Performance Reviews - ZAMBIA Fifth IHP+ Country Health Teams Meeting Aligning for better results in changing environments 2-5 December 2014, Sokha Angkor Resort, Siem Reap, Cambodia C. Simoonga W. Mwambazi Y. Siame 1

Background The Zambian Government thru MoH embarked on health sector reforms in 1991 based on three guiding principles: Leadership Accountability Partnership. The LAP principle emphasized a Platform of greater harmonization and alignment between different stakeholders in the sector. Sector Wide Approach (SWAp) institutionalised in 1992 as mainstay in sector coordination and programming, including mechanisms for joint sector performance reviews. First MoU signed in 2006 affirmed commitment of major Cooperating Partners to SWAps, e.g. DfID, SIDA, DGIS, EU, The World Bank, UN Agencies, etc 2

Background continued The framework of the International Health Partnership (IHP+), an addendum (Compact) to the MoU was developed in 2008, which both widened the scope of the agreement and the kind of stakeholders involved. However it was never signed due to the fiduciary problems that were disclosed in May 2009 which strained relations with development partners and the Government, leading to withdrawal of traditional bilateral partners from pooled and/or budget support. 3

Background continued In response, the Government with its CPs developed a Governance and Management Capacity Strengthening Plan (GMCSP ) which aims to strengthen fiduciary controls, systems and structures in the MoH with a view to rebuilding confidence in the health Sector Wide Programming (SWAp) approach. Advanced implementation of the GMCSP by all stakeholders (GRZ, CHAZ, CPs, etc); Signing of the second Memorandum of Understanding between GRZ (MoH, MCDMCH), CPs (includes GFATM) and NGOs, to reaffirm support to the NHSP

Zambian Health SWAp The Zambian health SWAp has been a culture of mutual accountability, aimed at achieving better health outcomes in a sustainable environment, but recognising the mandates and policies of all stakeholders. Fundamentally this involves: – Pooling of funds/resources for increased efficiency and effectiveness – Common planning and implementation coordination framework – Joint Performance Reviews (JARs, MTRs, ETRs), under One monitoring and evaluation framework. 5

Joint monitoring and evaluation This is done through:- Joint Annual Reviews (JARs) Mid Term Reviews (MTRs) End Term Reviews (ETRs) The JAR which is done annually involves: – Quantitative and Qualitative assessment of performance – In-depth review of performance on sampled areas (Policies, Themes, institutions, and health facilities) against key indicators, including district-level service delivery – Makes comparison of policies against thematic areas – Key stakeholder participation, includes NGOs 6

JARs: Advantages and Challenges Advantages – Joint performance review against agreed set of indicators and targets – Enhancing mutual accountability for results – Strengthens policy dialogue for sustaining gains – External validation and Low sector transaction costs Challenges – Projects and parallel funding (60% funding to NGOs, NHA 2013) – Lob-sided dialogue (Partners with limited commitment at country level) 7

Summary The JARs in Zambia now in its ninth year (2012 ),  (JAR-2013 replaced by MTR 2014 of the rNHSP ) It has emerged as a shared platform for purposes of the harmonisation of policies and systems It has also provided a common platform for a joint assessment of health system development over the preceding year as part of the enhanced effort of transparency and accountability within the sector. JARs have great potential for mutual accountability and strengthening policy dialogue for better health outcomes. 8

THANK YOU 9 Musi-oa-Tunya (Victoria Falls), Zambia