1. The International Health Partnership December 2007 Dr Stewart Tyson, DFID

2. IHP What is it? A high level agreement to apply the Paris Principles on aid effectiveness to the health sector –building on SWAP experience in many countries Commitments by all parties to Back country led national health plans Include all parties in the plan (non-state providers, CSO) Better coordinate efforts Provide assistance in ways that build sustainable health systems Mutual accountability for delivery of results Deliver more effective aid

3. What it is not A new Institution A new plan A new funding stream A new global fund for health An exclusive initiative About only budget support or pool funding

4. Apply Paris Declaration to Health 56 Action-Oriented Commitments

5. Context Paris declaration 2005 Post high level forum 2005 - 07 Global Campaign on the Health MDGs MDGs 2000 IHPGlobal Business Plan on MDGs 4&5 UNAIDS 3 Ones Increased aid effectiveness Increased resources

6. Context (2) More aid for health $6-$14bn (2000-2005) But limited reach of much investment: AIDS, TB, Malaria,childhood vaccination Much aid is off plan-not funding national priorities Complex and fragmented architecture Use of parallel systems rather than government Large transaction costs for governments “The result is limited reach and effectiveness of much aid”(World Bank & AU health strategies)

7. Complex architecture ….. MOH MOEC MOF PMO PRIVATE SECTORCIVIL SOCIETYLOCALGVT NACP CTU CCAIDS INT NGO PEPFAR Norad CIDA RNE GTZ Sida WB UNICEF UNAIDS WHO CF GFATM USAID NCTP HSSP GFCC P DAC CCM T-MAP 3/5 SWAP UNTG PRSP

8. Fragmentation….. Source; Don De Savigny & COHRED

9. Complex in-country Supply Chains!

10. Transaction costs.. 800 750 700 650 600 550 450 Vietnam(791) Cambodia(568) Honduras(521) Mongolia(479) Uganda(456) 10 453 missions in 34 countries in 2005 Number of donor missions in 2005

11. Developing country messages current aid make it hard to strengthen health systems need flexible, predictable and long term financing to budget for long term high transaction costs of dealing with multiple international partners; who operate outside of national planning & budgeting processes & compete for scarce resources, particularly staff; recognise benefits of targeted investments, but want to see greater coordination and integration of international support; ‘campaign vertically spend horizontally’ suspicious of new donor initiatives over which they have little influence; limited faith in their international partner’s performance in delivering on their commitments

12. International messages High-level political commitment for health lacking ; increase & sustain investment in health; overcome policy, implementation & governance obstacles to progress; Little confidence in quality of many national health plans: divorced from meaningful budgets; avoid difficult issues (eg gender, SRHR); exclude the non-state sector; Concern over limited capacity to implement health plans; inadequate engagement of supporting sectors such as water, education and transportation; Little confidence in accountability mechanisms to citizens; Must see support translated into improved health outcomes to maintain the case for aid to taxpayers

13. CSO messages Some irritation at the process and non- engagement Look to structured GFATM-like governance structure Generally supportive of principles AIDS lobby perceive threat to ‘AIDS exceptionalism’ and potential diversion of focus and resources

14. Mid -2007…a political opportunity New health leaders WHO, WB, GFATM Coordination H8 Group (UN, Major GHI, Gates) New UK Government-convinced of need for more effective aid and more aid Concept note for what became IHP High level compact-signed by 8 first wave countries, H8 group, UNDP, EC, IMF, and 8 bilaterals at launch September 2007

15. Developing countries will… Invest more in health Address policy constraints Strengthen planning & accountability mechanisms Link aid to demonstrable improvements in outcomes (MDGs, HSS)

16. Donor partners will… Better coordinate their support around National Health Plans Provide aid in ways that strengthens health systems Where possible, provide long term, more flexible support delivered though national systems

17. Civil society will Engage in design, implementation and review of National Health Plans and the Partnership at global and country level Deliver high quality health services, in line with national plans The performance of all parties will be subject to a joint review at country and global levels

18. What will success look like (1)? All partners work to achieve national health objectives as laid out in robust national plans that include the contributions of public, private and civil society providers. All share a collective commitment to help implement the plan effectively and deal with bottlenecks to progress and emerging issues. All external support is provided in ways that strengthen health systems and facilitate the delivery of a coordinated package of basic services that respond to all major health challenges and achieve results.

19. More resources are provided as long term, flexible aid with a greater proportion delivered through national systems. There is a clear, inclusive, credible monitoring mechanism that is able to demonstrate progress in improving health outputs/outcomes on an annual basis. International agencies are encouraged to rely on joint appraisal and reporting systems rather than requiring their own separate arrangements. What will success look like (2)?

20. Signatories… so far Zambia, Nepal, Kenya, Burundi, Mozambique, Ethiopia, Kenya, Mali UK, Norway, Netherlands, Germany, France, Italy, Portugal, Canada WHO, UNAIDS, UNICEF, UNFPA, World Bank, GFATM, GAVI, UNDP, IMF, ILO, AfDB, EC, Gates

21. Next steps Multilateral lead WHO/WB Develop country level compacts UK resources for process via WHO/WB and to first wave countries Engage US and Japan –G8 Meeting of first wave countries in 01/08 Ministerial meeting -margins WHA 05/08

22. Lessons from DFID SWAp Review Takes time to get processes working – IHP to build on these and not start again SWAp structures help coordination, allocation – IHP to encourage discipline Staff or minister changes – anticipate them, coordinate response, contingency plans

23. Lessons from DFID SWAp Review Mix of aid instruments is desirable – plan across donors – IHP role in this? Participation – neglected early on, IHP to address and learn lessons? Mutual accountability – often poor EDP performance, IHP to push accountability