1. Health Impact Assessment and Healthy Development: Health as an issue in donor supported poverty and sustainability impact assessments Peter Furu PLENARY SESSION III

2. 15 April 2011, Peter Furu Slide 2 DBL - Centre for Health Research and Development Dept. of Veterinary Disease Biology Section for Parasitology, Health and Development University of Copenhagen, Denmark WHO Collaborating Centre for Health and Environment in Sustainable Development WHO Collaborating Centre for Integrated Control of Helminth Infections WHO Collaborating Centre for Research and Training on Neglected and ccccccccccccccccccccccccccccc other Parasitic Zoonoses Peter Furu (pfu@life.ku.dk)

3. 15 April 2011, Peter Furu Slide 3 DBL - Centre for Health Research and Development Overview The rough landscape of aid for development, potential impact assessment overload and aid effectiveness Harmonization of IAs – health in PIAs and SIAs Demand-driven HIA capacity development – an area for donor support towards “healthy development”

4. 15 April 2011, Peter Furu Slide 4 DBL - Centre for Health Research and Development USD 128.7 billion (highest ODA level ever) 2010 Global country programmable aid is planned to grow at a real rate of 2% per year from 2011 to 2013, compared to 8% per year on average over the past three years. Bilateral aid to health amounted to USD 10.9 billion and multilateral agencies’ aid to USD 4.7 billion (2007) Health sector Crisis !! Beyond 2010 Crisis !? Landscape Official Development Assistance (ODA) Organisation for Economic Co-operation and Development (www.oecd.org)

5. 15 April 2011, Peter Furu Slide 5 (1972-2012 - not exhaustive) National Poverty Reduction Strategies in partner countries Aid agencies’ national and sector specific policies and strategies Rio +20 (2012) Accra Agenda for Action (2008) Paris Declaration on Aid Effectiveness (2005) Rome Declaration on Harmonization (2003) Rio +10 (2002) UN Millennium Development Declaration (2000) Rio Declaration on Environment and Development (1992) UN Conference on Human Environment, Stockholm (1972) DBL - Centre for Health Research and Development Landscape Key strategic and policy guidance for spending

6. 15 April 2011, Peter Furu Slide 6 DBL - Centre for Health Research and Development Landscape The health sector is considered one of the most fragmented and complex sectors with around 100 global health partnerships (OECD-DAC) OECD-DAC (2006): In 29 countries in sub-Saharan Africa between 18-23 donors active in the health sector - in addition – because health is a cross-cutting issue Sector level

7. 15 April 2011, Peter Furu Slide 7 DBL - Centre for Health Research and Development - and exposed to even more different impact assessment guidelines with different procedural approaches and their varied (and often inconsistent) use of definitions, terms and indicators ! Donors, developers and authorities are confronted with scores of mandatory or optional thematic impact assessments to facilitate safe spending of aid !! Landscape Health as a cross-cutting issue

8. 15 April 2011, Peter Furu Slide 8 DBL - Centre for Health Research and Development Impact assessment landscape Health Impact Assessment Social Impact Assessment Environmental Impact Assessment Strategic Environmental Assessment Biodiversity Impact Assessment Poverty Impact Assessment Sustainability Impact Assessment Human Impact Assessment Health-systems Impact Assessment Gender Impact Assessment Climate Impact Assessment Equality Impact Assessment Health Inequalities Impact Assessment Regulatory impact analysis Some elements Trade impact assessment Mental Health Impact Assessment Impact Assessment Health Equity Impact Assessment Integrated Environmental Health Impact Assessment Environmental Health Impact Assessment Poverty and Social Impact Assessment Global Impact Assessment

9. 15 April 2011, Peter Furu Slide 9 DBL - Centre for Health Research and Development From the donor perspective - does this diversity facilitate aid effectiveness and resulting development impact ?? Impact assessment landscape ?

10. 15 April 2011, Peter Furu Slide 10 DBL - Centre for Health Research and Development Impact assessment landscape Narrowing down to health Health Impact Assessment Integrated Environmental Health Impact Assessment Mental Health Impact Assessment Health Equity Impact Assessment Environmental Health Impact Assessment Health Inequalities Impact Assessment Health-systems Impact Assessment

11. 15 April 2011, Peter Furu Slide 11 DBL - Centre for Health Research and Development Impact Assessment landscape Will this diversity potentially confuse more than create thematic and procedural clarity for the users (e.g. the donor community)?? Health related ?

12. 15 April 2011, Peter Furu Slide 12 DBL - Centre for Health Research and Development Impact Assessment landscape What has some of the key donor partnerships done to facilitate the use of integrated impact assessment and is health an issue addressed? ?

13. 15 April 2011, Peter Furu Slide 13 DBL - Centre for Health Research and Development Harmonization of IAs OECD-Development Assistance Committee (DAC) Donor co-operation “The overarching objective (2011-2015) is: - to promote development co-operation and other policies so as to contribute to sustainable development, including pro- poor economic growth, poverty reduction, improvement of living standards in developing countries, and to a future in which no country will depend on aid.” (www.oecd.org) 24 members (largest funders of aid) 3 observers (WB, IMF, UNDP) European Parliament, Council and Commission World Bank Group

14. 15 April 2011, Peter Furu Slide 14 DBL - Centre for Health Research and Development Harmonization of IAs OECD-DAC Donor co-operation DAC Network on Poverty Reduction (POVNET) A Practical Guide to Ex Ante Poverty Impact Assessment (2007) OECD Guidance on Sustainability Impact Assessment (2010) European Commission Impact Assessment Guidelines (2009) IFC of the World Bank Group Environmental, Health and Safety Guidelines (2007) Performance Standards and Guidance Notes (2007)

15. 15 April 2011, Peter Furu Slide 15 DBL - Centre for Health Research and Development Harmonization of IAs OECD-DAC Donor co-operation DAC Network on Poverty Reduction (POVNET) A Practical Guide to Ex Ante Poverty Impact Assessment (2007) Key focus: Assessment against 1) five capabilities required by people to escape from or avoid poverty: Economic (e.g having assets to pursue sustainable livelihoods) Human (e.g. health, education, shelter, water, nutrition) Political (e.g human rights, having a voice) Socio-cultural (e.g. member of social and cultural networks) Protective-security (e.g. issues that help lessen vulnerability) Environment and gender as cross cutting issues -and assessment against 2) the MDGs and other strategic goals

16. 15 April 2011, Peter Furu Slide 16 DBL - Centre for Health Research and Development Harmonization of IAs Donor co-operation OECD Guidance on Sustainability Impact Assessment (2010) Key focus: Assessment against three pillars of sustainable development: Economic (e.g. functioning of internal market and competition; trade and investment flows; consumer prices) Social (e.g. employment and labour markets; access to and effects on health systems and services, public health and safety Environmental (e.g. the climate; quality of air; water; soil; land use; waster management)

17. 15 April 2011, Peter Furu Slide 17 DBL - Centre for Health Research and Development Harmonization of IAs Integrated Impact Assessment ? How do we as an HIA community of researchers, practitioners and other stakeholders ensure that health is sufficiently covered in such types of integrated impact assessments - and thereby assist donors in becoming health focused and effective? www.oecd.org

18. 15 April 2011, Peter Furu Slide 18 DBL - Centre for Health Research and Development Capacity development Whether we want to promote HIA as a stand alone exercise or emphasize health as an element of integrated impact assessment we need awareness creation and capacity development !!! Importantly: HIA capacity development is needed in both development partner countries as well as in donor countries !!!

19. 15 April 2011, Peter Furu Slide 19 DBL - Centre for Health Research and Development Capacity development Comprehensive intersectoral HIA capacity development in the Mekong Region, South East Asia supported by: Danish Government (Danida) German Government (InWEnt (now GIZ)) World Health Organization Creating an enabling environment for HIA ! One example of donor supported HIA CB 2003-2011

20. 15 April 2011, Peter Furu Slide 20 DBL - Centre for Health Research and Development Capacity development Lao PDR: Training of MOH staff on essential HIA functions Intersectoral HIA training, Support to HIA guidelines development, Support to HIA policy formulation process, HIA Policy decreed by Lao PDR government, HIA Unit operational in MOH Vietnam: Training of MOH staff, Training-of-trainers on HIA Provincial intersectoral HIA training (two provinces) HIA in “Law on communicable diseases control” HIA in National Environmental Health Action Plan (NEHAP) Technical assistance on HIA of hydropower dev. Some results

21. 15 April 2011, Peter Furu Slide 21 DBL - Centre for Health Research and Development Capacity development Cambodia: Training of MOH staff on essential HIA functions, Pilot blended (e-learning) course on Intersectoral HIA, Support to Department of Preventive Medicine, MOH on HIA policy formulation process including: -National strategy for environmental health protection -National Environmental Health Action Plan (NEHAP) -National HIA Policy Some results

22. 15 April 2011, Peter Furu Slide 22 DBL - Centre for Health Research and Development Capacity development Some challenges - to ensure continuous interest and commitment by both health and non-health sectors; -still work to be done promoting and ensuring intersectoral collaboration; - constraint for progress are limitations in funding.

23. 15 April 2011, Peter Furu Slide 23 DBL - Centre for Health Research and Development In conclusion Does the diversity of IA facilitate aid effectiveness and resulting development impact ?? ? From the perspective of the donor (authority) - will this diversity potentially confuse more than create thematic and procedural clarity for the users ?? ? For discussion

24. 15 April 2011, Peter Furu Slide 24 DBL - Centre for Health Research and Development In conclusion For discussion How do we as an HIA community of researchers, practitioners and other stakeholders ensure that health is sufficiently covered in such types of integrated impact assessments - and thereby assist donors in becoming health focused and effective? What has key donor partnerships done to facilitate the use of integrated impact assessment and is health an issue addressed ? ? ?

25. 15 April 2011, Peter Furu Slide 25 DBL - Centre for Health Research and Development Thank you - Gracias Acknowledgements: Danida, Denmark World Health Organization, Geneva InWEnt, Germany Ministries of Health in Cambodia, Vietnam and Lao PDR