Documenting results of efforts to improve health aid effectiveness

Case study: BENIN

Geneva, 27-28 October 2011

Elisabeth PAULBased on a report prepared by Christophe

DOSSOUVI

228 October 2011

Context• Low economic growth and budget execution

rates• Positive evolution of ODA (22% of P.E.), but

weak quality of data on executed external funding

• Proportion of health in the budget has stagnated over the past 10 years; State budget allocation reduced in 2011

• External funding accounts for ¼ of health budget

• Health sector coordination framework still not very well defined / organized; little effective fora for donor-MoH policy dialogue (2 meetings/year + annual performance review) no real health SWAp

• NHP = PNDS 2009-2018, PTD 2010-2012• Benin joined IHP+ in 2009, signed national

Compact in November 2010 with 5 donors – but some important pillars of the Compact were lacking: coordination, M&E and fiduciary frameworks not defined

328 October 2011

Q1: To what extent have aid effectiveness principles been

put into practice?• Donor coordination and joint reviews, but no real SWAp before IHP+ progress is recent

• Progress in ownership of national strategies at central level – but implementation problems

• Leadership is lacking (governance problems)• Some alignment on national strategies:

PNDS/PTD• Much less alignment with national public

financing and procurement systems (not reliable)

• Recent progress in harmonization: joint HSS platform (WHO, WB, GFATM, GAVI + BTC) >< yet, risk to weaken the more global Compact process

• M&E / PNDS performance plan recently developed

• Little progress in MfDR (OK theoretically but not in practice; PBF is starting on a large scale) and mutual accountability

4

Q2: Has this helped to improve results?

Results 1: Has aid effectiveness actually improved?• Growing external funding for health, but

decrease in State budget allocations to health in 2011 + low execution rates

• Predictability of aid is very limited (+ difficulty for the GoB to collect information)

• IHP+ Compact & search for effectively implementing it renewed impetus to collaboration between donors

• Joint HSS platform reduction in transaction costs + first step towards joint financing agreement in the health sector (no pooling but common PIU + procedures)

• More coherent support to HSS and distribution of districts between donors

28 October 2011

5

Q2: Has this helped to improve results?

Results 2: Has the health system been strengthened?• Participative process consensus over

the PNDS/PTD; yet, still misgovernance

• Various problems associated with financing (allocation / execution + underperforming PFM)

• Good coverage of infrastructures• Public sector HRH coverage has

deteriorated in recent years + regional disparities

• Better organization of the drug/med.product sector

• Still quality problems of data provided by NHIS; new M&E plan should drive improvements

28 October 2011

6

Q2: Has this helped to improve results?

Results 3: Have health services improved?• Performance still unsatisfactory against

targets, yet some progress has been recorded in recent years, specifically MCH indicators which are at relatively high levels:– Sharp reduction in MMR (224 137, 2003-2008) – HIV/AIDS preval., pregnant women (2.2%1.7%,

2003-2007)– Rise in HF consultation rate (38% 46.8%, 2003-

2010)– Stagnation of some indicators (ANC1 94% in

2010; ANC4 61% in 2006; assisted deliveries 80% since 2001)

– Inadequate neonatal care• Overall: progress in outcomes, but not

systematically linked to (weak) public-sector performance private sector has made an enormous contribution towards achieving the MDGs in Benin

28 October 2011

7

Q3: Decisive factors and constraints

overcomeMain factors contributing to achievement of results:• Coordination of donors (even if

imperfect)• Participative preparation process of

PNDS 2009-2018• Annual sector performance reviews• Thematic working groups & coordination

at national level• IHP+ new momentum to the sectoral

approach / MDGs• Search for ways to implement the

Compact in practice, especially through the HSS platform strengthened collaboration among a “core group” of donors

Progress at process level, that are expected to yield progress at results level

28 October 2011

8

Q3: Decisive factors and constraints

overcomeMain constraints:• Lack of MoH leadership + misgovernance of the

sector• Maladjustments in the sectoral coordination

framework + problems with quality and analysis of data have to date precluded ongoing and priority-focused policy dialogue donors often had to take the initiative to get projects moving

• MoH lost technical & financial support with WB/EC GBS

• Heterogeneity of donors no single voice towards MoH

• IHP+ process itself constrained by:– Weak leadership and ownership of MoH (except

DPP)– Nonexistence of a sectoral approach before

Compact with a number of undefined basic components (fiduciary, coordination and M&E arrangements) delayed implementation

– HSS platform reluctance of some other partners, and risk to weaken the more global Compact process

• Recurrent strikes and insufficient resources at operational level

28 October 2011

9

Conclusion and perspectives

• IHP+ & Compact undeniably acted as a catalyst for a sectoral approach, giving substance to aid effect. principles

• Yet, as certain basic components of the Compact were not defined when the document was signed, it has taken some time before being translated into practice

• HSS platform initiated by donors:– First concrete step to harmonization

(alignment seems not possible so far)– Possible nucleus for implementing the

Compact if extended to the whole PNDS + all donors

• To date, the results of putting aid effectiveness principles into practice are noticeable only at the process level, but promising outlook in terms of results provided improved MoH governance, relaunch of policy dialogue & HSS

28 October 2011