AusAID’s approach to health in developing countries Saving Lives AusAID’s approach to health in developing countries

Significant health issues are facing the region HIV infection Under-nutrition Weak health system Artemisinin resistance Poor maternal health and child health Non-communicable diseases Maps: Lonely Planet

There is a major funding gap for health USD 54 per person on health annually required to meet health MDGs In 2009, health spending was USD 25 per person in low-income countries USD 10 paid by patients ‘out-of-pocket’ Estimates in 2005 US dollars

But funding alone is insufficient: donors must engage countries on health policy and reform ODA accounts for only around 0.3% of total expenditures on global development health

To focus health assistance on the poorest Child mortality rates generally highest within the poorest 20% of a population Poor coverage and quality of health services and poor “health seeking behaviour” Influenced by wider social determinants Social determinants of health include: income, education, gender inequality, food (in)security

And build equitable health systems to improve maternal and child health Health centres Data on maternal health needs Maternal health policy Essential medicines Trained midwives Sufficient funding

Health assistance must also work within a complex international health ‘architecture’

Saving lives is a goal of Australia’s aid program Objective: to save the lives of poor women and children through: Greater access to quality maternal and child health services Large scale disease prevention, vaccination and treatment In addition, Australia aims to improve public health by increasing access to safe water and sanitation

Australia invests in health because Improving people’s health is a critical aim of international development Good health helps achieve other development goals, such as economic growth and poverty reduction Australia can contribute to improving the health of the poorest people, particularly in Asia and the Pacific Investing in health is in Australia’s national interest

Australia is focusing on six priorities for our health investment, guided by four key principles 2. Closing the funding gap 1. Supporting health services for poor people 3. Empowering poor people to improve their health 4. Working across sectors 5. Addressing regional and global threats 6. Maximising the impact of our investment

Australia has six priorities for our health investment, guided by four key principles Focussed on the poorest 2. Closing the funding gap 1. Supporting health services for poor people 3. Empowering poor people to improve their health 4. Working across sectors 5. Addressing regional and global threats 6. Maximising the impact of our investment

Australia has six priorities for our health investment, guided by four key principles Focussed on the poorest Country-led 2. Closing the funding gap 1. Supporting health services for poor people 3. Empowering poor people to improve their health 4. Working across sectors 5. Addressing regional and global threats 6. Maximising the impact of our investment

Australia has six priorities for our health investment, guided by four key principles Context-specific Focussed on the poorest Country-led 2. Closing the funding gap 1. Supporting health services for poor people 3. Empowering poor people to improve their health 4. Working across sectors 5. Addressing regional and global threats 6. Maximising the impact of our investment

Australia has six priorities for our health investment, guided by four key principles Context-specific Focussed on the poorest Country-led Backed by evidence 2. Closing the funding gap 1. Supporting health services for poor people 3. Empowering poor people to improve their health 4. Working across sectors 5. Addressing regional and global threats 6. Maximising the impact of our investment

1. Australia is supporting health services for poor people Advocating for health systems that provide equitable access to quality health services Supporting partner countries to identify and respond to their own health priorities Promoting cost-effective interventions Targeted support in humanitarian and fragile situations Supporting multilateral agencies

Case study: East Timor Context Fragile state emerging from conflict Communicable diseases major cause of death Maternal mortality rate: 440 per 100,000 live births AusAID is largest donor for health, but significant UN and other development partner presence Map: Lonely Planet

Case study: East Timor Mixed modalities approach Estimated $10 million for health in 2010-11 Strengthening government systems (through World Bank trust fund) Supporting NGOs to provide direct service delivery (in partnership with USAID) Filling gap in specialised surgical services Impact Skilled birth attendance has increased from 35% (2008) to 46.7% (2009) Infant mortality has decreased from 60 deaths per 1,000 live births (2003) to 44 deaths per 1,000 live births

2. Australia is helping to close the funding gap Increased resources through a range of avenues Health budget support Pooled funding arrangements Working with other donors on joint programs Advocating for increased, and better targeted, national health budgets Reducing out-of-pocket payments Better use of non-state sector

Case study: Solomon Islands Context Post-conflict state Weak health system Malaria endemic region Rising non-communicable diseases Australia is the major donor for the health system Map: Lonely Planet

Case study: Solomon Islands Budget support approach Estimated $18 million for health in 2010-11 Sectoral budget support, providing 40% of annual health budget Focus on supporting Solomon Islands Government to deliver effective, efficient and equitable health services Long-term and predictable financial support to government systems Work with other development partners Pacific regional mechanisms Impact Malaria cases have more than halved between 2003 and 2009

3. Australia is empowering poor people to improve their health Supporting poor and vulnerable people to demand and access affordable, quality health care Supporting civil society to demand quality care Providing incentives for people to access health care (eg. Voucher schemes, conditional cash transfers) Reducing ‘out-of-pocket’ payments

4. Australia is tackling the broader causes of ill health Social determinants of health include: income, education, gender inequality, food (in)security Multi-sectoral efforts to reduce non-communicable diseases Working across education, rural development, social protection, gender inequality to address broader causes of ill-health

5. Australia is reducing the impact of global and regional health threats Pandemic preparedness Tackling malaria drug resistance Responding to natural disasters Adapting to climate change

6. Australia is maximising the impact of Australia’s investment Aligning assistance to national priorities Coordinating with other donors Ensuring multilateral agencies are effective Building the evidence base

Case study: Nepal Context Least developed country Malnutrition major problem Increasing non-communicable diseases Busy donor environment: World Bank, DFID, USAID, GTZ, Asian Development Bank, JICA, AusAID Government budget allocation to health progressively increased (7% GDP) Map: Lonely Planet

Case study: Nepal Pooled funding approach Estimated $10 million for health in 2010-11 Contribute to Nepal’s health sector program through joint financing arrangement Good donor coordination mechanism AusAID influences health outcomes at policy level Impact Under five mortality rate decreased from 61 per 1,000 live births in 2006 to 50 in 2009

South and South-East Asia Australia’s focus is on the Asia-Pacific region, with increasing support to Africa Pacific Islands Strong health system Delivering health services Maternal and child health and high-burden infectious diseases Prevention and control of non-communicable diseases Building a sustainable health workforce South and South-East Asia Working with partner governments Supporting quality health services for the poorest people Strengthening health systems Focus on communicable diseases and maternal and child health Africa Targeted support for maternal and child health, focusing on East Africa Working with experienced to strengthen the delivery of health services.