SYDNEY MEDICAL SCHOOL AAAPS Conference | 9 April 2010 Joel Negin Sector wide approaches in health: Pacific experiences and lessons learned

Methodology ›Project was conducted for the Nossal Institute for Global Health’s Health Policy and Health Finance Knowledge Hub ›Working papers available from the Nossal Institute ›Literature review of academic, aid agency, multilateral agency reports ›Key informant interviews ›Trip to Solomon Islands 2

Background to the Study ›Project aid seen as ineffectual – not achieving sought after health goals ›Proliferation of actors leading to duplication, too many vertical projects and huge burden on Ministries of Health ›Commitment to do development better 3 Sector Wide Approaches

What are SWAps? ›Sector-wide approach: -Agreed health sector plan -Ownership by partner government -Partnership between all or most donors and governments -Increased funding availability and longer term commitments -Efforts to streamline funding arrangements -Institutional capacity and good governance -Stability of donor and partner government personnel ›Aim to reduce duplication, increase harmonisation, support country ownership and build capacity

How SWAps are supposed to work

What do we know about SWAps? ›Implemented in Africa and Asia from the mid-90s (Zambia, Bangladesh, Mozambique, Malawi, Nepal) ›Mixed success and not much firm evidence ›Yet are aligned closely with Paris Declaration, IHP+, Accra Agenda for Action ›The future of development assistance?

SWAps in the Pacific ›Education and water SWAps ›Health SWAp in PNG from early 2000s – not doing well by most accounts ›Health SWAp in Samoa and Solomon Islands ›AusAID and NZAID committed to future SWAps in the region

SWAps in the Pacific ›This study examined the process of establishment and implementation of health SWAps in Samoa and Solomon Islands to extract lessons learned for development actors in the region

Samoa SWAp ›Driven largely by government ›In partnership with World Bank, NZAID, AusAID -NZAID is donor day-to-day contact agency -Pooled funding in one account ›Increased funding and increased activity ›SWAp Secretariat within MoH ›Solid progress

Solomon Islands SWAp ›Driven initially by AusAID ›Contentious early relationship between AusAID and WB ›Initially a “SWAp of One” ›Limited government buy-in until April 2009 ›Much better progress now ›Limited pooled funding but improving harmonisation and collaboration ›Limited local capacity to manage various donors and take full ownership ›Lots of work to do but positive momentum

SWAp ElementsSamoa SWApSolomon Islands SWAp Agreed health sector planAvailable and used as basis for SWAp despite problems with baseline benchmarks Available and used despite some concerns with performance orientation Ownership by partner governmentDespite initial difficulties in the Ministry of Finance-MOH relationship, consensus that the SWAp is now owned by government Poor ownership by government throughout SWAp development, with some very recent encouraging signs Partnership between all or most donors and partner governments and among donors Strong collaboration between four main actors: government, NZ, World Bank, Australia Very contentious early history among donors has recently turned a corner Increased funding availability and longer term commitments Five year commitments of additional resources Limited commitments with some players only recently joining SWAp Efforts to streamline funding arrangements Yes: pooled funding between all four major actors, but not through government systems. Only Australia providing budget support though other partners are slowly seeking to streamline funding Institutional capacity and good governance Strong capacity but financial management systems need strengthening Generally weak capacity but national financial management systems are being used by SWAp Stability of donor and partner government personnel Stability within MOH; transition from AusAID to NZAID had difficulties High turnover of consultants and MOH executive

Movement towards a full SWAp ›SWAps are best seen as a process, as a means rather than an end Source: Walford 2003

Pacific Aid Effectiveness Principles Principle 1: Country ownership through national development planning which is adequately resourced using national budget and financial management system Principle 2: Multi-year commitments by development partners and countries aligned to nationally identified priorities as articulated in national strategies, with agreement on performance indicators and M&E mechanisms Principle 4: Development Partners and Countries pursue a coordinated and harmonised approach in the delivery of assistance. Principle 5: Strengthened institutional mechanisms and capacity in countries to enable increased use of local systems by development partners. Principle 6: Provision of technical assistance, including in aid coordination/management, that ensures that capacity is built with tangible benefits to the country to support national ownership. Principle 7: Use of an agreed M&E framework that will ensure joint assessments of the implementation of agreed commitments on aid effectiveness.

Lessons Learned ›Government ownership is critical ›SWAps are now more about partnership and coordination – “sitting together at the same table” ›Relationships are vitally important ›Must build management capacity ›Cross-country learning is useful

Critiques and Challenges ›SWAps increase transaction costs -More meetings, more money, more activity ›SWAps distract from service delivery -So much emphasis on procedures and meetings and bank accounts distract from getting the job done -‘We are a long way from having sound discussions about implementation of priorities with governments and with development partners’ -‘the nuts and bolts of service delivery are ignored’ ›Some vertical and regional projects don’t link in well to SWAps -Global Fund, SPC ›Technical assistance has not built Pacific capacity

Implications ›SWAps are not a panacea to better health outcomes ›But greater harmonisation is needed on all sides ›Strengthening Pacific capacity to lead the health sector is a long-term endeavour and momentum is in the right direction ›How serious are donors and Pacific governments about the Paris Declaration and the Pacific Principles on Aid Effectiveness