Seite 1 Nepal Health Sector SWAP and International Health Partnership Some Considerations Friedeger Stierle, GTZ

Seite 2 Seite 2 SWAP Component MissingPresent & Up-to date To be updated or improved 1) Policy & Strategy 2) Formalized Gov.-led process for EDP coordination, governance & mgt. arrg.mts 3) MTEF (level & use of ext. & int. res.) 4) Effective funding mechanism providing flexible and predictive funds 5) Performance monitoring system 6) Agreed process towards harmonized systems for rept., bugt., fin.mgt., procmt. 7) Broad consultation mechanism involving all actors & communication strategy SWAp agenda - Status of aid-effectiveness

Seite 3 Seite 3 Red, blue and white book … Red Book All in kind and in cash contributions White Book Source (identification) book Blue Book All technical cooperation & assistance Bilaterals & Multilaterals Bilaterals, Multilaterals; some INGOs, new emerging donors by -Donor -Programme The no book ??

Seite 4 Seite 4 Need for Better Mapping of Development Actors for improved harmonization, alignment and transparence 1.Who 2.What category of contribution Scaling up of measures of known effectiveness: “routine” work Support of change processes & innovation: “development work” 3.What link to nat. policy, strategy, programme? 4.Type of resources Financial resources (“pooled” and “parallel” financing) Technical assistance, technical cooperation 5.How to cost their value 6.What to do with off plan – off budget contributions? Some funds of global initiatives, (I)NGOs, new emerging donors 7.Humanitarian aid – development cooperation

Seite 5 Seite 5  SWAp often confused with a multi- donor programme (focusing on the public sector)  Often ritualized consultation mechanisms  Gov. showing more leadership, but no real “negotiation”culture  Focus on money Improving Effectiveness: Some Considerations

Seite 6 Seite 6  Focus on money  Yes, enough money is necessary, » but what about system quality & process improvement ?  Predictability of resources - dependency and sustainability ?  The thrust for scaling up activities – is it sidelining institutional reforms and change, and related TA/TC support?  Governance, and accountability to whom (GoN and EDPs)?  Often ritualized consultation mechanisms  Gov. showing more leadership, but no real “negotiation”culture Improving Effectiveness: Some Considerations

Seite 7 Seite 7  (Absorption) Capacity of the system – danger of substitution  What is the need for support to capacity development?  The overall picture of the health system is not sufficiently grasped by the current SWAp perspective  Actors, their activities, approaches, resources, intentions  This is needed to relate public efforts to the efforts and effectiveness of the private sector!!  Confusion SWAp = health sector support programme?  How to integrate global health initiatives and partnerships? Improving Effectiveness: Some Considerations

Seite 8 Seite Intermezzo: Global Partnerships are not new …. Source: Savigny, STI Basel, 2006

Seite 9 Seite Source: Savigny, STI Basel, 2006 But since 2000 …

Seite 10 Seite Source: Tanner, STI Basel, 2006 SWAp in a complex world full of initiatives and ideas …

Seite 11 Seite 11 Experiences so far with IHP+ Big push from DFID together with Moaoist-led MoHP Focus on IHP not so big with new Gov. No review of national compact since signature Lots of transaction costs - time would it have been better to invest all the energy which was put in the national compact into existing SWAp mechanisms? Some donors were “left out”- (but we got them in) IHP+ not replacing SWAp, but supporting it Expectation for more money Not very transparent processes, driven from global initiatives/secretariats GI stayed out of SWAp on country level Role of IHP+ (process, actors, integration in PME frameworks, results)

Seite 12 Seite 12 International Initiatives & Partnerships  Are too many - often created for political reasons and interests  Signed because nobody wants to belong to those who did not sign  Often linked to (political) persons, but what happens if persons/political leadership change? - who owns?  Tend to develop their own “organisational” structure, dynamics & logic  organisational hierarchy versus negotiated networking  Often led by an “expert approach” (knowledge-centred), but a systems (process) approach is needed  Often pretend to be strive for more integration/harmonization, but tend to develop own tools, instruments, mechanisms, and to apply those through “parallel” approaches

Seite 13 Seite 13 International Initiatives & Partnerships  Often (implicitly) expect - that country processes should adapt to their (often “centralistic”, “project-type”) approaches, but should make clear efforts to integrate themselves into country systems  Preach harmonization on the global level, but are often “absent” in country SWAps (even do counter-act SWAps?)  It’s easy to pool money, but very difficult to coordinate TA/TC  Taking into account all these, GI & partnerships can be very useful for countries, if country structures (incl. externl dev. Partners) make it clear what they need and  GI are instruments for country systems – and not the other way round !!

Seite 14 Seite Initiative on Social Health Protection Providing for Health (P4H)

Seite 15 Seite Growing International Consensus  Social Security Resolution and Conclusions, International Labour Conference 2001  GTZ-ILO-WHO Consortium on Social Health Protection, 2004  Resolution on Sustainable Health Financing, Universal Coverage and Social Health Insurance, World Health Assembly, 2005  Berlin Recommendations for Action, 2005  G8 Summit, St. Petersburg, 2006  Conference on Health Coverage in Developing Countries, Paris, 2007  G8 Summit, Heiligendamm - „Providing for Health (P4H)“, 2007  International Health Partnership (IHP+), including P4H, 2007  G8 Summit, Tokyo, 2008

Seite 16 Seite Thank You for Your Attention!