The International Health Partnership

Dr Louisiana Lush

1. Description
2. Background and context
3. Complex health architecture
4. Rationale for IHP
5. IHP Commitments
6. Progress to date
7. Next steps
1. Description: What is the IHP?

An accelerated effort to apply the OECD/DAC Paris Principles

on aid effectiveness to the health sector in 8 countries,
building on existing processes

The specific goals are to:

• Better coordinate aid for around national health plans

• Provide aid in ways that strengthen health systems
• Strengthen planning and accountability at the national level

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What it is not

• A new institution
• A new plan
• A new funding stream
• A new global fund for health
• An exclusive initiative
• About only budget support or pooled funding

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Apply Paris Declaration to Health

• 56 Action-Oriented Commitments

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2. Background context (1) (see annex 1 for detail)

MDGs 2000

Increased aid effectiveness

Paris declaration 2005
Increased resources

Post high level forum 2005 - 07

UNAIDS 3 Ones

Global Campaign on the Health

MDGs

IHP Global Business Plan

on MDGs 4&5
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Background context (2)

• Growth in external aid for health $6-$14bn (2000-2005)

• Most aid targets AIDS, TB, Malaria, child vaccination
• Much aid remains off plan and off budget – i.e. not funding
national priorities
• Complex and fragmented aid architecture (see next slides)
• Use of parallel rather than government systems for
delivering aid
• Large transaction costs for governments
• “The result is limited reach and effectiveness of much aid”
(World Bank & AU health strategies)

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3. Complex architecture (see Annex 2 for health
alphabet soup)
WHO INT NGO
GTZ CIDA UNAIDS 3/5

RNE UNICEF
Norad WB
Sida
USAID T-MAP MOF
UNTG PMO
CF DAC GFCCP
GFCCP PRSP
PRSP
PEPFAR
GFATM HSSP
HSSP
MOH SWAP MOEC
SWAP
CCM
NCTP
NCTP CTU
CCAIDS
NACP

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LOCALGVT CIVIL SOCIETY PRIVATE SECTOR
Fragmentation…..

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Source; Don De Savigny & COHRED

Complex in-country Supply Chains!

Constructed and produced by Steve Kinzett, JSI/Kenya - please communicate

Commodity Logistics System in Kenya (as of April 2004) any inaccuracies to skinzett@cb.jsikenya.com or telephone 2727210

Commodity
Type Blood Anti- Labor-
Contra- Condoms MOH
(colour coded)
STI Vaccines Safety
ceptives and for STI/ Essential Retro atory
and TB/Leprosy Reagents Malaria Equip-
RH HIV/AIDS Drugs Drugs Virals supp-
Vitamin A (inc. HIV ment
equipment prevention (ARVs) lies
tests)

Organization Key
Government
World Bank Loan
Bilateral Donor
Multilateral Donor
NGO/Private

U U D
Source of D J C G K S A Global
S K N W B G
funds for E F I I A N I N GOK, WB/ US Fund for
A f F H GOK T V
UNICEF D I
MSF
commodities U I C D C D IDA Gov AIDS, TB
I W P O C I F D
D A A V A and Malaria
D A A

U U C The
Procurement E
GTZ
S K U N Crown Government Japanese "Consortium"
Agent/Body
A f R
F Private UNICEF MEDS (procurement D
O Agents of Kenya Company
implementation (Crown Agents, MSF
I W P P unit) C GTZ, JSI and
A
D A KEMSA)

KEMSA
Point of first Regional KEPI Cold
KEMSA Central Warehouse MEDS NPHLS store
warehousing Depots Store

Organization Provincial and

NLTP KEMSA and KEMSA Regional Depots JSI/DELIVER/KEMSA Logistics KEPI
responsible MEDS District Private
for delivery to
(TB/
(essential drugs, malaria drugs,
Management Unit (contraceptives, (vaccines
(to Mission Hospital Drug
Leprosy condoms, STI kits, HIV test kits, TB and facilities) Laboratory Source
district levels drugs consumable supplies) vitamin A)
drugs, RH equipment etc) Staff

Organization
responsible for
delivery to sub-
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
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district levels
Transaction costs..

10 453 missions in 34 countries in 2005

800 Vietnam (791)

750

700

650

600
Cambodia (568)
550 Honduras (521)
Mongolia (479)
450
Uganda (456)

Number of donor missions in 2005 Page 10

 4. Rationale for IHP:
Developing country messages

• current aid make it hard to strengthen health systems

• need flexible, predictable and long term financing to budget for long
term
• high transaction costs of dealing with multiple international
partners; who operate outside of national planning & budgeting
processes & compete for scarce resources, particularly staff;
• recognise benefits of targeted investments, but want to see greater
coordination and integration of international support; ‘campaign
vertically spend horizontally’
• suspicious of new donor initiatives over which they have little
influence;
• limited faith in their international partner’s performance in delivering
on their commitments

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Rationale for IHP:
International messages
• Lack of high-level political commitment for health –to increase
investment in health & overcome policy, implementation &
governance obstacles to progress;
• Little confidence in quality of many national health plans: divorced
from meaningful budgets; often avoid difficult issues; exclude the
non-state sector;
• Concern over limited capacity to implement health plans;
• Inadequate engagement of supporting sectors such as water,
education and transportation;
• Little confidence in accountability mechanisms to citizens;
• Need to see support translated into improved health outcomes to
maintain the case for aid to taxpayers

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Rationale for IHP:
CSO messages
• Generally supportive of principles
• Some irritation at the process and non-engagement
• Look to structured GFATM-like governance structure
• AIDS lobby perceive threat to ‘AIDS exceptionalism’
and potential diversion of focus and resources

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Within this architecture, in mid-2007, there
was a political opportunity

• New health leaders at WHO, WB, GFATM

• Improved coordination of UN, GFATM, GAVI, Gates –
formation of the H8 Leaders’ Group – now met twice
• OECD/DAC focus on health as tracer sector for aid
effectiveness High Level Forum
• New UK Government – convinced of need for more
effective aid as well as more aid
• All this led to the concept note for what became IHP

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5. IHP commitments
Compact: Developing countries will…

• Invest more in health

• Address policy and implementation constraints
• Engage non-state providers
• Strengthen planning & accountability mechanisms
• Link aid to demonstrable improvements in outcomes
(MDGs, HSS)

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 Compact: Donor partners will…

• Better coordinate their support around National Health Plans

• Provide aid in ways that strengthens health systems (to meet

health challenges of today and future)

• Where possible, provide long term, more flexible support

delivered though national systems

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Compact: Civil society will

• Engage in design, implementation and review of national

health plans and the Partnership at global and country
level

• Support delivery of high quality health services, in line with

national plans

• The performance of all parties will be subject to a joint

review at country and global levels

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Launch September 2007

• Zambia, Nepal, Kenya, Burundi, Mozambique, Ethiopia,

Cambodia, Mali

• UK, Norway, Netherlands, Germany, France, Italy, Portugal,

Canada

• WHO, UNAIDS, UNICEF, UNFPA, World Bank, GFATM, GAVI,

UNDP, IMF, ILO, AfDB, EC, Gates Foundation

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 What will success look like (1)?
• All partners work to achieve national health objectives as laid out
in robust national plans that include the contributions of public,
private and civil society providers.
• All share a collective commitment to help implement the plan
effectively and deal with bottlenecks to progress and emerging
issues.
• All external support is provided in ways that strengthen health
systems and facilitate the delivery of a coordinated package of
basic services that respond to all major health challenges and
achieve results.

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What will success look like (2)?

• More resources are provided as long term, flexible aid with

a greater proportion delivered through national systems.
• There is a clear, inclusive, credible monitoring mechanism
that is able to demonstrate progress in improving health
outputs/outcomes on an annual basis.
• International agencies rely on joint appraisal and reporting
systems rather than requiring their own separate
arrangements.

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Health system priorities

• Financing gaps for health systems strengthening

• Human resources for health
• Results orientation of health plans
• Access to medicines

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6. Progress

Global level:
• Multilateral lead via WHO/WB
• UK catalytic funding of £3.5 million through WHO/WB
• Efforts to engage others eg US and Japan – G8

Country level
• Country compacts under development – for Sept 08
• Meeting of first wave countries Lusaka
• UK committed catalytic funding to support compacts
in first wave countries

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Early results
• Burundi was the first country to sign a compact, on 22
February. The IHP has helped ensure the national health
strategy is focused on key outputs such as immunisation
coverage and outpatient numbers.
• In Mozambique, the IHP helped facilitate Global Fund
resources into the health pooled fund. In future, it is likely
to focus on scaling up of health workers.
• In Nepal, the IHP provided important support to the recent
announcement to remove user fees for key health services.
• The UK is working with PEPFAR in 4 PEPFAR-IHP overlap
countries to improve and increase resources for health
workers – recent funding announcement of $420m from
UK and $1.2b from US.

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7. Next steps
• Ministerial meeting – World Health Assembly in
May 08 to assess progress and scale up
• High level political events:
• Discussions among G8
• Possible anniversary event in Sept 08 at UN MDG
Call to Action in New York
• DAC High Level Forum on Aid Effectiveness in
Accra in Sept 08
• WHO commissioning quick external review to
feed into these events
• Longer term North-South consortium to monitor
progress and hold agencies accountable.

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