The International Health Partnership: aligning for better results Marjolaine Nicod, IHP+/WHO Maxwell Dapaah IHP+/WB

What is IHP+ IHP+ is a partnership of countries, development agencies and civil society organizations that aim to accelerate better health services and health outcomes, particularly for the poor, by putting the principles on development effectiveness into practice. Partner commitments recorded in the IHP+ Global Compact Created in 2007 Goal: better results through more effective development cooperation

A strong efficient health system is needed to deliver quality services for country health priorities

IHP+: a response to rising number of partners, duplication, fragmentation Belgium France Sweden Netherlands Spain USAID Canada Luxembourg WHO UNICEF WFP UNFPA Plan International PSI Helen Keller Medecins Sans Frontieres Red Cross Japan Global Fund Against AIDS, TB & Malaria GAVI UNAIDS China United Nations Bilaterals International NGOs DCE Global Initiatives

Unintended burden of multiple missions – reaches district level *Assumes around 50 working days per quarter and 100 per half year although reported to work in excess of that Source:McKinsey: In-country interviews; DMO visitor log; team analysis PEPFAR GFATM NTLP Gates Foundation Norwegian TB EPI UNICEF WHO NACP NMCP London School Total JICA Finnish Axios UNICEF World Vision MoH – TB MoH – Malaria MoH – AIDS MoH – EPI MoH – Maternal Health Weekly notifiable disease reports Total Harmonizing report writing can help reduce the burden TANZANIA DISTRICT EXAMPLES Report writing can consume even more time Number of full days per quarter spent on writing reports (Morogoro) Missions can consume 10-20% of a DMO’s time: Number of one-day missions to Temeke during last 6 months

Supply logistics systems in Kenya

Developing countries:837 Bilateral donors:817 Int'l agencies and foundations:1112 TOTAL2766 Who is in IHP+?

The seven behaviours: not new but important requires action by all development partners

How does IHP+ work? Mobilises support behind one national health strategy with clear priorities: 1.Inclusive national planning and joint assessment processes 2.Unified support for implementation, through country compacts 3.Harmonized financial management 4.One platform for monitoring and accountability for results 5.South-south exchange on effective development cooperation IHP+ works through its partners – governments, development partners, non state actors including CSOs. Builds on existing processes

Country compacts Compacts: negotiated agreements between partners on how they will support the national health strategy/plan. Are many equivalent terms e.g. MOU Compacts can – Bring more partners behind the national strategy – new development partners, civil society, NGOs – Influence greater if commitments are made more explicit, are monitored Key elements – Commitments by governments; development agencies; implementing partners – Aid management modalities – Monitoring arrangements and indicators for tracking progress Experience: 2/3 of IHP+ partner countries have or are developing a compact Verdict of recent analysis: worth the effort, but on their own are not enough to get step change in partner behavior Go to

Inclusive national planning and joint assessment processes Joint assessment of National Strategy (JANS) developed to enhance quality of a national health strategy; to inform funding decisions and reduce transaction costs of multiple assessments – Shared, systematic assessment, using tool and guidelines developed by multi- partner IHP+ working group. – Principles: country-led; aligned with in-country processes; inclusive; strong independent element – Product: profile of strengths and weaknesses of a health strategy, not a pass/fail JANS experience to date – Used formally in 12 countries, informally by more. Lessons learned up on IHP+ website. – Helped strengthen national health strategies; less direct link to funding decisions

Financial management harmonization and alignment A plethora of FM arrangements for donor funding brings complexity to a whole new level

Harmonized financial management Problem: – Under-use of country financial management systems – transaction costs due to duplicated financial management assessments, parallel financial management systems. Action – Approach to joint financial management assessments developed. Standard elements of agreements on 'Joint Financing Arrangements' being defined – Countries encouraged to develop a costed national action plan to strengthen financial management, supported by all key government actors

Align with country systems whenever they meet the minimum acceptable level. Harmonize among development partners, when all or part of the national Public Financial Management (PFM) system is not sufficiently developed. Agree and support implementation of a joint action plan that strengthens the national systems so as to bring about the necessary changes to make the alignment feasible. Not wait until all problems have been solved, but use a step-wise approach by using elements of country systems as soon as possible as part of the process of improving systems and developing capacity. General Principles 09/07/2016

CountryDescription of workParticipating DPsAffiliated DPsStatus Burundi Conduct joint FM assessment and develop a joint capacity building action plan AfDB, EU, GF, WB Belgium Corporation, GAVI & USAID, Swiss Embassy English and French versions of the report have been completed. A workshop to disseminate the report, agree on an FM improvement action plan, and to draft Joint Fiduciary Arrangements (JFA) in March has been postponed due to the political situation in the country. Senegal Align FM arrangements for DP-financed projects with country systems USAID, WB, GFGAVI For its HSS grant support to Senegal, GF now uses the country system, joining the WB and USAID in the use of country systems DR Congo (1) Develop joint FM procedures for government and DP- financed projects; (2) Leverage WB-led PFM reforms to set a Directorate of Financial Management in MoH GF, WB, BTC, AfDBUNFPA, EU Joint FM Manual has been prepared. The MoH recruited two consultants to help finalize the manual. Donor consultations are on-going. A dissemination workshop is planned for July Sierra Leone Set up an Integrated Health Projects Administration Unit (IHPAU) within MoHS GAVI, GF, WBWHO Review undertaken in May Sudan Conduct joint FM assessment and develop a joint capacity building action plan GF, GAVI, WB, UNICEF, UNFPA, UNDP, WHO, DfIDJICA, EU Assessment misison planing in progress Liberia Conduct joint FM assessment and develop a joint capacity building action plan UNICEEF, UNFPA, EU, USAID, GAVI, GF, Irish AID & WB TBDJFMA report under preparation EthiopiaDraft a new JFA with DPs support GAVI, AusAID, Royal Dutch Embassy, GF, WB, and USAID JFA now signed by all major DPs. DPs using joint financial management arrangements Examples of work done so far

Today's environment The Sustainable Development Goals (SDGs) a renewed global commitment to health, underpinned by Universal Health Coverage (UHC). The inclusion of UHC in the SDGs presents an opportunity to promote a comprehensive and coherent approach to health, to focus on how the health system delivers integrated, people-centred health services. Domestic resources account for the large majority of health spending even in fragile states and low income countries (LIC) and there is need to focus on levers to strengthen institutions and efficient use of these resources for increased health security and equity. The Ebola and Zika tragedies have reminded everyone of the importance of public health systems and better ways of engaging with other sectors, to be relevant UHC cannot overlook growing concerns related to health security Many African economies growing Traditional development assistance for health has plateaued but still significant; non traditional donors increasingly important