1. Supporting Integrated Health Systems Strengthening A CIDA Perspective

2. 2 2 2 CIDA’s Institutional Context Mixed Approach Vertical (CEAs, INGOs, global initiatives) Horizontal (PBAs, SWAps) Shift to PBAs 2002 Policy Statement on Strengthening Aid Effectiveness Institutional Branch Structure Separation between bilateral and multilateral programming Africa, Americas, Asia, EMM Branches (Bilateral) Multilateral and Global Programs Branch (Multilateral) Canadian Partnership Branch (Canadian NGOs)

3. 3 3 3 CIDA experience with Vertical Vs. Horizontal Programming Vertical: Accountability Attribution of Results Technical expertise Target underserved populations Horizontal: Alignment of donor policies with country priorities Use of local procedures and systems. Shared accountability

4. 4 4 4 Challenges with PBAs and SWAPs Requires partner country leadership Initiate national health strategy, SWAp, etc… Health system capacity constraints: Human resource shortages Governance issues-absorption issues Coordination difficulties: Among donors, key actors outside common arrangements

5. 5 5 5 Africa Health Systems Initiative (AHSI) 3 focus areas 1. Front-line health workers 2. Health information systems 3. Equitable service delivery Primarily bilateral funding Multi-bi component (UNICEF 2007-2012) Based on government priorities: train 40 000 community health workers and deliver basic health services

6. 6 6 6 Multi-donor Initiatives International Health Partnership (IHP) Mobilizing donor countries and other development partners around a single country-led national health strategy Agreeing with governments on the sources and amounts of funding for the health plan Joint assessment CIDA signatory in Mali and Mozambique

7. 7 7 7 Country Example: Mali Bilateral Funding – Africa Branch Project (2003): reproductive health project in Kayes region via Canadian Executing Agency Programme-based approach (PBA): 2004/2005 earmarked funds for the reg: 1. operational plans in 3 regions of North Mali 2. paramedic training support –national. SWAp: 2006–2012 direct budget support incorporation of 3 projects and regional epidemiological surveillance support project International Health Partnership (IHP) – 2009 Country Compact

8. 8 8 8 Mali (Cont.) Strengths: Biannual joint monitoring and evaluation reports on national and regional health indicators Common operational plans, joint annual review, joint monitoring and evaluation, common results indicators Detailed HRH strategy and budget Long-term commitments (programs renewed) Sustainability Weaknesses: Some key players outside the SWAp Attribution not possible

9. 9 9 9 Country Example: Bangladesh Health sector support since 1976; SWAp since 1998 Support national priorities through parallel projects identified in SWAp (2005-2010) Strengths: Challenges: Issues of systems and governance capacity eg.slow disbursements External procurement Smalll contribution to pooled funds within SWAp ($5m)

10. 10 Summary Mixed approach -varying levels of country leadership and capacity. Sector and donor coordination needed -takes time and effort. SWAPs have worked best in sectors (with strong public investments and) where government is the main service provider. Adopting a sector development perspective as the basic point of departure.