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WHO Western Pacific Region
Synergies and Linkages –Planning, Policy, Strategies
and Programmes
12 May 2010
WHO Western Pacific Region
Significant increase in funding for health
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WHO Western Pacific Region
New Donors• USA $ 3.636 billion • Japan $ 1.156 billion• Gates Foundation $ 0.895 billion• UK $ 0.729 billion• Germany $ 0.593 billion• France $ 0.394 billion• Canada $ 0.318 billion
But, as with all good and new things….there are some concerns
WHO Western Pacific Region
New foundations: from 2000…
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WHO Western Pacific Region
High Level Taskforce on Innovative International Financing for Health Systems
Ongoing work 2010
…”Establish a health systems funding platform for the Global Fund, GAVI Alliance, the World Bank and others to coordinate, mobilize, streamline and channel the flow of existing and new international resources to support national health strategies”…
• Taskforce final report -May 2009
•UN General Assembly 2009 side event & Outcome document
•US$1 billion for expanded IFFIm
•Results based buy downs
•Voluntary solidarity contributions
•De-Tax
• The Global Fund, GAVI Alliance, World Bank, and World Health Organization Working Group
• 4 work streams around appraisal, financial management & procurement, a common performance measurement framework and harmonised technical support
• Consultations with Track I and II countries , Jan-June 2010
• Global Fund and GAVI Alliance Governance Committee decisions , April and June
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“More health for the money”
WHO Western Pacific Region
Planning – renewed interest
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WHO Western Pacific Region
Agency-based Country-based
Proposal-based National strategy based
Multiple deadlinesFlexible and aligned to country cycles
Outside the budget cycle
Aligned to the budget cycle
Contract drivenAccountable to country's citizens
FromFrom ToTo
The Joint Funding Platform – GFATM/GAVI/WB + WHOMore Health for Money - Implement Paris Declaration
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WHO Western Pacific Region
Mode of Health Systems Strengthening
TRACK 1
Harmonization of existing Health Systems Strengthening support with existing funding
•3 Agencies (Global Fund, GAVI and World Bank)•Support from WHO•Single performance framework and M&E, financial management and procurement, and program oversight
TRACK 2
Access to new funding for health systems strengthening
• 3 Agencies (Global Fund, GAVI and World Bank)• Support from WHO• Access funding through national health strategies or health systems strengthening strategies
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WHO Western Pacific Region
Harmonization and alignment of processes and proced ures of HSS programming based on existing portfolio
• Implementation approach– Step 1: Consultations in 3-4 countries (Pre March, 2010)– Step 2: GF/GAVI Board guidance as needed (March/Apr)– Step 3: Piloting H&A in selected countries (following Board
guidance)
Aim To harmonize existing processes and procedures between WB, GF and GAVI, with the facilitation of WHO, where the agencies support HSS programming in order to better align with country processes and timing
FocusHarmonized and aligned M+E frameworks, technical support, joint country missions, financial management and procurement processes
WHO Western Pacific Region
Potential pilot countries for Track 1Criteria for piloting
• Country demand/request• Existing HSS support funded by all 3
funders• Duration of support for at least next two
years (i.e., until 2011)• Regular health sector review process
that includes review of programme and financing elements
• ‘Large enough’ grants or credits with arrayed HSS activities that offer opportunities for reducing fragmentation, improving coordination, and creating positive synergies
• Does not necessarily need to be one of the 49 Least Income Countries
• At least one Francophone country
Countries where we provide existing HSS support and could move quickly to harmonize among three agencies if the country is willing:
• Benin• Cambodia• Ethiopia• Liberia• Sierra Leone• Senegal
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WHO Western Pacific Region
Track 2 support entails enabling new access to future funding for HSS
TRACK 1
Harmonization of existing Health Systems Strengthening support
•3 Agencies (Global Fund, GAVI and World Bank)•Support from WHO•Single performance framework and M&E, financial management and procurement, and program oversight
TRACK 2
New access to future funding from a health systems funding platform
• 3 Agencies (Global Fund, GAVI and World Bank)• Support from WHO• Access to funding based on national health strategy or health systems strengthening proposal
WHO Western Pacific Region
Track 2 will focus on 4 priority items for funding access
1 Appraisal/assessment processes and procedures
2 Financial management and procurement processes
3 Common performance measurement framework
4 Mechanisms for harmonized technical support
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Track1 Track 2Priority Item
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WHO Western Pacific Region
Access to Future Funding as Part of a Joint HSS Platform
Approach
– Step 1: Global Fund and GAVI improving business models, funding allocation mechanisms, procurement & financial oversight processes, learning from JANS tool pilot countries
– Step 2: Global Fund/GAVI Board guidance and approval– Step 3: Learning from further JANS visits– Step 4: Piloting the platform in selected countries
Aim
To explore ways for jointly supporting HSS through:� HSS funding proposal (Scenario 1)� Support national health strategies, likely with JANS (Joint Assessment of National Strategies) tool (Scenario 2)� Alternative mechanism most convenient for the country
WHO Western Pacific Region
Countries submit joint HSS strategy/application
Coordinated approval by both Boards; Option 1: GFATM and GAVI finance different
components Option 2: GFATM and GAVI provide different % of funds
Joint TRP-IRC assessment and recommendation Option 1: Assessment in GenevaOption 2: In-country assessment
GLOBAL FUND GAVI WORLD BANK
Agreement on HSS ScopeCommon mechanism for tracking resources invested in HSS
Common application form and guidelines; Common funding window with joint funding request
Common performance framework (Countries prepare one report)
Joint review of implementation
Joint review of implementation
Joint review of implementation
No request for proposalsHSS funding based on
CAS
HSS strategy in Project Appraisal Document
Internal WB review and approval of HSS
Approval, signing
Countries may pool funding at the country level
FundingFunding Funding
Scenario 1: Single HSS Funding Request
Definition and
Scope
Access to Funding
Assessment, Approval &
Funding
Program management & country support
M&E
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WHO Western Pacific Region
Common definition of scopeIndicative resource envelope
Countries develop National Health Strategies, with distinct cross-cutting HSS element
Joint in-country assessment of the National Health Strategies based on IHP+ JANS approach*
WORLD BANKGLOBAL FUND GAVI
Countries with favourable assessment invited to submit funding request
Joint review and recommendation to BoardsBoard approval**
Implementation overseen by lead implementer
Country-led harmonized program implementation Joint annual review (common performance framework)
ContributionContributionContribution
Scenario 2: Funding based on Joint Assessment of National Health Strategies Definition
and Scope
Access to Funding
Assessment, Approval &
Funding
Program management, country support
& M&E
WHO Western Pacific Region
Joint Assessment of
National Health Strategies and Plans
Joint Assessment Tool: the attributes of a sound national strategy
Draft July 2009
A companion set of Joint Assessment Guidelines, FAQ sheet and other materials, are at www.internationalhealthpartnership.net
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WHO Western Pacific Region
Global Fund Decision Points
• New Prioritisation Criteria – 12 points– Technical merit – 4 points– Disease burden – 4 points– Poverty level – 4 points
• “CCM encouraged to identify opportunities to include MCH issues in Proposals”
• HSS Joint Funding Platform– Track One – pilot 2010 (streamline current $)– Track Two – pilot 2011 (joint platform new $)
WHO Western Pacific Region
Cambodia Strategic Health Sector Plan, 3 Year Rolling Plans and Annual Operational Plans
Source: Dr Lo Veasna Kiry, MoH Cambodia
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WHO Western Pacific Region
What have we learned?
• It is more than the sum of program plans such as MH roadmap, TB plan…
• Blueprints won't work: it is not the "plan" that is important, but the process
• That process is messy; the key is inclusive policy dialogue
WHO Western Pacific Region
HS Framework: Building Blocks
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WHO Western Pacific Region
HS Framework: Control Knobs(Harvard Group)
WHO Western Pacific Region
Health Outcomes
Fairness of Financing
Responsiveness
GHI investment
Health workforce
Governance
Monitoring and Evaluation
Health Technologies
D
E
L
I
V
E
R
Y
Privateexpenditure
Governmentexpenditure
Financing
Other externalexpenditure
Epidemiological
PoliticalDemographic
Environmental
Technological
Social
Economic
Legal
Communities/Civil Society
HS Framework: Systems
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WHO Western Pacific Region
Conceptual Framework
WHO Western Pacific Region
Aligning behind country plansCambodia: health plan priorities and donor disbursements (2003-05)
NSDP: Priority Action Plan for Health 2003-05(percent of total)
0 10 20 30 40 50
Pilot health insurance
Staff incentives in remote areas
Communicable diseases ( non-HIVaids)
Communicable diseases HIV Aids
Public private partnership in basichealth
Health education (incl HIV aids)
Contracting in remote areas
Scale up equity funds
Primary health care coverage
Source: 2002 NSDP
NSDP: Priority Action Plan for Health NSDP: Priority Action Plan for Health NSDP: Priority Action Plan for Health NSDP: Priority Action Plan for Health 2003200320032003----05 05 05 05 (percent of total)
Donor disbursements for Health by Purpose 2003-05(percent of total)
0 10 20 30 40 50
Health education
Health personnel development
Basic nutrition
Basic health infrastructure
Population policy and admin. mgmt
Medical services, training and research
Reproductive health care & familyplanning
Basic health care
Health policy & admin. management
Infectious disease control
STD control including HIV/AIDS
Source: OECD, CRS database.
Donor Disbursements for Health by Donor Disbursements for Health by Donor Disbursements for Health by Donor Disbursements for Health by purpose 2003purpose 2003purpose 2003purpose 2003----05 05 05 05 (percent of total)