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Presentaion to HEPNEt- Zambia 29th May 2008 1 Consequences of donor aid not Channelled through the Govt System: the case of Global Fund Emily Nyanzi K.(Mrs)

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Presentation on theme: "Presentaion to HEPNEt- Zambia 29th May 2008 1 Consequences of donor aid not Channelled through the Govt System: the case of Global Fund Emily Nyanzi K.(Mrs)"— Presentation transcript:

1 Presentaion to HEPNEt- Zambia 29th May Consequences of donor aid not Channelled through the Govt System: the case of Global Fund Emily Nyanzi K.(Mrs) Economist/TA Ministry of Health - UGANDA

2 Presentaion to HEPNEt- Zambia 29th May Outline of Presentation Background Background Donor Funding Donor Funding Uganda experience (Global fund) Uganda experience (Global fund) Benefits Benefits Consequences Consequences Way forward Way forward

3 Presentaion to HEPNEt- Zambia 29th May Background-1 In The late 80s Ugandas health system, had literally collapsed after many years of civil strife and was characterized by heavy donor support and multiple projects; In The late 80s Ugandas health system, had literally collapsed after many years of civil strife and was characterized by heavy donor support and multiple projects; This support however did not translate into significant improvements in health outputs and outcomes – thus no improvements in peoples health; This support however did not translate into significant improvements in health outputs and outcomes – thus no improvements in peoples health;

4 Presentaion to HEPNEt- Zambia 29th May Background -2 In Year 2000, GoU and partners noted a lot of shortcomings Donor support and Multiple projects & agreed to introduce Sector-Wide Approaches (SWAP). In Year 2000, GoU and partners noted a lot of shortcomings Donor support and Multiple projects & agreed to introduce Sector-Wide Approaches (SWAP). This was further strengthened by the Paris Declaration 2005 on aid effectiveness. This was further strengthened by the Paris Declaration 2005 on aid effectiveness.

5 Presentaion to HEPNEt- Zambia 29th May Paris Declaration 2005 Endorsed on 2 nd March 2005, an international agreement to which over one hundred Ministers & Heads of Agencies committed their countries and organizations to: Endorsed on 2 nd March 2005, an international agreement to which over one hundred Ministers & Heads of Agencies committed their countries and organizations to: 1. Increase efforts in AID harmonisation, 2.Align and manage aid for results with a set of monitorable actions and indicators

6 Presentaion to HEPNEt- Zambia 29th May % of Donor funding to TT Sector Funding FY2002/0303/0404/0505/0606/0707/08 Total %

7 Presentaion to HEPNEt- Zambia 29th May % of Donor Funding 2006/07 – 36.4% 2006/07 – 36.4% 2007/ % 2007/ %

8 Presentaion to HEPNEt- Zambia 29th May % donor funding from 2002 to 2008

9 Presentaion to HEPNEt- Zambia 29th May Donor Funding Components 1. PAF –Poverty Action Fund General PAF General PAF Earmarked PAF Earmarked PAF 2.Budget Support also called SWAp ( Sector Wide Approach) 3. Project Support- Funding for specific projects in the country at central and district level e.g DANIDA. Global Fund, etc.

10 Presentaion to HEPNEt- Zambia 29th May Donor funding from FY 2002/03 to 2007/05 Excluding ( PAF Funding) 2002/ 03 03/0404/0505/06 06/ 07 07/

11 Presentaion to HEPNEt- Zambia 29th May Global Fund Uganda (GFTAM) Started Operation in FY 2004/05 this was the first phase of funding by GFTAM in Uganda 1.Disagreement between MOH & Global Fund Secretariat regarding Budget Support Viz. Project Support 2. GFTAM opted for project model and eventually got into trouble.

12 1.Funding was project mode outside the SWAp mainly to specific central level projects and projects at districts & different Ministries and NGOs) 2.Funding was for Drugs ARVs for HIV/AIDS control, TB and ACT for Malaria control programmes & LINS Presentaion to HEPNEt- Zambia 29th May

13 Presentaion to HEPNEt- Zambia 29th May Funding- GFTAM 2004/05 1. There was a Project management Unit (PMU) Premised outside MOH Headquarters 2. Characterized by Third Party Procurements and high admin costs.

14 Presentaion to HEPNEt- Zambia 29th May GFTAM-2005/ /06 there was suspension of funding and Global fund activities in Uganda due to. 2005/06 there was suspension of funding and Global fund activities in Uganda due to. Misappropriation of funds and improper condition of project activities. Misappropriation of funds and improper condition of project activities. Many NGOs most of them new in the country, district level activities and govt programs had not accounted for funds. Many NGOs most of them new in the country, district level activities and govt programs had not accounted for funds.

15 Presentaion to HEPNEt- Zambia 29th May GFTAM-2005/06 Conditionality for lifting the suspension was to have all programs/NGOs account for funds received. Conditionality for lifting the suspension was to have all programs/NGOs account for funds received. GOU and Global fund had to agree to conditions of funding modalities, M&E and accountability of funds. GOU and Global fund had to agree to conditions of funding modalities, M&E and accountability of funds.

16 Presentaion to HEPNEt- Zambia 29th May GFTAM 2007/08 -1 Funding streamlined with clear and stipulated roles for all Ministries/NGOs Funding streamlined with clear and stipulated roles for all Ministries/NGOs MFPED is the Principal recipient of funds and realizes them to different Ministries/NGOs. MFPED is the Principal recipient of funds and realizes them to different Ministries/NGOs. Earnest and Young a private company oversees MGT of funds at a cost of US.Dollars 1m every year. Earnest and Young a private company oversees MGT of funds at a cost of US.Dollars 1m every year.

17 Presentaion to HEPNEt- Zambia 29th May GFTAM 2007/ MOH Coordinating role MOH Coordinating role M&E by UAC etc M&E by UAC etc Funds are realized in rounds after Malaria, TB and HIV/AIDs programmes producing and sending acceptable proposals which are sent to Geneva. Funds are realized in rounds after Malaria, TB and HIV/AIDs programmes producing and sending acceptable proposals which are sent to Geneva.

18 Presentaion to HEPNEt- Zambia 29th May Benefits - (GFATM)- 1 GFATM focuses on the implementation of interventions related to particular diseases:- Mainly Malaria, HIV/AIDs and Tuberculosis. GFATM focuses on the implementation of interventions related to particular diseases:- Mainly Malaria, HIV/AIDs and Tuberculosis. Free Antimalarial, TB and ARVs although too much concentration in specific geographical esp urban areas. Free Antimalarial, TB and ARVs although too much concentration in specific geographical esp urban areas. Are characterized by a vertical or categorical mode of delivery Are characterized by a vertical or categorical mode of delivery

19 Presentaion to HEPNEt- Zambia 29th May Benefits of Project Mode of Funding (GFATM) At project level the focus of attention lies on a relatively narrow range of issues. At project level the focus of attention lies on a relatively narrow range of issues. Essential approach to flexibility and quick response in health systems Essential approach to flexibility and quick response in health systems Ownership of project activities Ownership of project activities

20 Presentaion to HEPNEt- Zambia 29th May Benefits - (GFATM)- 2 Demonstrates results in key priority health concerns Demonstrates results in key priority health concerns Easy and Focused M&E Easy and Focused M&E Fragmentation of the health system into several sub systems enables deliveries of different interventions to different beneficiaries Fragmentation of the health system into several sub systems enables deliveries of different interventions to different beneficiaries

21 Presentaion to HEPNEt- Zambia 29th May Consequences -1 High admin costs due to third party procurrements High admin costs due to third party procurrements Difficulties in financial flows from the central government to the districts Difficulties in financial flows from the central government to the districts Limited human resource capabilities at health facilities and beneficiaries centres/NGOs Limited human resource capabilities at health facilities and beneficiaries centres/NGOs Generally large system constraints within the project framework Generally large system constraints within the project framework

22 Presentaion to HEPNEt- Zambia 29th May Consequences -2 Proliferation of projects, multiple reporting requirements, lack of coherence in donor support Proliferation of projects, multiple reporting requirements, lack of coherence in donor support Distortion of spending priorities and leading to problems of sustainability, with limited scope for preparing comprehensive sectoral budgets; Distortion of spending priorities and leading to problems of sustainability, with limited scope for preparing comprehensive sectoral budgets; Creation of parallel systems undermining organizational capacity building Creation of parallel systems undermining organizational capacity building

23 Presentaion to HEPNEt- Zambia 29th May Consequences -3 Such international initiatives have a strong political dimension and; Such international initiatives have a strong political dimension and; decisions (taken outside the country) no longer lie at technical level where emphasis is on harmonization with the health system. decisions (taken outside the country) no longer lie at technical level where emphasis is on harmonization with the health system. General lack of knowledge of local realities and ; not in line with locally agreed policies. General lack of knowledge of local realities and ; not in line with locally agreed policies.

24 Presentaion to HEPNEt- Zambia 29th May GFTAM- Way Forward All in all GFATAM is considering joining the SWAP- budget support mode of funding. All in all GFATAM is considering joining the SWAP- budget support mode of funding. Long Term Institutional Arrangement (LTIA) that HPAC are working on as a future framework for handling Global Fund, GAVI, Long Term Institutional Arrangement (LTIA) that HPAC are working on as a future framework for handling Global Fund, GAVI, etc. Generally SWAp reduces administrative costs for government Generally SWAp reduces administrative costs for government

25 Presentaion to HEPNEt- Zambia 29th May SWAp- Budget Support Essentially SWAp was established to enable governments to: Own and coordinate development assistance in any given sector Own and coordinate development assistance in any given sector Policy design Policy design Strategic and operational management Strategic and operational management Financial pooling, Resource allocation and common arrangements for M&E Financial pooling, Resource allocation and common arrangements for M&E

26 Presentaion to HEPNEt- Zambia 29th May Core elements of Budget Support Government in driver s seat Government in driver s seat Sector-wide in scope Sector-wide in scope Agreed policy framework & strategy Agreed policy framework & strategy All/most donors sign on All/most donors sign on Common/joint work program Common/joint work program Common management arrangements: Common management arrangements: 1. disbursement and accounting of funds 2.reviewing performance Move to streamline govt. procedures Move to streamline govt. procedures

27 Presentaion to HEPNEt- Zambia 29th May Further readings Oliveira Cruz. V, et al sing agency theory to analyse relationships between recipient governments and international development partners. Oliveira Cruz. V, et al sing agency theory to analyse relationships between recipient governments and international development partners. Ministry of health,Uganda 2006.Health systems reforms in Uganda: Processes and Out puts Ministry of health,Uganda 2006.Health systems reforms in Uganda: Processes and Out puts

28 Presentaion to HEPNEt- Zambia 29th May Thank you for Your Audience


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