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The International Health Partnership
Briefing to the All-Party Parliamentary Group on Malaria and Neglected Tropical
Diseases
Phyllida Travis, WHO/IHP+16 October 2012
IHP+
IHP+: what it is, and why it was created
IHP+ partners, goals and what is being done
What are the results
What's the relevance for malaria and NTDs?
What is IHP+?
A partnership of countries, development agencies and civil society organizations that aim to accelerate better health services and health outcomes, particularly for the poor, by putting the Paris principles on aid effectiveness into practice. Created in 2007, with the first signatories to the Global Compact...
A strong efficient health system is needed to deliver quality services for a range of
country health priorities
Financing
Policy Directions universal coverage,
primary care, health in all policies
Strategies-Plans-Regulation Medicines
Technology & Infrastructure
Workforce
Policy dialogue within and beyond
health sector
Comprehensive, integrated, continuous
and people-centred care along the life-
cycle
Cost-effective and safe interventions: clinical &
public health
Universal access to close-to-client
networks, responsible for a defined population
Including interventions for MDGs 4, 5, 6
Trust in health authorities:● Fairness
● Protection● Competence● Accountability
Health Equity
Health & health security
Health System building blocks
Service Delivery
Outcomes
Social inclusion and participation
Country leadership
■ Value given to health, equity, solidarity, social
justice■ Individual & institutional
capacities
Including MDGs 4-5-6
Including MDGs 4-5-6
Strategic Information, Research
Effective aid
■ Ownership,
■ Alignment
■ Harmonization
■ Mutual accountability
Governance
Political commitment
Critical subsystems
Including MDGs 3
Including MDG 8
Why was IHP+ created? country reality can be..
aid fragmentation, duplication, inefficiencies, transaction costs
Belgium
France
Sweden
Netherlands
Spain
USAID
Canada
Luxembourg
WHO
UNICEF
WFP
UNFPA
Plan International
PSIHelen Keller
Medecins Sans Frontieres
Red Cross
Japan
Global Fund Against AIDS, TB & Malaria
GAVI
UNAIDSChina
UnitedNations
(5)
EU Members (6)
International NGOs (8)
DCE
GlobalInitiatives
unintended burden of multiple missions – reaches district levelunintended burden of multiple missions – reaches district level
*Assumes around 50 working days per quarter and 100 per half year although reported to work in excess of thatSource:McKinsey: In-country interviews; DMO visitor log; team analysis
PEPFAR
GFATM
NTLP
Gates Foundation
Norwegian TB
EPI
UNICEF
WHO
NACP
NMCP
London School
Total
4
2
2
1
1
1
1
1
1
1
1
16
3.00
3.00
3.00
3.00
3.00
2.00
2.00
2.00
2.00
2.00
0.25
~25.25
JICA
Finnish
Axios
UNICEF
World Vision
MoH – TB
MoH – Malaria
MoH – AIDS
MoH – EPI
MoH – Maternal Health
Weekly notifiable disease reports
Total
Harmonizing report writing can help reduce the burden
TANZANIA DISTRICT EXAMPLES
Report writing can consume even more timeNumber of full days per quarter spent on writing reports (Morogoro)
Missions can consume 10-20% of a DMO’s time:Number of one-day missions to Temeke during last 6 months
Supply logistics systems in Kenya, 2007
Contra-ceptives and
RH equipment
STI Drugs
Essential Drugs
Vaccines and
Vitamin A
TB/Leprosy
Blood Safety
Reagents (inc. HIV
tests)
DFID
KfW
UNICEF
JICA
GOK, WB/IDA
Source of funds for
commodities
Commodity Type
(colour coded) MOH Equip-ment
Point of first warehousing KEMSA Central Warehouse
KEMSA Regional Depots
Organization responsible
for delivery to district levels
KEMSA and KEMSA Regional Depots (Logistics Managagement Unit and customer service)
Procurement Agent/Body
Crown Agents
Government of Kenya
GOK
GTZ (procurement
implementation unit)
EU
KfW
UNICEF
KEPI Cold Store
KEPI (vaccines
and vitamin A)
Malaria
USAID
USAID
UNFPA
EUROPA
Condoms for STI/
HIV/AIDS preventio
n
CIDA
UNFPA
US Gov
CDC
NPHLS store
MEDS (to Mission facilities)
Private Drug Source
GDF
Government
Private/NGO
Bilateral Donor
Multilateral Donor
World Bank Loan
Organization Key
Japanese Private
Company
WHO
GAVI
SIDA
NLTP (TB/
Leprosy drugs
Supplies Logistics System in Kenya (as of January 2007) Constructed and produced by Steve Kinzett, RHSC/PATH - please communicate any inaccuracies to [email protected] or telephone +32 (0) 2 210 0221
Anti-Retro Virals
(ARVs)
Labor-atory supp-lies
Global Fund for AIDS, TB
and Malaria
PSCMC (Crown Agents, GTZ, JSI
and KEMSA)
IPPF
MEDS
DANIDA
Mainly District level staff: DPHO, DPHN, DTLP, DASCO, DPHO, etc or staff from the Health Centres, Dispensaries come up and collect from the District level
MEDS
Provincial and District
Hospital Laboratory
Staff
Organization responsible for delivery to sub-district levels
KNCV
MSF
MSF
KEMSA
WHO
Other NGO
Stores (e.g. MSI,
FPAK)
NGO clinics/ centres
Mission Hospitals/
Health Centres
Who is IHP+?
2007 2012
Developing countries: 8 31
Bilateral donors: 8 13
Int'l agencies and foundations*: 11 12
TOTAL 27 56
*African Development Bank, Bill and Melinda Gates Foundation, European Commission, GAVI Alliance, Global Fund, International Labour Organization, UNAIDS, UNICEF, UNDP, WHO, UNFPA, World Bank
Civil society also plays a key role in IHP+
IHP+ goals
Stronger government leadership in defining national health priorities, and in promoting coordination behind one national health plan, leading to..
Reduced management burden, therefore more time for implementation, leading to..
Better results through better use of existing resources
Goals remain relevant today
IHP+ work
Increased support for one national health strategy, through:1. More inclusive, better aligned national planning and joint
assessment processes2. More unified support for national plans, through country compacts 3. More harmonized financial management 4. One results monitoring platform, to track strategy implementation5. Greater mutual accountability by monitoring progress against
commitments
IHP+ works through its partners – governments, development partners, CSOs; builds on existing processes
What is working and what is not working?
1. There is more evidence that better aid coordination gets value for money and results
2. Overall, there is some progress in health aid effectiveness but no room for complacency – there has not been the 'step change' that was anticipated
3. Countries have moved further than development partners in putting principles into practice
More evidence of links between effective aid and results
More can be achieved with a clear vision and a credible plan: In Ethiopia, a health extension worker programme went nation-wide over 5 years, faster than many thought possible, because FMOH provided a credible plan and indicated where support was needed from Development Partners
More can be achieved together than separately: In Nepal, scale up of free maternal health care from a few districts to nation-wide was possible because government and donors acted collectively – no one could have done it alone. Institutional deliveries rose from18% to 28% in 2011.
Better coordination of resources can deliver greater value for money: in DRC, a new MOH single donor coordination unit led to threefold reduction in management costs for donor funds, from 28% - 9%. Liberated funds for other uses.
Is it working? IHP+Results performance reports
Progress but no room for complacency. Countries moved further than development
partners
Partner countries Development partners What is working?
Country ownership and leadership in health development cooperation has increased
Country aid governance and financial management systems are improving
Development partners are supporting country leadership
Development partners are providing better coordinated support, helping to develop frameworks to better manage health aid
What is not working?
There is less progress on country health budget allocations: only some have increased
Changes in actual aid delivery by development partners much more limited.The target for increasing the proportion of external funding recorded in national budgets has been missedDevelopment partner have not increase the proportion of aid delivered through country systems
What does all this mean for malaria and NTDs?
Sustaining gains, protecting investments Need to understand the shared system bottlenecks to delivering
services
Respond in ways that follow 'good aid' / development practice Support sound national health plans with clear priorities:
malaria and NTDs should feature where needed in national health plans; technical interventions should be 'correct'; implementation feasible.
Work together - jointly agree ways to make better combined use of limited resources – health workers, medicines etc.
Maintain efforts to track results and resources, with less fragmentation and duplication of reporting – shared oversight