place

– 2 CS members on steering SuRG

– 1 southern CS solicited for business SuRG

– 1 CS member will join each thematic working group

– A consultative group will be formed

Value Added of Civil Society in the IHP+

• Engage and provide guidance on the implementation of the IHP+ work-plan– assisting in the facilitation of the IHP+ process at the country level by encouraging

local civil society organizations to participate in all stages of the development and implementation of country compacts;

• Facilitate and improve dissemination of IHP+ outputs– sharing good practices widely through existing networks, – supporting implementation of locally appropriate implementation methods and

strategies,– establishing linkages with other existing similar or complimentary efforts.

• Monitor progress achieved as a result of the IHP+– advising on ways to strengthen effectiveness of the IHP+ process and – effectively relaying potential and existing bottlenecks to implementation (global and

country level) for problem solving (donor bottlenecks, implementation bottlenecks, etc)

• Ensure responsiveness of the IHP+ to government-led, inter-agency country teams, holding IHP+ development partners (donors, governments, etc.) accountable.

Conclusions• MDG goals 1b, 4, 5 and 6 will not be achieved without a revised and

streamlined approach to implementation, which will require collaboration of all development partners.

• The IHP+ is an opportunity to harmonize and align development partners for improved health-related MDG outcomes, in line with the Paris Declaration on Aid Effectiveness.

• The focus of IHP+ is results at the country-level.

• Compacts are based on ONE National Health Plan

• Civil Society is key to ensuring successful implementation of the IHP+

Thank You!

Documents

Guggi Laryea Civil Society Focal Point World Bank The International Health Partnership and related initiatives (IHP+) Presentation for the Action for Global