PARTNERSHIP FOR HEALTH DEVELOPMENT Dr. Mirta Roses Periago DirectorAMRO 4th Global Meeting of Heads of WHO Country Offices with DG and RDs Geneva, November 2007

What does it mean Partnership for Health Development?

Typology to classify Partnership Research and Development Technical assistance/service support Advocacy Financing

MOH MOEC MOF PMO PRIVATE SECTORCIVIL SOCIETY GOVERNMENT NACP CTU CCAIDS INT NGO PEPFAR Norad CIDA RNE GTZ Sida WB UNICEF UNAIDS WHO CF GFATM USAID NCTP HSSP GFCCP DAC CCM T-MAP 3/5 SWAP UNTG PRSP Source: Mbewe, WHO

Major negative consequences of GHP interactions with countries Countries struggle to absorb GHP resources because GHPs do not provide adequate technical and other support to implement programs Countries are burdened with parallel and duplicative processes and systems from multiple GHPs, since GHPs often bypass and undermine those that countries already have in place A.Shifts in policy and technology not well supported B.Relevant assistance for implementation not forthcoming C.Country coordination forums proliferating and not set up to be effective A.“One size fits all” processes do not recognize country diversity” B.GHP-led efforts on cross- cutting system-level issues cause duplication Consequences of GHP interactions Complication: GHPs have not communicated effectively with countries and partners

Hosting missions and report writing are major burdens at the district level *Assumes around 50 working days per quarter and 100 per half year although reported to work in excess of that Source: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

GHP communication is weak on multiple levels, especially with countries Communication channels “It is almost impossible to get responses by or phone from our GHP contact....” “... even if were to reach him, we don’t feel like we could push back.” Variation in quality/quantity of communication with GHP Communication channels inadequate Unclear feedback Perceived lack of secretariat’s country knowledge Weaknesses Country GHP Secretariat “We don’t have formal agreements with partners.” “Field offices receive no guidance on how they should cooperate with or support GHP programs.” Lack of clarity on roles/responsibilities to support GHP activities Multilateral/ Implementing Partners GHP flexibility not clear to country (do not feel empowered to ask)

Challenges Countries struggling to absorb partnerships resources The need for enhanced coordination of partners Country coordination mechanisms and forums proliferating Performance-based funding approaches Partnerships bypassing and undermining country plans and processes Distorting effects of uncoordinated funding flows

Challenges Proliferation of partnerships leading to lack of clarity of roles and responsibilities with other implementing partners. Inadequate information flow Restricted concept of partnerships.

Governance Challenge Accountability frameworks for Partnerships and countries Internal governance Representation on multiple boards Interface of PHDs with multilateral organizations

Thank you Dr. Mirta Roses Periago AMRO’s Director