1. VIET NAM 5 th IHP+ Country Teams Meeting Session 4c: Middle income countries (MICs) On behalf of the Health Partnership Group

2. Viet Nam’s transition to LMIC status #1 Total population of 89.7 million Since economic reforms of the late 1980s: GNI per capita <$100 in 1986 → $1,920 in 2013 Economic growth (av. 6.4% per year for the past decade) Steady increase in ODA commitments (1993→2010) Economic growth → 75% reduction in poverty, increased living standards and improved health

3. Viet Nam’s transition to LMIC status #2 LMIC status granted in 2010 when GNI per capita reached US$1,270 External resources for health (ODA) = 3% of THE at this time. Government expenditure on health = 45.2% of THE Since 2010, health ODA has dropped to 2.4% A small reduction, but the impact has been felt. Global financial crisis impacting donor budgets and Viet Nam’s own economy. Government expenditure on health has dropped to 40.8% of THE in 2012. In real terms, 2.4% is represented by 38 ODA projects in health, totalling approx. US$1.5 billion.

4. Viet Nam’s commitment to aid/development cooperation effectiveness Health Partnership Group HPG 2005 Hanoi Core Statement HCS t Joint Annual Health Review JAHR 2007 Statement of Intent SoI 2009 VHPD 2013 Government, Bilaterals, multilaterals, INGOs, private sector, & CSOs/NGOs

5. Now an LMIC, what has changed in health development cooperation? #1 National capacity is increasing (happily) Donors/development partners are withdrawing UK, Netherlands, Australia; PEPFAR in the process of withdrawing – and GFATM for HIV will end in 2016. Modalities of support are changing Grants shifting to loans; concessional loans evolving into ‘hard loans’. LMIC status does not capture the whole picture Economic growth → the rise of new challenges that require investment: increased disparities in income and health status; shifting demographic and disease patterns; increasing expectations of the health system among the population. So in response…

6. Now an LMIC, what has changed in health development cooperation? #2 The government … Has identified UHC as the overarching health development agenda Is shifting towards leveraging available technical support offered by in-country DPs especially technical support for strengthening health systems Is actively undertaking efforts to become less reliant on donor funding, for example: i ntegrating HIV services into the mainstream health system; and using donor funds to fill gaps, rather than for implementation. Is leading the HPG to implement the new VHPD, including the IHP+ commitments.

7. A few tips/lessons to share with other countries heading towards MIC status #1 Strengthen country systems (behaviour 3) for improved: i) evidence-based prioritization (e.g. TWGs); ii) planning, budgeting and financial management; iii) advocacy for investment in health; iv) monitoring and evaluation (e.g. national core list of indicators; JAHR); and v) coordination (e.g. HPG supported by TWGs) Ensure strategically planned and well-coordinated technical support by coordinating DPs around national priorities (e.g. HPG) (behaviour 7) Offer DPs a regular opportunity for policy dialogue Enable MoH to coordinate DPs’ support and ensure it is aligns with national priorities

8. A few tips/lessons to share with other countries heading towards MIC status #2 Start thinking about ways to generate funding from domestic sources - and consider innovative funding mechanisms (e.g. airline levies) to fill gaps that donor funds will leave as they withdraw Identify new sources and different types of support Maximize opportunities to learn from other countries that have had success in a particular area/issue Explore opportunities for South-South cooperation Consider strategies for reducing transaction costs in coordinating DPs/managing development cooperation With MIC status, support reduces but transaction costs are still high Finding ways for DPs to help strengthen (and use!) public financial management systems would help