National Strategy Applications and Health Systems Funding Platform (Presentation)

8/2/2019 National Strategy Applications and Health Systems Funding Platform (Presentation)

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National Strategy Applications and Health

Systems Funding Platform

Joint Assessment and Multi-Stakeholder Involvement

Regional Workshop for Civil Society14 October 2010



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Context

Growing complexity of global health aid architecture

Paris Principles (2005) & Accra Agenda for Action(2008)

Creation and growth of

Global Fund

Global Fund initiatives to

simplify and streamline

fundingInternational Health

Partnership (IHP)

New grant

architectureJoint Assessment of

National Strategies (JANS) NSAs

HSFP



3

Joint Assessment

National Strategy Applications

Health Systems Funding Platform

Multi-stakeholder involvment

Session Overview



4

Background International Health Partnership (IHP), Joint Assessment of National Strategies (JANS)

± Principles for joint assessment

± Attributes of sound national strategies (JANS Tool)

Definition

Joint assessment is a process by which country stakeholders and international partnerscome together to carry out an independent assessment of a national strategy and its

accompanying documentation. It is based on JANS principles and tool.

Scope

Can be applied to national health sector strategies or sub-sector strategies (e.g. disease

strategies).

Purpose

1. provide countries with constructive feedback on the national strategy documentation; and

2. provide international agencies with relevant information to help them make technical

support and/or funding decisions.

What is joint assessment?



5

IHP JANS Principles including the following: ± country-demand driven and country-led;

± building as appropriate on existing in-country processes and

experience

± strong independent element;

± inclusive process, involving civil society and other stakeholders;

Joint Assessment

JANS principles



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Civil society consultation on Global Fund initiatives

JANS Tool/Attributes

Commonly agreed basis for assessing technical soundness of national strategiesCategory Focus of attributes (for full language see IHP website)

1. Situation Analysis and

Programming

Sound situational and response analysis

Clearly defined priority areas, objectives and interventions,

contributing to improved health outcomes

Planned interventions, cost effectiveness, sustainability

Risk assesment and mitigation strategies

2. Process Multi-stakeholder involvement in development and

endorsement of national strategy documentation

Consistency with higher and lower level strategies

3. Finance and Auditing Comprehensive budget/costing, financial gap analysis

Specification of allocation of funds

Financial management system4. Implementation and

Management

Operational plans, resource deployment

Procurement policy

Governance, management and coordination framework

5. Results, Monitoring and

Review

Monitoring and evaluation

Joint periodic performance reviews



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Multi-stakeholder 1 involvement in development of

national strategy (which is led by government, with a

transparent consultative/participative process) and multi-stakeholder 1 final endorsement of national strategy.

1: Including government, civil society (according to the UN definition) and the private sector

Joint Assessment

Attribute related to MSI



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Joint Assessment

JANS Principles and Tool

JANS applied so far in two different areas, using same principles and tool:

IHP-led joint assessment

of national health sector

strategies

3-4 countries in 2010 so

far. Process ongoing.

Feeding (in some cases)

into donor funding

decisions.

Global Fund-led

assessments of national

disease strategies

7 assessments in First

Learning Wave of NSAs

in 2009

5 NSA grants approved

November 2009

Some differences in emphasis and details of process



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Joint Assessment




Session Overview



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A pplication

(³NS A´)

C ountries

National

strategy

documentation*

Joint assessment

report

³National strategy application´ to Global Fund

(= jointly assessed national strategy

+ minimal additional information)

G rant

management

Funding decision-making process for other funder(s)

* National strategy documentation = national strategy + complementary documents (e.g., operational plan)

National strategy

µjoint assessment¶


NSA concept



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Puts focus on development, financing and implementation of robustnational disease strategies aimed at improving health outcomes and

supports Paris aid effectiveness principles and Accra Agenda for Action

Anticipated benefits:

Alignment with country priorities, national programmatic andbudgetary timeframes;

Reduced transaction costs and paperwork for countries;

Improved harmonization with other donors;

Opportunity to extend multi-stakeholder inclusion to the scope of

the national strategy;

A focus on managing for results and accountabilitywithin national

disease strategies;

Improved quality and credibility of national strategic frameworks


Anticipated benefits of NSA approach



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Unique characteristics:

C

ompressed timeline (to be ready in same timeframe as R9 proposals) Limited number of countries (22 countries invited)

Review of national disease strategies by TRP only (exceptional since

no j oint mechanism in place)

5 NSAs approved in November 2009

At the end of 2008, Global Fund Board decided to launch a phased roll-outof NSAs, beginning with a ³First LearningWave´ of NSAs in 2009, with

aim to draw lessons to inform the future, broader roll-out of NSAs


First Learning Wave of NSAs



13

C onducted by Scope

TRP All NSA countries

UNAIDS- commissioned

consultants

The 3 countries that submitted NSA for HIV

McKinsey, commissioned by GF

12 countries, spanning all three diseases anddifferent FLW outcomes


Reports on FLW & message on value of NSA approach

All 3 reports indicate perceptions of value of NSA approach

from both country- and global-level stakeholders to be

broadly positive



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In April 2010, Global Fund Board approved the initiation of a Second Wave of NSAs, drawing on the lessons from the First Learning Wave, with the following

characteristics:

Timing

± allow countries more time for key process steps

± have NSA funding decisions at end of 2011 Approach to country participation

± include a limited but incrementally larger number of countries than the First

Learning Wave

± move towards longer-term vision of open ³self-selection´ process

National strategy assessment

± move towards a credible, j oint assessment approach

Multi-stakeholder involvement

± strengthen approach used in First Learning Wave

+ also ensure consistency with new Global Fund grant architecture


Second Wave of NSAs



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The long-term vision of the joint assessment in the NSA approach is to move towardsa truly µjoint¶ process. This is currently in evolution:

First Learning Wave: GF-driven, GF-organised, TRP conducted

Purpose: learn about assessment of national disease strategies and link with GF NSA

funding application

Second Wave: GF/donor-driven, jointly-organised, jointly conducted

Purpose: learn how to do a country-driven

j oint assessment of a national disease strategy that can form the basis of

funding/support decisions of international agencies

Intended future model: country-driven, jointly organised, jointly conducted

Purpose: enable countries to conduct joint assessment at time that bests suits their

national calendar , and use it as basis of funding/support requests as these arise.

Second Wave of NSAs

Joint assessment for Second Wave of NSAs



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Will follow JANS Principles and use JANS Tool.

In addition, joint assessment of national disease strategies needs to besufficiently reliable to allow the Global Fund and other donors to use itsoutcome as the basis of their technical support and/or funding decisions.

Hence, some key requirements (agreed by Multi-Partner Working Group), including:

All joint assessment team members independent (no involvement in drafting the

national strategy and no conflict of interest with regards to assessment outcome);

µnational facilitators¶ possible in addition;

Assessment team leader external to country;

A few experts nominated and paid for by donors included in team; At least one member with expertise in multi-stakeholder involvement;

Agenda developed consultatively;

Assessment report to present strengths and weaknesses of national strategy.

Second Wave of NSAs

Joint assessment approach



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Key steps

1. Nominate a joint assessment organizing body;

2. Identify a joint assessment team leader and assessment dates;

3. Prepare the joint assessment (define scope and focus; identify other

assessment team members; prepare agenda);

4. Provide an update on joint assessment preparations;

5. Conduct the in-country joint assessment.

Second Wave of NSAs

Joint assessment process



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Joint Assessment




Session Overview



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Health Systems Funding Platform (the Platform) is a joint partner initiative of the

G AVI Alliance (G AVI), the Global Fund and the World Bank, with facilitation from the

World Health Organization (WHO)

Goes back to a letter from the Global Fund ED and the G AVI CEO in March 2009 to

the co-Chairs of the High Level Taskforce on Innovative Financing for Health

Systems proposing collaboration on HSS funding

High Level Taskforce welcomed proposal and recommended Platform as amechanism to ³«coordinate, mobilize, streamline and channel the flow of existing

and new international resources to support national health strategies.´

Aim is to make better use of new and existing funds for health systems

strengthening (HSS) through simplification of countries¶ access to HSS sup-

port, and through harmonization and alignment of the way this support is

provided

Principles of the Platform are in line with those of the Paris Declaration, the Accra

Agenda for Action on Aid Effectiveness and the International Health Partnership

(IHP+) .

Health Systems Funding Platform (HSFP)

Background



20

1

2

3

Aligning partner support to national plans and

strategies, through an inclusive process

Reduced transaction costs (for both funders and

implementers)

Coordinated funding for HSS

Improvement of

Aid Effectiveness

(Paris and AccraPrinciples)


Anticipated benefits

Greater Value for Money Improved outcomes for the three diseases

and immunization

Contributing to MDGs 4, 5 & 6



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Global Fund Board Decision from April 2010:

Continue rapid implementation of Track 1

Development of joint proposal form for HSS with G AVI (for Round 11)

Design pilot for 4-5 countries to submit funding requests based on jointly assessed

national health strategies (parallel to Round 11)

Scope of GF HSS support to be maintained for the purposes of the Platform


Platform applies to existing and new HSS funding

Track 1

³Existing

financing´

Track 2³New

financing´

Harmonization1 of existing HSS grants/credits

Access via joint proposal form

Access via jointly assessed

national health strategy

Grant/creditmanagement1

O

p t 1

O p t 2

1 Harmonized monitoring & evaluation and fiduciary frameworks (incl. procurement)



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Cambodia:

First joint country mission (with G AVI, WB and WHO representatives) in early

June 2010

Ministry of Health approved approach in August 2010, and has given

permission for work to go ahead.

All three Platform funding partners have harmonized performance indicators

with those of national strategy and have agreed to strengthen country¶s health

information system.

Further work planned to support upcoming mid-term review of the national

health strategy

DRC:

Mission in August 2010 to discuss harmonization of performance frameworks

(G AVI and GF grants managed by same MoH project management unit)

Benin:

Joint partner work started to harmonize and align, with a potential focus on

performance frameworks and financial management.


Track 1 - Existing funding: Progress to date



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Track 2.1: Joint proposal form with GAVI

Joint process

(but not in all instances)

Based on joint

mechanism/framework

Separate

Proposal

Development

Submission

of

joint

proposal

Independent

review

by

TRP/IRC

Board

approval

Financial

arrange-

ments

Step 1 Step 2 Step 3 Step 4 Step 5

Grant

manage-

ment

Step 6

Key elements (current thinking):

One form to request HSS funding from G AVI and/or Global Fund (same structure, same M&E and

financial management framework) ± this will reduce transaction cost

Applicants still requested to delineate amounts requested from each of the agencies

Possible to submit joint requests to G AVI and the Global Fund, but could also be individual

requests to either agency (form is replacing current GF 4B/5B for HSS cross cutting component)

Joint requests will be developed and signed off by CCM and health sector coordinating body ±

strong coordination required

Joint request and joint review by TRP/IRC (for joint requests) enables holistic view on HSS

needs in country

Grant management based on harmonized M&E and financial management procedures (if

requested within the parameters of a joint financing agreement)

Work in progress



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Track 2.2: Pilot for funding based on assessed strategy

Joint process

(but not in all instances)

Based on joint

mechanism/framework

Separate

Joint

Assessment

Funding

request

Independent

review

Board

approval

Financial

arrange-

ments

Step 1 Step 2 Step 3 Step 4 Step 5

Grant/credit

manage-

ment

Step 6

World Bank project appraisal

process

Key elements (current thinking):

Joint assessment of national health strategy based on IHP+ JANS tool and

process including all relevant stakeholders (incl. civil society)

Light funding request predominantly consisting of existing documentation (could

be joint request to G AVI/GF) ± therefore directly aligned with country priorities

Development and submission of funding request by CCM under strong coordination

with health sector coordinating body

Joint review by TRP/IRC (for joint requests)

Grant management based on harmonized M&E and financial management

procedures (if requested be within the parameters of a joint financing agreement)

Pending PSC approval



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Next steps

Continue joint partner work and consultations (including

monthly phone calls with civil society representatives of all

three Platform funding partners)

Policy and Strategy Committee reviewing proposed design

for HSFP pilot for approval (25/26 October )

Portfolio and Implementation Committee reviewing draft

joint proposal form for sign off (Feb 2011)



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Joint Assessment




Session Overview



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Multi-stakeholder involvement (MSI) is an absolutely essentialprinciple for GF. Application of joint assessment in Global Fund

context needs to be designed in accordance with this core principle.

The question is not whether but how we should achieve this.

NSA approach in fact provides an opportunity to extend MSI todevelopment of a national strategy (as opposed to just development

of a GF-specific proposal ± as in regular rounds-based approach)

Need to see this as an evolutionary process; learn as you go

Key objective in µearly¶ NSA waves and HFSP pilot is to learn whatmechanisms are appropriate and effective to achieve this more

ambitious level of MSI over time (including via positive incentives)


Context



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Strategy development process

Decision to participate in joint assessment

Joint assessment team and processDecision to develop and submit NSA

Grant implementation and oversight


Various entry points for MSI



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Joint assessment stage (NSA)

Requirements on joint assessment of national disease strategies for purposes of NSA Second Wave:

Requiring that joint assessment organizing body incorporates multi-

stakeholder representatives and/or consults them systematically during

preparation process

Assessment of national strategies against IHP+ attributes of sound nationalstrategies, including attribute focusing on ³multi-stakeholder involvement

in the development [«] and final endorsement of a national strategy´;

At least one assessment team member with specific responsibility and

expertise for examining MSI;

Joint assessment team discussions with civil society stakeholders as partof in-country visit;

Requiring that details of the joint assessment (including organizing body, agenda, and outcome briefing) are published transparently



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Multi-stakeholder inclusion

Global Fund application stage (NSA and HSFP Pilot*)

Existing Global Fund mechanisms maintained:

Development of funding request:

Maintaining role of CCM and eligibility criteria for CCMs (ensuring appropriate multi-

stakeholder representation)

CCM decides on how to apply for funding:

For NSA Second Wave:CCM to decide whether to submit NSA (based on jointly

assessed national disease strategy) or whether to apply through regular proposal

For HSFP Pilot: CCM to decide whether funding request should be based on jointly

assessed health strategy or whether regular proposal should be developed

Submission of funding request:

Submission by CCM

In addition: In case of joint assessment showing insufficient multi-stakeholder inclusion in

development of the strategy, need for CCM to describe Äremedial actions³

Selection of PRs:

Maintaining of Dual-Track Financing policy

*Current thinking ± input required



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1. How to ensure joint assessment organizing body at country level

incorporates civil society as part of preparation process?

2. How to ensure selection of an appropriately qualified and unbiased

µcivil society expert¶ for assessment team?

3. How to ensure consistent and thorough assessment of µMSI

attribute¶ across countries?

4. What mechanism to support development and application of

appropriate µremedial actions¶ where weaknesses found in µMSI

attribute¶, and follow up on these?


Issues requiring further elaboration

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National Strategy Applications and Health Systems Funding Platform (Presentation)

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