SuRG Presentation September 2008

Review Objectives1. To assess the degree to which those that signed the global

Compact at the launch of the International Health Partnership in September 2007, in particular the development partners working with governments, are adhering to the commitments made

2. To review progress in the development and, where appropriate, commitment to country Compacts using the definition prepared in first country health sectors team meeting in Lusaka in February 2008

3. To review progress with implementation of the common work-plan of the IHP+ including the development of a common M&E framework, and the adequacy of management and accountability arrangements

4. To make recommendations to the SuRG based on the review findings...

to recommend...

‣ How the various M&E frameworks for reporting of outcomes could be consolidated & simplified

‣ Ways to strengthen accountability of government & donors

‣ Specific recommendations for individual countries, agencies and initiatives based on review findings

‣ How the second phase of the IHP+ should be taken forward

The approach

‣ Review of accountability in the short-term, not assessing impacts

‣ Focused on reviewing the extent to which the core expectations are shared and being met

‣ Identifies whether partners have taken specific actions towards the IHP+ vision (building on their existing Aid Effectiveness efforts)

‣ Assesses partner & country readiness to take this forward

‣ Based on 100 Key stakeholder interviews, extensive document review, limited participant observation.

‣ Undertaken during June-July 2008 by small Review Team (Conway, Harmer, Spicer) with own Expert Advisory Panel

Good coverage of perspectives

Limitations of the Study

‣ Timing (only 9 months since launch)

‣ Broad scope (many countries & partners)

‣ Selection bias (only signed-up partners)

‣ Mostly individual opinions - little collective or alternative perspective

‣ No country-level U.S.G. agency interviews

‣ Moving target - many developments in process

Recommendations for 3yr Review

1.More structured approach to 3-year evaluation, with phased focus (inputs to outcomes/impact)

2.In-depth study of 2 countries each year (linked to sectoral reviews)

3.Make a collaborative, participative process

4.Public communications & transparency for advocacy & accountability

IHP+ in the Health Architecture

‣ Global campaign for the health MDGs - where does the IHP+ fit?

‣ IHP vs IHP+

‣ Countries & partners are confused - how to engage (or avoid)?

‣ Risk that the IHP+ will become ‘another big initiative’ - and this is not what is needed

‣ Need for consolidating & re-structuring the global aid architecture

A framework for change

‣ No log-frame against which to evaluate the IHP+ (which is appropriate, given its complexities)

‣ An appropriate model to capture how the IHP+ is expected to bring about expected change

‣ Moving from H&A to results through phased Coordination, Cooperation & Collaboration

Starting from H&A...

Towards a vision of Results

Framing aid effectiveness for health

What .... How

‣ Coordination is about organisation

‣ Cooperation is about procedural compliance in shared pursuit of a common goal

‣ Collaboration is about co-creating shared & emergent solutions

Recommendations for Positioning the IHP+

‣ Improve how the IHP+ is communicated and understood to be relevant, both within partner institutions and amongst external stakeholders- IHP as a movement for accelerated donor reforms- Emphasis on more effective cooperation between partners- Communicate practical actions to reciprocate iteratively- Increased donor financing a non-negotiable commitment- Simplify terminology (IHP not IHP+/Scaling up for Better

Health)- Identify & support organizational champions as change

agents- Conduct more country-level consultations and open events- Articulate a vision of how the IHP will evolve to 2015

A. Moving in the right direction?

‣ Converging opinion about expectations

‣ IHP+ is a valid response

‣ But too early to tell whether on-track

‣ Short-term progress measured as concrete actions

B. Building momentum

‣ All signatories to Global Compact expected to have made progress on commitments

- Increasing cooperation between partners at global level

- Has established useful forums to jointly focus on aid effectiveness & HSS (especially National Health Plans)

- Could produce the conditions for increasing cooperation between global partners, building on existing processes

- However, focus on activities at the international level has delayed progress on real reforms

- Partners have not yet started to institutionalise IHP+ Business as usual at operational levels, though moving in right direction

- Multilaterals have not communicated well what actions they are taking

Understanding this as Reform

Progress by each partner

‣ WHO

‣ World Bank

‣ UNFPA, UNAIDS, UNICEF

‣ Gates Foundation

‣ Global Fund

‣ GAVI Alliance

‣ European Union

‣ Bilateral Governments

‣ US Government

‣ National Governments

Governments do not yet seem to

have realized the full political

leverage of the IHP global compact to challenge DP’s on

their ways of doing business

Recommended actions

‣ Partners must work cooperatively to achieve reforms by initiating and reciprocating specific actions

- WHO strengthen technical focus & capabilities on HSS in country offices & restructure as necessary. More coherent guidance with link to disease control & integrated PHC

- WB play a more strategic role with MoFs; Devolve more authority for decisions & report on how this is working; Communicate what specific actions will be taken

- Other partners - see recommendations

C. Preparing Country Compacts

‣ Expected that Compacts (or their equivalent) will be established as close to binding commitments to collaborate in supporting one costed, results-based national health plan in a harmonized & aligned way.

How Compacts are evolving

‣ Country-level activity mainly directed towards drafting compacts (opportunity cost for immediate reform)

‣ Overall good progress (4 of 8 countries expecting to sign this year)

‣ Different expectations of the Compact mechanism - additional financing vs more effective cooperation

‣ Question of relevance in relation to existing agreements and SWaps

‣ Ethiopia compact provides a leading example

Ethiopia Targets & Benchmarks

1. 90% provide information on long-term financing commitment2. 95% confirmed commitments disaggregated by programme and

geographic area3. 95% don’t request a separate plan document from Government4. 100% of activities and budgets are reflected in the government’s

plan5. 60% of funds provided through Government preferred modality6. 90% of funds disbursed on time7. 80% of procurements conducted through Government preferred

mechanism8. 100% of partners contribute to the TA pooled fund9. 100% of partners use HMIS for reporting10.80% of missions conducted jointly11.Total expenditure on health rising to 21 USD/capita

Gaps in Compacts

‣ Balancing inclusivity with specificity

‣ Inability of key global partners (GFATM, GAVI) to sign

‣ How to include Civil Society as a partner

‣ Implications of joint and several liability

‣ Not having explicit government commitments & government-centric focus

‣ Not linking to multisectoral approaches, or PHC

‣ Weak on equity and rights

D. Financing for Results

‣ Expect country-level partners to agree on amounts, sources & mechanisms (e.g. SWAps) for increased financing of NHPs and for HSS- Created country expectations of significantly increased funding &

donor expectations of increased domestic spending on health- Lack of consensus amongst DPs about the extent to which the IHP

is about new money. Unlikely that funding expectations will be met - potential failure

- SWap as the preferred mechanism (SUPER-SWAp?), but technical approaches to budgeting are confusing to stakeholders

- Numerous challenges in meeting financing needs- However., there are existing flexibilities that can be better used- Need to look at reforming the architecture & further innovation

ODA Trends in IHP+ countries

E. Changing ways of working

‣ IHP+ is expected to change the behaviours of international agencies and bilateral agencies... to review policies & procedures at the global level to enable better coordination and longer-term support at country level.

‣ Staff should be incentivised and empowered to change ways of working

Evolutionary or Revolutionary?

‣ Need to see the IHP+ as a process for accelerated reforms - based on cooperation

‣ Know what needs to be done, by not sure how. ‣ IHP+ not well communicated within institutions‣ Progress depends on people with behavioural and

technical competencies, supported by competent systems. But Partner institutions have not invested in this.

‣ Important to start by building on what works, rather than fix what does not

‣ Many disincentives and internal restrictions in the way. Also donor politics & some Govt resistance to change

Recommendations for change

‣ Implement the IHP+ more effectively by investing in change management processes within partner institutions and through developing people’s competencies to implement new ways of working

- Provide supplementary budgets, staffing & training to facilitate change- Develop technical competencies through training & professional

development- Hold decision-makers responsible as individuals (e.g. through Performance

assessments) - Provide incentives to motivate (e.g. public acknowledgement)- Undertake internal institutional assessments of policies, systems, etc- Consider structural reform in aid architecture (e.g. merging GF & GAVI)

F. Civil Society as equal partner

‣ IHP+ process is expected to meaningfully engage CS at global & country levels. Govts expected to include this sector in their plans, with funding & technical support

- CS acknowledged as an important partner but had to initiate

- Lack of mechanisms for country-level engagement, but hope for change.

- Legitimacy of representation still an issue & still lack of consensus amongst global CS on some issues

- IHP+ needs to more explicitly promote equity & rights, with belief that People are central to their own health (link to People’s Health Movement)

Recommendations for People

‣ Consider the idea of Local Health Partnerships that are underpinned by a People’s Movement for Health, led by Civil Society to promote meaningful coordination and collaboration from the ground up.- Include this in Country Compacts, based on same

effectiveness and partnership principles- Implement at District/sub-National level, to strengthen

Integrated PHC services- Inclusive of all partners - including private sector- Mechanism to engage non-state providers- Based on the People’s Health Charter- Donors must continue to support CSOs

G. Informing action, tracking results

‣ Expect that common processes & national systems would be used for M&E of implementing NHPs - linked to planning & budgeting at all levels. With resources to strengthen HMIS.

Using information effectively

- Results framework widely accepted, but questions about validity of inferences & timescales for showing results

- Public accounting systems weak/disastrous and could undermine results focus - where is the money spent, etc?

- Disputed assumption that H&A are necessary to achieve health outcomes

- Linking aid to expectations of performance could undermine long-term HSS for short-term results

- Transparency emerging as a key IHP+ principle

- Potential for using networks to collect, analyse & share information

- Still an area for considerable development - with implications for the results basis of the IHP+ However, unprecedented collective action is needed

Recommendations for M&E

‣ Implement the IHP+ Results Framework and build in strong transparency mechanisms for mutual accountability

- Push for 5-10% spend on HMIS, M&E (Include in agreements)

- Further develop transparency mechanisms

- Implement Donor Scorecard (like business Global Reporting Initiative)

- Establish open-access clearing-house for monitoring data (Observatory)

- Focus on learning & improvement, with feedback loop on actions

- Independently research validity of H&A impact on Health Outcomes

H. Managing the IHP+

‣ The IHP+ Core Team is expected to have ensured that the process is well-managed... whilst keeping this institutionally light to avoid further complicating the donor architecture or adding administrative burden on countries

- Importance of Interagency Country Health Sector Teams, but roles & functioning not clear

- SuRG an effective mechanism from building interagency cooperation & dialogue at global level

- But not clear whether appropriate for addressing agency reforms or bottlenecks

- Good progress in implementing the common workplan- Role of WB-WHO leadership has been key

- But don’t institutionalize as secretariat

Recommendations for the next phase

‣ The IHP+ SuRG & Core Team must focus over the next 12 months on facilitating & supporting increased cooperation between partners at the country level to achieve specific reforms:- Strengthen Interagency Country Health Sector Teams- Establish a collaborative (web-based) rolling Global Task List.

Implement an Issue Management system.- Develop approaches to sharing good practices & follow-up learning

forums- Do not expand the Core Team or institutionalize this as a

secretariat- Undertake a review of the SuRG ToRs- Continue to support Civil Society involvement- Proactively enable CSO engagement at country level

What is changing in Countries?

‣ Partners using IHP+ to add political momentum to existing processes (in some countries)

‣ Specific opportunities have been identified for actions on policy, planning & budgeting

‣ Influencing the scope & ambition of National Health Plans and budgets

‣ But concerns about unrealistic expectations and whether rhetoric will translate to actions

‣ Transaction (& opportunity) costs are being incurred

Slideshare Resource

Documents Wiki Resource

Collaboration Platform Resource

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Overall Impression

‣ The IHP+ is an ambitious and complex initiative.

‣ This cannot be expected to achieve immediate results.

‣ Or to be measured through linear approaches.

‣ Instead, this needs to create the conditions for cooperation that will enable more fit ways of delivering aid to evolve.

‣ To achieve enduring results through practical, reciprocal actions.

‣ Building on coordination attempts and aiming to become truly collaborative.

Acknowledgements

‣ Expert Advisory Panel

- Gill Walt; Ruairi Brugha; Hailom Banteyergu; David Wilkinson; Thabale Jack Ngulube

‣ The Interagency Core Team

- Bob Fryatt, Nicole Klingen; Justine Hsu

‣ Global Health Initiatives Network

‣ Human-Scale Development Network

‣ The Respondents (listed in the report)