Is E2 sufficient to ensure sustainability? Definitions, principles, actors, priorities

Definitions Sustainability of Both immediate and long-term Finances – predictable, increasingly domestic (integrated) health and community systems Institutional capacity, health work force Local sustainability Both immediate and long-term

Principles National ownership of plans and priorities Global solidarity Commonly agreed goals - mutual accountability Synergies with other health and development sectors

Challenges Perceptions in Ministries of Finance that MoHs are not accountable, e.g. off-budget support, GFATM absorption, or results of E2 studies How to reverse crowding-out How to advocate for use of economic growth, matching of burden of disease, competing sectors (which with greater ease demonstrate value for money) Transitioning from donor support – also technical and market place elements Pooled vs. nationally owned commodities Transition costs money

Stakeholders Affected communities, activists Implementers Programs Ministries of Health Ministries of Finance, Treasury Donors

E2 necessary, not sufficient Allocate efficiently within HIV and health Optimize service delivery models Harmonize different actors Better identify bottlenecks Make explicit equity concerns

A new global compact Countries take the lead – national vision and plan; partners pulled into alignment Resources are reallocated according to country needs and priorities, for greater, more sustainable results Partners and countries fill the investment gap together – ‘fair share’, based on capacity Programs are implemented as efficiently as possible (without parallel structures, stand-alone services or higher than necessary program costs)

Sustainability elements for roadmap Strengthen national strategic and costed operational plans Methodology to determine “fair-share” Address new data requirements: program and unit costs, expenditure surveys, evaluation studies, etc Estimate return on investment Development partners to more systematically strengthen E2 – tool kits, capacity strengthening From 3 ones to joint M&E and accountability framework