1. Special Briefing on Health October 5, 2006 Development Partners Group

2. Overview Health situation and needs (Julie McLaughlin, present DPG Health chair, World Bank)Health situation and needs (Julie McLaughlin, present DPG Health chair, World Bank) History of SWAp and sector dialogue (Colleen Wainwright, in-coming DPG Health chair, Irish Aid)History of SWAp and sector dialogue (Colleen Wainwright, in-coming DPG Health chair, Irish Aid) Sector financing (Jacqueline Mahon, out-going DPG Health chair, Swiss Development Cooperation)Sector financing (Jacqueline Mahon, out-going DPG Health chair, Swiss Development Cooperation)

3. 50% of the MDGs Address Health Reduce by ½ the proportion of people who suffer from hungerReduce by ½ the proportion of people who suffer from hunger Reduce by 2/3 the mortality rate among children under fiveReduce by 2/3 the mortality rate among children under five Reduce by 3/4 the maternal mortality ratioReduce by 3/4 the maternal mortality ratio Halt and begin to reverse the spread of HIV/AIDSHalt and begin to reverse the spread of HIV/AIDS Halt and begin to reverse the incidence of malaria and other major diseasesHalt and begin to reverse the incidence of malaria and other major diseases

4. Results 2000 DHS 2005 DHS Infant Mortality Rate 99/1,00068/1,000 <5 Mortality Rate 147/1,000112/1,000 < 5s who slept under a bednet the night prior (treated net) 20.7 (10%) 36.1% (17.8%) Children <5 Underweight 29.4%21.8% Maternal Mortality Ratio 529/100,000578/100,000 Delivered by Health Professional 38%46% Contraceptive Prevalence Rate (CPR) 16.9%20% % women wanting to delay/prevent pregnancy 47.2%69% Total Fertility Rate (TFR) 5.55.7

5. Maternal Mortality  >1 women dies in every 200 deliveries: Little change in risk factors: High fertility, Low contraceptive use, malnutrition/anemia & role of women  Globally, E. Africa has lowest % women delivered by a skilled attendant at 34.5%  45% in Tanzania  Progress:  90% of women seek antenatal care  Roadmap to Reduce Maternal & Neonatal Deaths  IPT coverage (74% receive at least one dose) + increased bednet use should reduce anemia  Availability of contraceptives There has been no reduction in the risk of a woman dying due to childbirth in a decade

6. Nutrition is under prioritized & a multisectoral issue oMalnourishment & Micronutrient Deficiencies  reduce learning ability, innovation & drive, productivity affecting economic growth (2-3% GDP) oHealth, education, agriculture & social protection all need to be involved oContributes to other health problems: AIDS, maternal mortality, child mortality (nutrition associated with 50% of all child mortality)

7. Malnutrition Correlates with <5 Mortality

8. The Crisis in Human Resources for Health One physician per 138,000 peopleOne physician per 138,000 people Production, deployment, motivation, retentionProduction, deployment, motivation, retention Health professionals are different: global labor marketHealth professionals are different: global labor market Health service delivery demands multiple, highly specialized skills – cannot produce health with one cadreHealth service delivery demands multiple, highly specialized skills – cannot produce health with one cadre

9. Getting the Input Mix Right Motivated Staff Facilities (& maintenance) Drugs Trained Staff Equipment

10. Sector Wide Approach

11. Annual Review 7 Joint Annual Health Sector Reviews7 Joint Annual Health Sector Reviews Major tool used by SWAp to monitor the implementation of the HSSPMajor tool used by SWAp to monitor the implementation of the HSSP PER and MTEF are reviewedPER and MTEF are reviewed Review previous, and agree new milestones and key actions for the next yearReview previous, and agree new milestones and key actions for the next year Satisfactory? – stakeholders, M&E, MoHSW leadership/ownershipSatisfactory? – stakeholders, M&E, MoHSW leadership/ownership

12. Sector Dialogue Health Retreat in September 2005Health Retreat in September 2005 Troika chairing structure and secretariatTroika chairing structure and secretariat Revised sector dialogue modelRevised sector dialogue model Division of labourDivision of labour Aid modalities – FY06/07 - PRBS $70million, $51million basket, $53million projects (from MTEF)Aid modalities – FY06/07 - PRBS $70million, $51million basket, $53million projects (from MTEF)

13. Costs of delivering health services are increasing  Population growth, but also unit costs  Health bears the burden of the response to AIDS  More expensive drugs due to resistance  New technologies: more cost-effective, but also more costly

14. Long-Term Financial Commitments with no Predictability  Spending on AIDS ≈ total health sector budget  Global Fund, USAID & WB money for AIDS not infinite, yet costs could not be taken up in health budget  Meanwhile, large external earmarked money (mainly for AIDS) crowds out discretionary funding for health

15. Institutionalizing External Funding  Project financing budget support?  District Basket Block Grants?  Joint Rehabilitation FundCapital Dev. Grant? BUT, Sector not yet prepared  Ability to negotiate for resources  Disincentives to move fully to budget support Delays in 1 st quarter Delays in 1 st quarter Time required to process payments Time required to process payments Difficulty processing external consultant contracts Difficulty processing external consultant contracts

16. Conclusions Although sector has shown substantial success, health challenges are increasingAlthough sector has shown substantial success, health challenges are increasing HRH, Nutrition, Women’s status – issues beyond sectorHRH, Nutrition, Women’s status – issues beyond sector Good progress under the SWAp, but sector dialogue needs strengtheningGood progress under the SWAp, but sector dialogue needs strengthening Sector is organising itself, but coordination of multiple DPs is an on-going challengeSector is organising itself, but coordination of multiple DPs is an on-going challenge Commitments made today need to consider predictability of long-term funding should affectCommitments made today need to consider predictability of long-term funding should affect GBS yes, but….GBS yes, but…. How best for DPGHealth to link up with DPG in future?How best for DPGHealth to link up with DPG in future?