1. Towards Aid Effectiveness The Role of the Donor Community
The Palestinian National Authority Ministry of Health Palestinian Health Conference “Toward Quality and Sustainable Health Services” Ramallah, Best Eastern Hotel, May 7-8, 2009
Towards Aid Effectiveness
The Role of the Donor Community
Angelo Stefanini MD, MPH
Italian Development Cooperation

2. MOH National Conference Ramallah, May 7-8, 2009
Summary
Challenges for the Palestinian Health Sector
Possible future scenarios
Role of Donors, MOH & Mutual Responsibilities
Agenda ahead (& Questions)
MOH National Conference Ramallah, May 7-8, 2009

3. MOH National Conference Ramallah, May 7-8, 2009
Main challenges for the Palestinian Health Sector Adapted from: World Bank, 2009
Fragmented, unbalanced
Inadequate financial protection
Low MOH management & stewardship capacity
Increasing burden of NCD
MOH National Conference Ramallah, May 7-8, 2009

4. Causes of present situation Mataria et al., Lancet 2009
Internal
Lack of control over health determinants
External
Political instability
Occupation policies (access and movement restrictions)
Donors-related
Fragmented, short-term and unpredictable
Multiplicity, conflicting agendas
Bilateral arrangements
From development to humanitarian assistance
MOH National Conference Ramallah, May 7-8, 2009

5. MOH National Conference Ramallah, May 7-8, 2009
Health Financing by Source (2004) Source: World Bank Public Expenditure Review, 2007.
MOH National Conference Ramallah, May 7-8, 2009

6. MOH National Conference Ramallah, May 7-8, 2009
In summary:
Most pre-conditions for meaningful reforms are absent
Role of international partners is crucial
MOH National Conference Ramallah, May 7-8, 2009

7. Moving forward Mataria et al., Lancet 2009
Under the best-case scenario
MOH as the steward of the system
Under the worst-case scenario
Emergency relief (+capacity development)
Under the status quo scenario
Donors and providers coordination & harmonization
MOH National Conference Ramallah, May 7-8, 2009

8. The Paris Declaration on Aid Effectiveness (March 2005)
Aid would be most effective if:
Partner countries exercise greater leadership over development policies and plans (ownership)
Donors base support on country priorities and systems (alignment)
Donor agencies coordinate their activities and minimise transaction costs (harmonisation)
Together partner countries and donors manage for results (managing for results) and
Are accountable to each other in achieving real results from aid (mutual accountability).
MOH National Conference Ramallah, May 7-8, 2009

9. MOH National Conference Ramallah, May 7-8, 2009
Aid modalities
Project Aid
Using parallel systems
Using govt. systems (Planning, Budgeting, Procurement, Accounting, Reporting, etc.)
Pooled Funds or Programme Aid
Budget Support
Sector BS (earmaked or to a discrete sub-sector activity)
General BS
Sector-Wide Approach (SWAp)
MOH National Conference Ramallah, May 7-8, 2009

10. When Project Aid, then Source: PNA’s Partnership Principles
Support PRDP’s priorities
Explain why project approach
Follow PNA’s systems (e.g. budget classification, procurement procedures)
Provide multi-year projection
Joint Reviews (Donor/PNA)
MOH National Conference Ramallah, May 7-8, 2009

11. Mutual Responsibilities Source: PNA’s Partnership Principles
Systematic information sharing
Joint analytical work
Joint approaches to review and monitoring
Working with, and through, each other
Rationalising number of sectors (division of labour as per EC Code of Conduct)
MOH National Conference Ramallah, May 7-8, 2009

12. Donor’s Responsibilities
Make aid effectiveness a priority
View ourselves as “players” (development partners) as well as “payers” (donors)
Align projects with NSHP’s goals
Provide information on mid-term funding
Regularly update MOH on interventions
Coordinate timing & content of missions
Aim at joint analytical work & development programmes
Work towards pooling funding & SWAP
Invest in the Health Sector Working Group
MOH National Conference Ramallah, May 7-8, 2009

13. MOH National Conference Ramallah, May 7-8, 2009
PA responsibilities
Draw up annual operational plans/budgets
Monitor/evaluate NSHP implementation
Decline projects/programmes not in line with NSHP
Share financial procedure & budget
Devote dedicated human resources to sector harmonization
Invest on HSWG
MOH National Conference Ramallah, May 7-8, 2009

14. MOH National Conference Ramallah, May 7-8, 2009
The Agenda ahead
Step 1: Donor’s internal scrutiny (both here and at HQs)
Step 2: Informal consultation with core partners to agree preliminary platform
Step 3: Build dialogue with MOH leadership
MOH National Conference Ramallah, May 7-8, 2009

15. MOH National Conference Ramallah, May 7-8, 2009
Questions to MOH
Is the MOH willing to upgrade coordination practices?
Is the MOH prepared to negotiate with donor agencies mutually binding commitments?
Would the MOH accept a more proactive focal donor?
Is the MOH open to external scrutiny, in order to strengthen its inner functioning?
MOH National Conference Ramallah, May 7-8, 2009

16. MOH National Conference Ramallah, May 7-8, 2009
Questions to Donors
Are donors willing to recognize the need for a major shift in their way of working in the Palestinian Health Sector?
Are donors prepared to negotiate with the MOH mutually binding commitments?
What commitments are offered by donors in return?
MOH National Conference Ramallah, May 7-8, 2009

17. MOH National Conference Ramallah, May 7-8, 2009
Thanks for Your Attention
MOH National Conference Ramallah, May 7-8, 2009