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 skinzett@path.org 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