Guidelines

1
Applying the Paris Principles on Aid
Effectiveness
What does this mean for AIDS Financing?
The contribution of health systems strengthening
to achieving universal access
Dr Carissa Etienne Assistant Director-General
Health Systems and Services
2
OUTLINE

• Health systems challenges
• The emerging vision of universal access
• Health financing and social protection
• Investing in health

3
Health systems challenges
1. Human resources 2. Infrastructure
3. Catastrophic health spending 4.
Ineffective delivery 5. Insufficient funds
4
What is a health system?

• A health system consists of all organizations,
  people and actions whose primary intent is to
  promote, restore or maintain health.

5
Health systems continued

• Health systems building blocks

6
The emerging vision of universal access

• All actions to strengthen health systems MUST be
  built upon the core principles and values of
  Primary Health Care
• Social justice
• Equity
• Solidarity
• "Health for all" is relevant for ALL countries
• Guided by responsiveness to peoples needs and
  their growing expectations
• Putting people at the centre of health care
• Organization of health services is a country
  specific decision and country-led process

7
The emerging vision continued
Framework for PHC reforms
Health equity Solidarity Social
inclusion (Universal Coverage reforms)
People centred care (Primary Care reforms)
What citizens expect for their personal life and
that of their families
What citizens aspire to for their society
Communities where health is secured (Public
Policy reforms)
Health authorities one can rely on (Leadership
reforms)
8
Health financing and social protection

• World Health Assembly 2005 All Member States
  adopted a resolution on Sustainable health
  financing, universal coverage and social health
  insurance.
• The resolution urged countries to develop health
  financing systems that
• Ensure all people have access to needed services
• Do not expose users to risks of financial
  catastrophe and impoverishment
• 2. The resolution recognized the diversity of
  national health systems and the need for unique
  responses

9
Health financing and social protection
continued
Number of People with Catastrophic Expenditure
and Impoverishment due to Health Spending
financial catastrophe
impoverished

Eastern Mediterranean
Africa
Europe
South-East Asia
America
Western Pacific
0
30
60
90
Number of people (millions)
10
Health financing and social protection
continued

• Specific policies
• Conditional cash transfers subject to fulfilling
  certain conditions (e.g. vaccinations)
• Vouchers (e.g. to better access health services)
• Waivers and exemptions
• Policies integrating the poor
• Universal provision of health services (UK)
• Explicit inclusion of the poor in social health
  insurance (F)

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Investment in Health how do we improve?
1. Raise additional funds where health needs are
high and revenues insufficient. 2. Reduce
reliance on high out of pocket payments by moving
towards pre- payment. 3. Improve social
protection by ensuring the poor and other
vulnerable groups have access to necessary
personal and non personal services. 4. Improve
efficiency of resource use by focusing on the
appropriate mix of resources. 5. Promote
transparency and accountability in health
financing systems.
12
The International Health Partnershipand related
initiatives IHP
Objectives

• Develop results-focused, country-led compacts
  that rally all development partners around one
  national health plan one ME framework and one
  review process.
• Generate and disseminate relevant knowledge,
  guidance and tools.
• Enhance coordination and efficiency at country,
  regional and global levels.
• Ensure mutual accountability and monitoring of
  performance.

13
IHP Signatories

• As of 23 May 2008, the IHP global compact has
  been signed by
• Ten Ministers from developing country governments
  (Burundi, Cambodia, Ethiopia, Kenya, Madagascar,
  Mali, Mozambique, Nepal, Nigeria, Zambia),
• Nine international organizations (WHO, World
  Bank, Global Fund, GAVI Alliance, UNFPA, UNAIDS,
  UNICEF, UNDP, EC),
• Eleven bilateral donors (Australia, Finland,
  Sweden, UK, Norway, Germany, France, Italy,
  Portugal, Canada and Netherlands), and
• Two other donors (Bill Melinda Gates Foundation
  African Development Bank).

14
Value-added of the IHP

• Country-focused and country-led activities.
• One costed ,results-oriented country health plan.
• Build consensus and inclusion of all stakeholders
  through country compacts.
• Long-term predictable financing for strengthening
  health systems, which addresses volatility,
  fiduciary and procurement issues.
• Improved harmonization and alignment of aid,
  which reduces fragmentation and transaction
  costs.
• Improved coordination between country governments
  and development partners.
• Strengthened mutual accountability and
  transparency.

15

• Thank you!