National Strategy Applications and Health Systems Funding Platform Joint Assessment and Multi-Stakeholder Involvement Regional Workshop for Civil Society 14 October 2010

2 Context Growing complexity of global health aid architecture Paris Principles (2005) & Accra Agenda for Action (2008) Creation and growth of Global Fund Global Fund initiatives to simplify and streamline funding International Health Partnership (IHP) New grant architecture Joint Assessment of National Strategies (JANS) NSAs HSFP

3 Joint Assessment National Strategy Applications Health Systems Funding Platform Multi-stakeholder involvment Session Overview

4 Background International Health Partnership (IHP), Joint Assessment of National Strategies (JANS) –Principles for joint assessment –Attributes of sound national strategies (JANS Tool) Definition Joint assessment is a process by which country stakeholders and international partners come together to carry out an independent assessment of a national strategy and its accompanying documentation. It is based on JANS principles and tool. Scope Can be applied to national health sector strategies or sub-sector strategies (e.g. disease strategies). Purpose 1. provide countries with constructive feedback on the national strategy documentation; and 2. provide international agencies with relevant information to help them make technical support and/or funding decisions. What is joint assessment?

5 IHP JANS Principles including the following: –country-demand driven and country-led; –building as appropriate on existing in-country processes and experience –strong independent element; –inclusive process, involving civil society and other stakeholders; Joint Assessment JANS principles

6 Civil society consultation on Global Fund initiatives JANS Tool/Attributes Commonly agreed basis for assessing technical soundness of national strategies CategoryFocus of attributes (for full language see IHP website) 1. Situation Analysis and Programming Sound situational and response analysis Clearly defined priority areas, objectives and interventions, contributing to improved health outcomes Planned interventions, cost effectiveness, sustainability Risk assesment and mitigation strategies 2. ProcessMulti-stakeholder involvement in development and endorsement of national strategy documentation Consistency with higher and lower level strategies 3. Finance and AuditingComprehensive budget/costing, financial gap analysis Specification of allocation of funds Financial management system 4. Implementation and Management Operational plans, resource deployment Procurement policy Governance, management and coordination framework 5. Results, Monitoring and Review Monitoring and evaluation Joint periodic performance reviews

7 Multi-stakeholder 1 involvement in development of national strategy (which is led by government, with a transparent consultative/participative process) and multi- stakeholder 1 final endorsement of national strategy. 1: Including government, civil society (according to the UN definition) and the private sector Joint Assessment Attribute related to MSI

8 Joint Assessment JANS Principles and Tool JANS applied so far in two different areas, using same principles and tool: IHP-led joint assessment of national health sector strategies 3-4 countries in 2010 so far. Process ongoing. Feeding (in some cases) into donor funding decisions. Global Fund-led assessments of national disease strategies 7 assessments in First Learning Wave of NSAs in NSA grants approved November 2009 Some differences in emphasis and details of process

9 Joint Assessment National Strategy Applications Health Systems Funding Platform Multi-stakeholder involvment Session Overview

10 Application (“NSA”) Countries National strategy documentation* Joint assessment report “National strategy application” to Global Fund (= jointly assessed national strategy + minimal additional information) Grant management Funding decision-making process for other funder(s) * National strategy documentation = national strategy + complementary documents (e.g., operational plan) National strategy ‘joint assessment’ National Strategy Applications NSA concept

11 Puts focus on development, financing and implementation of robust national disease strategies aimed at improving health outcomes and supports Paris aid effectiveness principles and Accra Agenda for Action Anticipated benefits: Alignment with country priorities, national programmatic and budgetary timeframes; Reduced transaction costs and paperwork for countries; Improved harmonization with other donors; Opportunity to extend multi-stakeholder inclusion to the scope of the national strategy; A focus on managing for results and accountability within national disease strategies; Improved quality and credibility of national strategic frameworks National Strategy Applications Anticipated benefits of NSA approach

12 Unique characteristics: Compressed timeline (to be ready in same timeframe as R9 proposals) Limited number of countries (22 countries invited) Review of national disease strategies by TRP only (exceptional since no joint mechanism in place) 5 NSAs approved in November 2009 At the end of 2008, Global Fund Board decided to launch a phased roll-out of NSAs, beginning with a “First Learning Wave” of NSAs in 2009, with aim to draw lessons to inform the future, broader roll-out of NSAs National Strategy Applications First Learning Wave of NSAs

13 Conducted byScope TRPAll NSA countries UNAIDS- commissioned consultants The 3 countries that submitted NSA for HIV McKinsey, commissioned by GF 12 countries, spanning all three diseases and different FLW outcomes National Strategy Applications Reports on FLW & message on value of NSA approach All 3 reports indicate perceptions of value of NSA approach from both country- and global-level stakeholders to be broadly positive

14 In April 2010, Global Fund Board approved the initiation of a Second Wave of NSAs, drawing on the lessons from the First Learning Wave, with the following characteristics: Timing –allow countries more time for key process steps –have NSA funding decisions at end of 2011 Approach to country participation –include a limited but incrementally larger number of countries than the First Learning Wave –move towards longer-term vision of open “self-selection” process National strategy assessment –move towards a credible, joint assessment approach Multi-stakeholder involvement – strengthen approach used in First Learning Wave + also ensure consistency with new Global Fund grant architecture National Strategy Applications Second Wave of NSAs

15 The long-term vision of the joint assessment in the NSA approach is to move towards a truly ‘joint’ process. This is currently in evolution: First Learning Wave: GF-driven, GF-organised, TRP conducted Purpose: learn about assessment of national disease strategies and link with GF NSA funding application Second Wave: GF/donor-driven, jointly-organised, jointly conducted Purpose: learn how to do a country-driven joint assessment of a national disease strategy that can form the basis of funding/support decisions of international agencies Intended future model: country-driven, jointly organised, jointly conducted Purpose: enable countries to conduct joint assessment at time that bests suits their national calendar, and use it as basis of funding/support requests as these arise. Second Wave of NSAs Joint assessment for Second Wave of NSAs

16 Will follow JANS Principles and use JANS Tool. In addition, joint assessment of national disease strategies needs to be sufficiently reliable to allow the Global Fund and other donors to use its outcome as the basis of their technical support and/or funding decisions. Hence, some key requirements (agreed by Multi-Partner Working Group), including: All joint assessment team members independent (no involvement in drafting the national strategy and no conflict of interest with regards to assessment outcome); ‘national facilitators’ possible in addition; Assessment team leader external to country; A few experts nominated and paid for by donors included in team; At least one member with expertise in multi-stakeholder involvement; Agenda developed consultatively; Assessment report to present strengths and weaknesses of national strategy. Second Wave of NSAs Joint assessment approach

17 Key steps 1.Nominate a joint assessment organizing body; 2.Identify a joint assessment team leader and assessment dates; 3.Prepare the joint assessment (define scope and focus; identify other assessment team members; prepare agenda); 4.Provide an update on joint assessment preparations; 5.Conduct the in-country joint assessment. Second Wave of NSAs Joint assessment process

18 Joint Assessment National Strategy Applications Health Systems Funding Platform Multi-stakeholder involvment Session Overview

19 Health Systems Funding Platform (the Platform) is a joint partner initiative of the GAVI Alliance (GAVI), the Global Fund and the World Bank, with facilitation from the World Health Organization (WHO) Goes back to a letter from the Global Fund ED and the GAVI CEO in March 2009 to the co-Chairs of the High Level Taskforce on Innovative Financing for Health Systems proposing collaboration on HSS funding High Level Taskforce welcomed proposal and recommended Platform as a mechanism to “…coordinate, mobilize, streamline and channel the flow of existing and new international resources to support national health strategies.” Aim is to make better use of new and existing funds for health systems strengthening (HSS) through simplification of countries’ access to HSS sup- port, and through harmonization and alignment of the way this support is provided Principles of the Platform are in line with those of the Paris Declaration, the Accra Agenda for Action on Aid Effectiveness and the International Health Partnership (IHP+). Health Systems Funding Platform (HSFP) Background

Aligning partner support to national plans and strategies, through an inclusive process Reduced transaction costs (for both funders and implementers) Coordinated funding for HSS Improvement of Aid Effectiveness (Paris and Accra Principles) Health Systems Funding Platform Anticipated benefits Greater Value for Money Improved outcomes for the three diseases and immunization Contributing to MDGs 4, 5 & 6

21 Global Fund Board Decision from April 2010: Continue rapid implementation of Track 1 Development of joint proposal form for HSS with GAVI (for Round 11) Design pilot for 4-5 countries to submit funding requests based on jointly assessed national health strategies (parallel to Round 11) Scope of GF HSS support to be maintained for the purposes of the Platform Health Systems Funding Platform (HSFP) Platform applies to existing and new HSS funding Track 1 “Existing financing” Track 2 “New financing” Harmonization 1 of existing HSS grants/credits Access via joint proposal form Access via jointly assessed national health strategy Grant/credit management 1 Opt 1 Opt 2 1 Harmonized monitoring & evaluation and fiduciary frameworks (incl. procurement)

22 Cambodia: First joint country mission (with GAVI, WB and WHO representatives) in early June 2010 Ministry of Health approved approach in August 2010, and has given permission for work to go ahead. All three Platform funding partners have harmonized performance indicators with those of national strategy and have agreed to strengthen country’s health information system. Further work planned to support upcoming mid-term review of the national health strategy DRC: Mission in August 2010 to discuss harmonization of performance frameworks (GAVI and GF grants managed by same MoH project management unit) Benin: Joint partner work started to harmonize and align, with a potential focus on performance frameworks and financial management. Health Systems Funding Platform (HSFP) Track 1 - Existing funding: Progress to date

23 Health Systems Funding Platform (HSFP) Track 2.1: Joint proposal form with GAVI Joint process (but not in all instances) Based on joint mechanism/framework Separate Proposal Development Submission of joint proposal Independent review by TRP/IRC Board approval Financial arrange- ments Step 1Step 2Step 3Step 4Step 5 Grant manage- ment Step 6 Key elements (current thinking): One form to request HSS funding from GAVI and/or Global Fund (same structure, same M&E and financial management framework) – this will reduce transaction cost Applicants still requested to delineate amounts requested from each of the agencies Possible to submit joint requests to GAVI and the Global Fund, but could also be individual requests to either agency (form is replacing current GF 4B/5B for HSS cross cutting component) Joint requests will be developed and signed off by CCM and health sector coordinating body – strong coordination required Joint request and joint review by TRP/IRC (for joint requests) enables holistic view on HSS needs in country Grant management based on harmonized M&E and financial management procedures (if requested within the parameters of a joint financing agreement) Work in progress

24 Health Systems Funding Platform (HSFP) Track 2.2: Pilot for funding based on assessed strategy Joint process (but not in all instances) Based on joint mechanism/framework Separate Joint Assessment Funding request Independent review Board approval Financial arrange- ments Step 1Step 2Step 3Step 4Step 5 Grant/credit manage- ment Step 6 World Bank project appraisal process Key elements (current thinking): Joint assessment of national health strategy based on IHP+ JANS tool and process including all relevant stakeholders (incl. civil society) Light funding request predominantly consisting of existing documentation (could be joint request to GAVI/GF) – therefore directly aligned with country priorities Development and submission of funding request by CCM under strong coordination with health sector coordinating body Joint review by TRP/IRC (for joint requests) Grant management based on harmonized M&E and financial management procedures (if requested be within the parameters of a joint financing agreement) Pending PSC approval

25 Health Systems Funding Platform (HSFP) Next steps Continue joint partner work and consultations (including monthly phone calls with civil society representatives of all three Platform funding partners) Policy and Strategy Committee reviewing proposed design for HSFP pilot for approval (25/26 October) Portfolio and Implementation Committee reviewing draft joint proposal form for sign off (Feb 2011)

26 Joint Assessment National Strategy Applications Health Systems Funding Platform Multi-stakeholder involvement Session Overview

27 Multi-stakeholder involvement (MSI) is an absolutely essential principle for GF. Application of joint assessment in Global Fund context needs to be designed in accordance with this core principle. The question is not whether but how we should achieve this. NSA approach in fact provides an opportunity to extend MSI to development of a national strategy (as opposed to just development of a GF-specific proposal – as in regular rounds-based approach) Need to see this as an evolutionary process; learn as you go Key objective in ‘early’ NSA waves and HFSP pilot is to learn what mechanisms are appropriate and effective to achieve this more ambitious level of MSI over time (including via positive incentives) Multi-stakeholder involvement Context

28 Strategy development process Decision to participate in joint assessment Joint assessment team and process Decision to develop and submit NSA Grant implementation and oversight Multi-stakeholder involvement Various entry points for MSI

29 Multi-stakeholder involvement Joint assessment stage (NSA) Requirements on joint assessment of national disease strategies for purposes of NSA Second Wave: Requiring that joint assessment organizing body incorporates multi- stakeholder representatives and/or consults them systematically during preparation process Assessment of national strategies against IHP+ attributes of sound national strategies, including attribute focusing on “multi-stakeholder involvement in the development […] and final endorsement of a national strategy”; At least one assessment team member with specific responsibility and expertise for examining MSI; Joint assessment team discussions with civil society stakeholders as part of in-country visit; Requiring that details of the joint assessment (including organizing body, agenda, and outcome briefing) are published transparently

30 Multi-stakeholder inclusion Global Fund application stage (NSA and HSFP Pilot*) Existing Global Fund mechanisms maintained: Development of funding request: Maintaining role of CCM and eligibility criteria for CCMs (ensuring appropriate multi- stakeholder representation) CCM decides on how to apply for funding: For NSA Second Wave: CCM to decide whether to submit NSA (based on jointly assessed national disease strategy) or whether to apply through regular proposal For HSFP Pilot: CCM to decide whether funding request should be based on jointly assessed health strategy or whether regular proposal should be developed Submission of funding request: Submission by CCM In addition: In case of joint assessment showing insufficient multi-stakeholder inclusion in development of the strategy, need for CCM to describe „remedial actions“ Selection of PRs: Maintaining of Dual-Track Financing policy *Current thinking – input required

31 1.How to ensure joint assessment organizing body at country level incorporates civil society as part of preparation process? 2.How to ensure selection of an appropriately qualified and unbiased ‘civil society expert’ for assessment team? 3.How to ensure consistent and thorough assessment of ‘MSI attribute’ across countries? 4.What mechanism to support development and application of appropriate ‘remedial actions’ where weaknesses found in ‘MSI attribute’, and follow up on these? Multi-stakeholder involvement Issues requiring further elaboration