1. EuropeAid Workshop Towards shared principles for reporting health impacts of development aid; Brussels February 6th, 2012: The aid policy framework - Interntional agreements and aid policy context Walter Seidel - European Commission Directorate General for Development and Cooperation – EuropeAid Unit D4 – Health Sector

2. EuropeAid 1. Introduction: Aid Effectiveness What do we mean by "aid effectiveness"? The EU citizen's view: Does aid work? Is my money well spent? The LIC citizen’s view: Does health care get better? The public health scientist’s view: How can we measure aid effects in terms of health impact [mortality, morbidity]? The aid professionals' view: Have we progressed on our commitments as stated in the Paris Declaration and the Accra Agenda for Action?

3. EuropeAid 2. Aid Effectiveness (AE) (Paris 2005, Accra 2008, Busan 2011) Paris and Accra address essentially the problems of “Northern” aid to aid dependent low income countries with emerging institutional capacities; in Busan, the “BRICS” and the issue of South-South- Cooperation have been included into the AE agenda. 3 key elements relevant for our discussion: o harmonisation (among donor agencies) o alignment (to national policies, mechanisms and systems; respecting national ownership) o managing for results

4. EuropeAid 3. Aid Effectiveness commitments – Practical consequences for EC health aid Sector Policy Support Programmes (SPSP) => « Sector Reform Contracts » Wherever possible as predictable budget support Where criteria not fulfilled: Pooled fund with other donors, aligned forms of project support Accompanied by a structured sector policy dialogue and sector performance monitoring EC health aid is currently roughly 600 million EUR p.a.; 4/5th direct bilateral aid; 1/5th global funds and initiatives

5. EuropeAid 4. Reporting Results: Lives saved (LS): (GF web site accessed Nov 9th, 2011)

6. EuropeAid 5. Known problems with LS-Approach Over-simplification of the model used (one or several of the following not considered) o Quality of care / provider compliance o Patient or user compliance o Drop out o Concurrent mortality o National variability in the above Double Counting (linked to attribution) – some of the lives saved my have been claimed by other donors, or could be claimed by the Ministry of Health

7. EuropeAid 6. Emerging problems with the LS Approach Lives saved has become a public accountability issue As such, it potentially shapes the views and underlying assumptions that are at the basis of funding decisions of the public and the political level: o E.g.: It looks as if it would just need some products to fight the disease o E.g.: It looks, as if the Global Health Initiatives can save lives, whereas comprehensive systems support at country level can’t

8. EuropeAid 7. Aid at the country level: Complicated...

9. EuropeAid... nevertheless: Results at country level (1/3) Indicator: Proportion of births attended in health facility There is a slight improvement on the births attended at the health facility from 51% in 2007 to 52% in 2008 ; result for 2009? 2010?

10. EuropeAid... nevertheless: Results at country level (2/3) Indicator: Percent of TB Treatment success/completion rate Great improvement in treatment success rate from of 84.7% in 2006 to 87.7% in 2008; the achievement surpassed the global target set at 85%.

11. EuropeAid... nevertheless: Results at country level (3/3) Indicator: Outpatient attendance per capita The Tanzania Mainland OPD per capita is 0.68 in 2008 (below Diagram); it increased to 0.74 in 2009

12. EuropeAid 8. Consequences for results reporting by donor agencies From Global Fund’s High Level Review Panel Report (September 2011): “… international organizations to refine their methodologies for tracking results as a critical measure of performance." "In the end, the Global Fund [and indeed any other development agency W.S.] itself cannot be the guarantor of accountable results; the recipient countries, especially their Governments, must be." Final Recommendations : "Getting serious about results...Measure outcomes, not inputs:...v. Coordinate much more closely with other donors on data, including joint analyses to attribute results more precisely, and avoid double-counting"

13. EuropeAid 9. Apply health impact reporting to the country level first – the method Implementing the HLRP recommendation: Apply the impact algorithm (in analogy to GF / GAVI method) to a broader spectrum of diseases / interventions, Apply it to the outputs of the entire health system at country level (for countries where output reporting is of reasonable quality, e.g. where there are established SWAps, compacts), Agree on an attribution key at he country level first (e.g. based on the proportion of financing),... and then take home „your“ impacts and report to your constituency.

14. EuropeAid 10. Apply health impact reporting to the country level first – the feasibility Principles: Build on the achievements of established SWAps, allowing for more comprehensive aid impact reporting Build on the work already done by done by specialised agencies, partnerships and academia (WHO, Health Metrics Network, International Health Partnership IHP+, GF, GAVI …) Next steps: Further examine feasibility; agree among major donors Further develop the method(s) – mobilise resources to get started get volunteer countries on board for test-run Cross-check computed impacts against survey data (DHS, etc.)

15. EuropeAid Apply health impact reporting to the country level first – the AE criteria o harmonisation (among donor agencies) o alignment (to national policies, mechanisms and systems; respecting national ownership) o managing for results