Action For Global Health

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• Action For Global Health
• Health as a Tracer Sector
• Berlin 8 April 2008
• Elisabeth SANDOR
• OECD DCD

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Content

• 1. Background on Health as a tracer sector
• 2. The challenges and progress
• in Aid Effectiveness in Health
• 3. Health as a Tracer Sector in Accra

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Better results are needed !

• Tracking Health MDGs in SSA
• HIV prevalence among pregnant women aged 15-24
  only 8 out of 36 countries on target
• TB prevalence only 4 countries on target, 27 with
  worsening trend
• Under-5 Mortality Rate 2 countries on target, 25
  making progress but behind time-bound target, 9
  with worsening trend
• Source Global Fund, 2007

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Background

• High-Level Fora on Aid Effectiveness and Scaling
  up for Better Health (2004-2006) focused on AE
  lack of aid predictability, alignment and CH,
  insufficient ownership and use of country systems
  produced best practice for GHPs interventions
  in countries
• Dec.2006 WHO/WB/OECD meeting on Aid
  Effectiveness and health participants endorsed
  Health as a tracer sector
• Health as a tracer sector to feed the broader
  agenda on AE (best practice, lessons, keeping
  public support to financing for development)

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Background (2)

• OECD work on AE in health DCR 2007, DCD EFF
  coordinates with IHP and other health-related
  initiatives (HMN, IHME, Global Innovative
  financing), preparation of HLF3 in Accra
• One Task Team on HaTS to pilot and guide the
  work up to Accra and beyond (links with IHP and
  UNSG Steering Committee on MDGs in Africa)
• So objective not only for Accrabut keep Health
  as a source of lessons for better AE/results and
  development impact

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The challenges in AE in Health more aid is
needed

• Health captured a large part of the ODA increase
  but more aid is still needed to reach common
  agreed objectives (also DAH increase brings
  greater need for accountability)
• The current uncertainties about future increase
  of aid
• The bulk of the increase in DAH has been going to
  specific initiatives and few bilateral programs

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The path to delivering the 2010 promises is
getting steeper and what will there be for
health ?
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DAH has significantly increased and changed

• Most of the
• recent increase
• focused on Africa
• focused on specific diseases
• was channeled through bilateral (US) and new
  multilateral agencies (GAVI A, GFTAM)

Source Michaud 2006
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Bilateral ODAH (in constant USD millions)
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Bilateral ODAH (in constant USD Millions)
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The challenges in AE in HealthBetter aid is
neededImplementing the 2005 Paris Declaration
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The challenges in AE in health better aid is
needed

• Improve AE is key in a sector which is
• - complex (large number of actors,
  multi-sectoral nature of the determinants of
  health and multiple financing streams, health
  results require long-term and sustained
  investments)
• - heavily fragmented at global and country
  levels

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Fragmentation in international effort .
Source Don De Savigny COHRED
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Health aid can be very volatile and
unpredictable Disbursements from DAC members
2001- 2005
Source OCDE, 2007
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The challenges in AE in Health Donor aid can be
poorly aligned within country systems and
priorities

• Example from Rwanda (Scaling up for Better
  Health, 2005)
• Donor preference to disburse via NGOs/manage
  funds themselves/send them directly to
  local-level projects . Central Government manages
  only 14 of donor support to the health sector.
• Inequalities in the distribution of donor funding
  by strategic objective 18mn earmarked for
  malaria (the biggest cause of mortality and
  morbidity), 1mn for the integrated management of
  childhood illnesses and 47mn for HIV/AIDS.

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Donor collaboration is a challenge
INT NGO
WHO
CIDA
3/5
UNAIDS
GTZ
RNE
UNICEF
Norad
WB
Sida
MOF
USAID
T-MAP
UNTG
PMO
CF
DAC
GFCCP
PRSP
PEPFAR
HSSP
GFATM
MOEC
MOH
SWAP
CCM
NCTP
CTU
CCAIDS
NACP
PRIVATE SECTOR
CIVIL SOCIETY
LOCAL GVT
Source Mbewe, WHO
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The progress and remaining challengesin AE in
health

• The current renewed interest for Health Systems
  has generated a set of interventions which need
  to be coordinated/harmonised
• Changes in aid modality can have unintended
  consequences for health
• Its important to report on progress about the
  different ongoing initiatives and innovative
  financing for development

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The progress and remaining challenges in AE in
Health

• Division of labour and coordination at the global
  level informal group of the H8 and IHP
• Global Programs continuous effort to implement
  the Paris agenda
• Harmonise ME
• Change behaviour remains key

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What is Accra ?

• High Level political event on aid, a few months
  before Financing for Development in Doha
• Mid-term Stock-taking of the Paris Declaration
  mutual commitments
• Forward looking event road to 2011.
• 100 partner countries, most donors, most
  international aid agencies,
• 800 to 1000 participants
• Strong civil society engagement (consultations
  Advisory Group-CSO contribution pre Accra
  meeting)

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List of Roundtables

• RT 1 Country ownership
• RT 2 Alignment country syst, predictability
• RT 3 Harmonisation- complementarity
• RT 4 Results impacts
• RT 5 Mutual accountability
• RT 6 Civil society aid effectiveness
• RT 7 Situations of fragility conflicts
• RT 8 Sector applications (health, education,
  infrastructure)
• RT 9 Aid architecture (incl. Global Health
  Partnerships)

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Core Issues (Partner Countries) for the RTs and
the Accra Agenda for Action

• Untying
• Conditionality
• Predictability
• Division of Labour
• Incentives
• Capacity Development
• cross cutting issues human rights,
  environment, gender

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Health as a Tracer Sector in Accra

• A contribution to the Roundtable on sector
  application of the PD (will look at lessons
  Sector Wide Approaches and Programme-Based
  Approaches - across 4 sectors priority areas
  and cross-cutting issues)
• One Report on Health and Aid Effectiveness to
  take stock of progress and remaining challenges
• Other inputs to other RTs and to the Market
  place
• Concrete recommendations for the Accra Action
  Agenda
• all prepared by the Task Team on HaTS

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Examples of inputs on HaTS in Accra

• Compacts for mutual accountability in a set of
  partner countries
• Study on donors constraints to provide long-term
  health aid
• Best practice and lessons from GHPs
• Study on Human Rights and AE in health
• Monitoring progress in AE in health (country and
  global levels)

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• Thank You !
• www.accrahlf.net