Guggi Laryea Civil Society Focal Point World Bank The International Health Partnership and related initiatives (IHP+) Presentation for the Action for Global Health Conference Madrid May 26, 2008

What is the IHP+? Country-focused and country-led Builds on existing structures, mechanisms, and country health plans Provides long term, predictable financing for results-oriented national plans and strategies Ensures mutual accountability for delivering on compact commitments A renewed effort to support countries in achieving their health MDGs (1b, 4, 5, 6) Through a single harmonized in-country implementation effort With scaled-up financial, technical and institutional support for health MDGs How will it be implemented?

IHP+ Signatories As of 23 May 2008, the IHP global compact has been signed by: Ten Ministers from developing country governments (Burundi, Cambodia, Ethiopia, Kenya, Madagascar, Mali, Mozambique, Nepal, Nigeria, Zambia), Nine international organizations (WHO, World Bank, Global Fund, GAVI Alliance, UNFPA, UNAIDS, UNICEF, UNDP, EC), Eleven bilateral donors (Australia, Finland, Sweden, UK, Norway, Germany, France, Italy, Portugal, Canada and Netherlands), and Other donors (Bill & Melinda Gates Foundation & African Development Bank).

International Health Partnership Catalytic Initiative to Save a Million Lives UN SG MDG Africa Initiative Innovative Results- Based Financing Providing for Health Initiative Deliver Now For women and children Global Fund National Strategy Applications GAVI Health Systems Strengthening Health Metrics Network Global Health Workforce Alliance IHP+ Related Initiatives

Objectives of the IHP+ Four main objectives consistent with the Paris Declaration on Aid Effectiveness: 1.Developing results-focused, country-led compacts that rally all development partners around one national health plan; one M&E framework; and one review process, thus improving harmonization, alignment, focus on results and mutual accountability 2.Generating and disseminating relevant knowledge, guidance and tools 3.Enhancing coordination and efficiency at country, regional and global levels 4.Ensuring mutual accountability and monitoring of performance

Why now?

Progress towards MDGs: inadequate Trend in Under-Five Deaths, (Millions deaths per year)

Progress towards MDGs: inadequate No region is on track to reduce maternal mortality by three-quarters by 2015.

Health system constraints: unaddressed Human resources Production, retention and migration Infrastructure L ogistics, procurement, physical infrastructure Catastrophic health spending Reduction of out-of-pocket expenditure, social protection Ineffective delivery Integration and coordination, primary care, community engagement, non- state providers, management

Investment in health: insufficient

International funding: unpredictable

MOH MOEC MOF PMO PRIVATE SECTORCIVIL SOCIETYLOCALGVT 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 Support to countries: inefficient

The challenge to put an end to deaths from preventable and treatable illnesses needs ALL of us to join forces.

Value-Added of the IHP+ Country-focused and country-led activities ONE costed, results-oriented national health plan Build consensus and inclusion of all stakeholders through Country Compacts Long-term predictable financing for strengthening health systems which addresses volatility, fiduciary and procurement issues Improved harmonization and alignment of aid which reduces fragmentation and transaction costs Improved coordination between country governments and development partners Strengthened mutual accountability and transparency

Strengthening Health Systems The fragmentation of donor assistance to health, including fragmented financing of health systems strengthening, generates serious constraints to the delivery and sustainability of results in health, including: –Funding distortions –Increased transaction costs –Unpredictable donor financing; –Lack of fungibility of donor financing (earmarked/vertical programs); –Poor donor coordination/harmonization; –Lack of absorptive capacity (HRH, health systems); –Insufficient cross-sectoral coordination/investment IHP+ aims to facilitate better coordination and increased financing for health based on country-led processes for improved results by rallying partners to support and take forward one costed, validated, results-oriented national health plan through the signing of country compacts, which will contribute to broader goals of overall health systems strengthening.

Empowering Women The IHP+ seeks to improve results for achieving the health MDGs – 1b, 4, 5, and 6, however progress against these MDGs will have positive spill-over effects and may lead to advances in other areas, such as improving gender equality and empowering women (MDG 3). Gender inequalities contribute to poor progress against MDG 5. –Due to lack of access to information and family planning services, 108 million married women in developing countries have an unmet need for contraception. –66% of unintended pregnancies occur among women who are not using any method of contraception. Access and availability of high-quality contraceptive information and services would prevent many unintended pregnancies and reduce induced abortions. –If contraception were provided to all women who lack access, maternal mortality would decline by 25%–35%. By delivering on health MDGs through the IHP+, other positive results, such as women’s empowerment and improved gender equality, should be achieved.

Possible Elements of a Country Compact ONE single country health plan ONE single results framework ONE single policy matrix ONE single budget that will be the basis for funding ONE single mutual monitoring and reporting process ONE single country-based appraisal and validation process for the country health plan Benchmarks for government performance Benchmarks for development partner performance Agreement on aid modalities Process for resolution of non-performance and disputes

ONE National Health Plan Central to the compact is the national health plan and how it will be used in the new aid environment:

Common Monitoring & Evaluation Framework

IHP+ Management Structure

The role of the IHP+, country level

Civil Society’s involvement in the IHP+ –Concept note on CS Engagement drafted and commented on; currently being revised –Consultation on mode of engagement has taken place –2 CS members on steering SuRG –1 southern CS solicited for business SuRG –1 CS member will join each thematic working group –A consultative group will be formed

Value Added of Civil Society in the IHP+ Engage and provide guidance on the implementation of the IHP+ work-plan – assisting in the facilitation of the IHP+ process at the country level by encouraging local civil society organizations to participate in all stages of the development and implementation of country compacts; Facilitate and improve dissemination of IHP+ outputs – sharing good practices widely through existing networks, – supporting implementation of locally appropriate implementation methods and strategies, –establishing linkages with other existing similar or complimentary efforts. Monitor progress achieved as a result of the IHP+ – advising on ways to strengthen effectiveness of the IHP+ process and – effectively relaying potential and existing bottlenecks to implementation (global and country level) for problem solving (donor bottlenecks, implementation bottlenecks, etc) Ensure responsiveness of the IHP+ to government-led, inter-agency country teams, holding IHP+ development partners (donors, governments, etc.) accountable.

Conclusions MDG goals 1b, 4, 5 and 6 will not be achieved without a revised and streamlined approach to implementation, which will require collaboration of all development partners. The IHP+ is an opportunity to harmonize and align development partners for improved health-related MDG outcomes, in line with the Paris Declaration on Aid Effectiveness. The focus of IHP+ is results at the country-level. Compacts are based on ONE National Health Plan Civil Society is key to ensuring successful implementation of the IHP+

Thank You!