Synergies and Linkages Planning, Policy, Strategies and Programmes

Transcription

1 Synergies and Linkages Planning, Policy, Strategies and Programmes 12 May 2010 Significant increase in funding for health 1

2 New Donors USA Japan Gates Foundation UK Germany France Canada $ billion $ billion $ billion $ billion $ billion $ billion $ billion But, as with all good and new things.there are some concerns New foundations: from

3 More health for the money High Level Taskforce on Innovative International Financing for Health Systems Establish a health systems funding platform for the Global Fund, GAVI Alliance, the World Bank and others to coordinate, mobilize, streamline and channel the flow of existing and new international resources to support national health strategies Taskforce final report - May 2009 UN General Assembly 2009 side event & Outcome document US$1 billion for expanded IFFIm Results based buy downs Voluntary solidarity contributions De-Tax Ongoing work 2010 The Global Fund, GAVI Alliance, World Bank, and World Health Organization Working Group 4 work streams around appraisal, financial management & procurement, a common performance measurement framework and harmonised technical support Consultations with Track I and II countries, Jan- June 2010 Global Fund and GAVI Alliance Governance Committee decisions, April and June 5 Planning renewed interest 3

4 The Joint Platform GFATM/GAVI/WB + WHO More Health for Money - Implement Paris Declaration From Agency-based Proposal-based Multiple deadlines To Country-based National strategy based Flexible and aligned to country cycles Outside the budget cycle Contract driven Aligned to the budget cycle Accountable to country's citizens 7 Mode of Health Systems Strengthening TRACK 1 Harmonization of existing Health Systems Strengthening support with existing funding 3 Agencies (Global Fund, GAVI and World Bank) Support from WHO Single performance framework and M&E, financial management and procurement, and program oversight TRACK 2 Access to new funding for health systems strengthening 3 Agencies (Global Fund, GAVI and World Bank) Support from WHO Access funding through national health strategies or health systems strengthening strategies 4

5 Harmonization and alignment of processes and procedures of HSS programming based on existing portfolio Aim To harmonize existing processes and procedures between WB, GF and GAVI, with the facilitation of WHO, where the agencies support HSS programming in order to better align with country processes and timing Implementation approach Step 1: Consultations in 3-4 countries (Pre March, 2010) Step 2: GF/GAVI Board guidance as needed (March/Apr) Step 3: Piloting H&A in selected countries (following Board guidance) Focus Harmonized and aligned M+E frameworks, technical support, joint country missions, financial management and procurement processes Potential pilot countries for Track 1 Criteria for piloting Country demand/request Existing HSS support funded by all 3 funders Duration of support for at least next two years (i.e., until 2011) Regular health sector review process that includes review of programme and financing elements Large enough grants or credits with arrayed HSS activities that offer opportunities for reducing fragmentation, improving coordination, and creating positive synergies Does not necessarily need to be one of the 49 Least Income Countries At least one Francophone country Countries where we provide existing HSS support and could move quickly to harmonize among three agencies if the country is willing: Benin Cambodia Ethiopia Liberia Sierra Leone Senegal 5

6 Track 2 support entails enabling new access to future funding for HSS TRACK 1 Harmonization of existing Health Systems Strengthening support 3 Agencies (Global Fund, GAVI and World Bank) Support from WHO Single performance framework and M&E, financial management and procurement, and program oversight TRACK 2 New access to future funding from a health systems funding platform 3 Agencies (Global Fund, GAVI and World Bank) Support from WHO Access to funding based on national health strategy or health systems strengthening proposal Track 2 will focus on 4 priority items for funding access Priority Item Track1 Track 2 1 Appraisal/assessment processes and procedures - 2 Financial management and procurement processes 3 Common performance measurement framework 4 Mechanisms for harmonized technical support 6

7 Access to Future as Part of a Joint HSS Platform Aim To explore ways for jointly supporting HSS through: HSS funding proposal (Scenario 1) Support national health strategies, likely with JANS (Joint Assessment of National Strategies) tool (Scenario 2) Alternative mechanism most convenient for the country Approach Step 1: Global Fund and GAVI improving business models, funding allocation mechanisms, procurement & financial oversight processes, learning from JANS tool pilot countries Step 2: Global Fund/GAVI Board guidance and approval Step 3: Learning from further JANS visits Step 4: Piloting the platform in selected countries Scenario 1: Single HSS Request Definition and Scope GLOBAL FUND GAVI WORLD BANK Agreement on HSS Scope Common mechanism for tracking resources invested in HSS Access to Assessment, Approval & Common application form and guidelines; Common funding window with joint funding request Countries submit joint HSS strategy/application Joint TRP-IRC assessment and recommendation Option 1: Assessment in Geneva Option 2: In-country assessment Coordinated approval by both Boards; Option 1: GFATM and GAVI finance different components Option 2: GFATM and GAVI provide different % of funds HSS strategy in Project Appraisal Document No request for proposals HSS funding based on CAS Internal WB review and approval of HSS Approval, signing Countries may pool funding at the country level Program management & country support Joint review of implementation Joint review of implementation Joint review of implementation M&E Common performance framework (Countries prepare one report) 7

8 Scenario 2: based on Joint Assessment of National Health Strategies Definition and Scope Access to GLOBAL FUND GAVI Common definition of scope Indicative resource envelope WORLD BANK Countries develop National Health Strategies, with distinct cross-cutting HSS element Joint in-country assessment of the National Health Strategies based on IHP+ JANS approach* Countries with favourable assessment invited to submit funding request Assessment, Approval & Joint review and recommendation to Boards Board approval** Implementation overseen by lead implementer Contribution Contribution Contribution Program management, country support & M&E Country-led harmonized program implementation Joint annual review (common performance framework) Joint Assessment of National Health Strategies and Plans Joint Assessment Tool: the attributes of a sound national strategy Draft July 2009 A companion set of Joint Assessment Guidelines, FAQ sheet and other materials, are at 8

9 Global Fund Decision Points New Prioritisation Criteria 12 points Technical merit 4 points Disease burden 4 points Poverty level 4 points CCM encouraged to identify opportunities to include MCH issues in Proposals HSS Joint Platform Track One pilot 2010 (streamline current $) Track Two pilot 2011 (joint platform new $) Cambodia Strategic Health Sector Plan, 3 Year Rolling Plans and Annual Operational Plans 18 Source: Dr Lo Veasna Kiry, MoH Cambodia 9

10 What have we learned? It is more than the sum of program plans such as MH roadmap, TB plan Blueprints won't work: it is not the "plan" that is important, but the process That process is messy; the key is inclusive policy dialogue HS Framework: Building Blocks 10

11 HS Framework: Control Knobs (Harvard Group) HS Framework: Systems Epidemiological Demographic Political Governance Social GHI investment Government expenditure Private expenditure Other external expenditure Financing Health workforce Monitoring and Evaluation Health Technologies Communities/Civil Society D E L I V E R Y Health Outcomes Fairness of Financing Responsiveness Legal Technological Economic Environmental 11

12 Conceptual Framework Aligning behind country plans Cambodia: health plan priorities and donor disbursements ( ) NSDP: NSDP: Priority Action Action Plan for Health Plan for Health (percent (percent of total) of total) Primary health care coverage Scale up equity funds Contracting in remote areas Health education (incl HIV aids) Public private partnership in basic health Communicable diseases HIV Aids Communicable diseases ( non-hiv aids) Staff incentives in remote areas Pilot health insurance Source: 2002 NSDP Donor Disbursements disbursements for Health by for Purpose Health by purpose (percent 05 of (percent total) of total) STD control including HIV/AIDS Infectious disease control Health policy & admin. management Basic health care Reproductive health care & family planning Medical services, training and research Population policy and admin. mgmt Basic health infrastructure Basic nutrition Health personnel development Health education Source: OECD, CRS database. 12

13 Service delivery has to be designed within the existing capacity MC H MC H 13