U GANDA ’ S EXPERIENCE WITH MONITORING AID EFFECTIVENESS COMMITMENTS IN THE HEALTH SECTOR Dr. Sarah Byakika Ministry of Health 5 th October 2012

H OW IS IT BEING DONE, AND WHAT IS BEING MONITORED ? Compact between GOU and Partners for Implementation of the Health Sector Strategic and Investment (HSSIP) 2010/11 – 2014/15 Guiding Principles: Ownership and leadership by government Alignment of all partner programmes, activities and funding to one national plan (HSSIP) and harmonized annual plan Use of common management arrangements Value for money, and One monitoring framework to promote accountability

H OW IS IT BEING DONE, & WHAT IS MONITORED ? Health Policy and Advisory Committee (HPAC) serves as the main oversight and steering body for monitoring implementation of the Compact. Specifically responsible for; Quarterly review of whether signatories are on track with their commitments. Attendance of the quarterly sector performance review meetings Participating in Annual reviews to monitor whether “Government” has met its commitments with respect to the implementation of HSSIP

H OW IS IT BEING DONE, & WHAT IS MONITORED ? How it should be done? What is monitored? What is being done? Quarterly review during HPAC Whether signatories are on track with their commitments Not done. No monitoring tool. Quarterly and Annual sector performance reviews Whether government has met its commitments Quarterly and annual sector performance reviews conducted based on the key outputs in the workplan and HSSIP core indicators

W HAT IS BEING MONITORED ? INPUT & PROCESSOUTPUTOUTCOMEIMPACT Health financing Information, Governance Service access and readiness Coverage of interventionsHealth status 1 GGA on health as % of total gov’t budget 5 TB case detection rate 10 % pregnant women attending 4 ANC sessions 22 Maternal Mortality Ratio Workforce6 Per capita OPD utilization rate 11 % of deliveries in public and PNFP 23 Neonatal mortality rate 2 Annual reduction in absenteeism rate 7 % of HFs w/o of any of 6 tracer medicines 12 % children under one year immunized with 3 rd dose pentavalent vaccine 24 Infant Mortality Rate 3 % of posts filled by trained HWs 8 % functional HCs IV 13 % one year old children immunized against measles 25 Under 5 mortality rate Infrastructure Service quality and safety 14 % pregnant women who have completed IPT2 Financial risk protection 4 % of villages/ wards with a functional VHT 9 % clients expressing satisfaction 15 % of children exposed to HIV accessing HIV testing within 12 months 26 % of HHs experiencing catastrophic pay 16 % UFs with fever receiving malaria treatment within 24 hrs 17 % eligible persons receiving ART Risk factors and behaviours 18% of households with a pit latrine 19% U5’s new visits with stunting 20% U5s with marasmus 21Contraceptive Prevalence Rate

H OW ARE FINDINGS BEING USED, AND BY WHOM ? Quarterly/biannual and annual reports compiled, discussed and disseminated Annual performance report findings are discussed at the Joint Review Mission; Involves all stakeholders in health Focuses on performance against the core indicator targets, Jointly identify challenges, priority interventions and targets for the remaining period in the FY and subsequent year. Expected to guide planning & resource allocation by government and partners Used for recognition and reward

H OW ARE FINDINGS BEING USED, AND BY WHOM ? Used to meet other national and global reporting requirements e.g. Government of Uganda Annual Report, Project Reports, IHP+ report

W HAT HAS CHANGED, AS A RESULT ? Government taking lead in determining sector priorities (HSSIP) and available resource allocation Using a common M&E framework (Country-led) with harmonized M&E tools. Minimised reporting requirements at implementation level Joint Assessment Framework – jointly agreed targets and monitoring avoiding conflicting reports

M AIN LESSONS Continuous dialogue necessary to bring all partners on board (Long consultative process) All key stakeholders need to be involved in development of monitoring tools to cater for data/reporting needs, ensure ownership, use and transparency

M AJOR C HALLENGES Not all donors are signatory to the Compact Some partners hesitant to adopt the SWAPs – off budget funding which is difficult to program and monitor and may not be aligned to sector priorities Opting for project support and Parallel Implementing Units with focus on achieving project indicators. (skews resources) Difficult to track donor resources due to lack of transparency. (Some do not share MOU, commitments or amounts disbursed with MoH and this information is not easily accessible from MoFPED) Sometimes disbursements are below commitments. Who is to be held accountable? Development Partner Commitments are not assessed or discussed during the sector performance reviews.