Towards Aid Effectiveness The Role of the Donor Community The Palestinian National Authority Ministry of Health Palestinian Health Conference “Toward Quality and Sustainable Health Services” Ramallah, Best Eastern Hotel, May 7-8, 2009 Towards Aid Effectiveness The Role of the Donor Community Angelo Stefanini MD, MPH Italian Development Cooperation

MOH National Conference Ramallah, May 7-8, 2009 Summary Challenges for the Palestinian Health Sector Possible future scenarios Role of Donors, MOH & Mutual Responsibilities Agenda ahead (& Questions) MOH National Conference Ramallah, May 7-8, 2009

MOH National Conference Ramallah, May 7-8, 2009 Main challenges for the Palestinian Health Sector Adapted from: World Bank, 2009 Fragmented, unbalanced Inadequate financial protection Low MOH management & stewardship capacity Increasing burden of NCD MOH National Conference Ramallah, May 7-8, 2009

Causes of present situation Mataria et al., Lancet 2009 Internal Lack of control over health determinants External Political instability Occupation policies (access and movement restrictions) Donors-related Fragmented, short-term and unpredictable Multiplicity, conflicting agendas Bilateral arrangements From development to humanitarian assistance MOH National Conference Ramallah, May 7-8, 2009

MOH National Conference Ramallah, May 7-8, 2009 Health Financing by Source (2004) Source: World Bank Public Expenditure Review, 2007. MOH National Conference Ramallah, May 7-8, 2009

MOH National Conference Ramallah, May 7-8, 2009 In summary: Most pre-conditions for meaningful reforms are absent Role of international partners is crucial MOH National Conference Ramallah, May 7-8, 2009

Moving forward Mataria et al., Lancet 2009 Under the best-case scenario MOH as the steward of the system Under the worst-case scenario Emergency relief (+capacity development) Under the status quo scenario Donors and providers coordination & harmonization MOH National Conference Ramallah, May 7-8, 2009

The Paris Declaration on Aid Effectiveness (March 2005) Aid would be most effective if: Partner countries exercise greater leadership over development policies and plans (ownership) Donors base support on country priorities and systems (alignment) Donor agencies coordinate their activities and minimise transaction costs (harmonisation) Together partner countries and donors manage for results (managing for results) and Are accountable to each other in achieving real results from aid (mutual accountability). MOH National Conference Ramallah, May 7-8, 2009

MOH National Conference Ramallah, May 7-8, 2009 Aid modalities Project Aid Using parallel systems Using govt. systems (Planning, Budgeting, Procurement, Accounting, Reporting, etc.) Pooled Funds or Programme Aid Budget Support Sector BS (earmaked or to a discrete sub-sector activity) General BS Sector-Wide Approach (SWAp) MOH National Conference Ramallah, May 7-8, 2009

When Project Aid, then Source: PNA’s Partnership Principles Support PRDP’s priorities Explain why project approach Follow PNA’s systems (e.g. budget classification, procurement procedures) Provide multi-year projection Joint Reviews (Donor/PNA) MOH National Conference Ramallah, May 7-8, 2009

Mutual Responsibilities Source: PNA’s Partnership Principles Systematic information sharing Joint analytical work Joint approaches to review and monitoring Working with, and through, each other Rationalising number of sectors (division of labour as per EC Code of Conduct) MOH National Conference Ramallah, May 7-8, 2009

Donor’s Responsibilities Make aid effectiveness a priority View ourselves as “players” (development partners) as well as “payers” (donors) Align projects with NSHP’s goals Provide information on mid-term funding Regularly update MOH on interventions Coordinate timing & content of missions Aim at joint analytical work & development programmes Work towards pooling funding & SWAP Invest in the Health Sector Working Group MOH National Conference Ramallah, May 7-8, 2009

MOH National Conference Ramallah, May 7-8, 2009 PA responsibilities Draw up annual operational plans/budgets Monitor/evaluate NSHP implementation Decline projects/programmes not in line with NSHP Share financial procedure & budget Devote dedicated human resources to sector harmonization Invest on HSWG MOH National Conference Ramallah, May 7-8, 2009

MOH National Conference Ramallah, May 7-8, 2009 The Agenda ahead Step 1: Donor’s internal scrutiny (both here and at HQs) Step 2: Informal consultation with core partners to agree preliminary platform Step 3: Build dialogue with MOH leadership MOH National Conference Ramallah, May 7-8, 2009

MOH National Conference Ramallah, May 7-8, 2009 Questions to MOH Is the MOH willing to upgrade coordination practices? Is the MOH prepared to negotiate with donor agencies mutually binding commitments? Would the MOH accept a more proactive focal donor? Is the MOH open to external scrutiny, in order to strengthen its inner functioning? MOH National Conference Ramallah, May 7-8, 2009

MOH National Conference Ramallah, May 7-8, 2009 Questions to Donors Are donors willing to recognize the need for a major shift in their way of working in the Palestinian Health Sector? Are donors prepared to negotiate with the MOH mutually binding commitments? What commitments are offered by donors in return? MOH National Conference Ramallah, May 7-8, 2009

MOH National Conference Ramallah, May 7-8, 2009 Thanks for Your Attention MOH National Conference Ramallah, May 7-8, 2009