Today I am going to speak with you about the importance of the Paris Declaration on aid effectiveness for health system strengthening and WHO role in promoting aid effectiveness. Where relevant I will complement my presentation with the experiences of implementing these principles in the occupied Palestinian territory, the place I am currently working and several other contexts…
The international aid system was born out of the ruins of the Second World War, when the United States used their aid funds to help rebuild Europe. In the Cold War era that followed the foreign aid was often used to support ally states in the developing world. After the end of the Cold War, the declared focus of official aid began to move towards the alleviation of poverty and the promotion of development. It is against this background that the international aid effectiveness movement began taking shape in the late 1990s. Donor governments and aid agencies began to realize that their different approaches and requirements were imposing huge costs on developing countries and making aid less effective. They began working with each other, and with developing countries, to harmonize their work in order to improve its impact.The aid effectiveness movement picked up steam in 2002 at the International Conference on Financing for Development in Monterrey, Mexico, which established the Monterrey Consensus. There, the international community agreed to increase its funding for development—but acknowledged that more money alone was not enoughIn 2003, aid officials and representatives of donor and recipient countries gathered in Rome for the High Level Forum on Harmonization. At this meeting, convened by the Organization for Economic Co-operation and Development (OECD), donor agencies committed to work with developing countries to better coordinate and streamline their activities at country level. They agreed to take stock of concrete progress before meeting again in Paris in early 2005 In Paris, countries from around the world endorsed the Paris Declaration on Aid Effectiveness, which was a more comprehensive attempt to change the way donor and developing countries do business together, based on principles of partnership. In2008, the Third High Level Forum in Accra, Ghana and in 2011 Fourth High Level Forum on Aid Effectiveness, Busan, South Korea, took stock of progress and built on the Paris Declaration to accelerate the pace of change.The principles agreed upon in the declarations are however still not always practiced by donors and multilateral bodies
The declaration is built around the following five principles, which if implemented will drastically improve the effectiveness of development aidI’am going to speak about these in more details in the following slides
The MoH takes ownership when it sets the health agenda and exercises effective leadership over its policies and strategies, and coordinates development actions.This principle supports the Ministries of Health in: • Building strong country leadership in health. • Developing and implementing national development strategies through broad consultative processes. • Translating those into prioritized results-oriented operational programmes as expressed in medium-term expenditure frameworks (MTEF) and annual budgets. • Coordinating health aid with national governments, aid partners civil society and the private sectorThis principle highlights some of the challenges facing the Palestinian MoH in exercising effective stewardship of the health sector. Unable to effectively govern health system development in Gaza due to political split between Hamas and Fatah and the most territory of the West Bank due to Israeli occupation it fully exercises the stewardship of the health system in around 30% of the Palestinian territory only. At the same time the oPt and its health sector in particular is the major per capita aid recipient in the world (2008-2010 7.7 b USD).WHO plays a major role in supporting the MoH ownership of the HS development agenda and facilitating alignment and harmonization of development and humanitarian aid to the health sector“Since 1993, a complex structure for donor coordination has been put in place in an effort to balance competing American and European positions, facilitate agenda-setting, reduce duplication, and foster synergies. The overall monitoring of the donors' activities was assigned to the Ad-Hoc Liaison Committee, which was established in November 1993, operates on the basis of consensus, and aims at promoting the dialogue between the partners of the "triangular partnership", namely the donors, Israel, and the PNA”
WHO in oPt acts as a convener, liaison and advocate for supporting Palestinian health systems in line with the nationally set standards and strategies. It is a lead technical advisor to the Health Sector Working Group: a forum that brings together MoH and major health sector donors to jointly develop and monitor health sector development activities. MoH chairs the group.WHO liaises with the Israeli authorities and Gaza health authorities to enable Health Service provision and harmonize approaches to health systems building across West Bank and Gaza.It advocates with the Israeli authorities to ease access of the Palestinians to health and with donors to provide predictable, coordinated aid that contributes to achievement of the national health priorities and plans
Alignment implies that development assistance is based on, and delivered in accordance with countries’ national development priorities, strategies, institutions and procedures.To facilitate alignment of the development aid with health priorities, strategies and procedures the MoH should ensure that:Health priorities are included in the national development plansEffective systems, procedures and standards are set to develop and implement health programs (particularly procurement and finance structures)It should also shift from project to longer term and more comprehensive program approaches, supported by appropriate financial mechanisms such as Medium Term Expenditure FrameworksThe DP-s shallAlign their assistance with the national priorities and strategiesUtilize more the national financial and procurement systemsReduce of the parallel implementation mechanismsThe alignment of aid had variable success across the globe: one of the successful examples is Philipines:The Philipines had substantial experience coordinating development aid long before the Paris Declaration was adopted , both the government and its development partners in the donor community have adopted the Medium-Term Philippine Development Plan in formulating country partnership strategies. After 2005, both parties agreed to adhere to the Paris Declaration principles as basic guide for the conduct of aid-funded programs. The Philippine Development Forum has been an effective forum for aid coordination, implementation, monitoring and evaluation. The above had a significant positive impact across many sectors including health where serious efforts were made to organise assistance around the government’s health sector reform agenda. At the same time in NepalApplying the Paris Declaration is still perceived as an additional requirement, rather than bringing a change in the ways in which aid is designed and managed. The proportion of aid that is off budget has remained the same (around 25%) throughout the last 10 years though there has been some reduction recently. Support for country systems has also changed little though there has been some reduction due to DP confidence declining.
To facilitate the alignment of the development aid WHO shall:Itself follow principles of aid effectiveness throughout the internal planning cycle (development of CCS)Facilitate alignment of UN coordination and partnership platforms such as the Common Country Assessment/United Nations Development Assistance Framework (CCA/UNDAF) with national planning cyclesBuild MoH capacities in development of strategies, plans and budgetsStrengthen MoH engagement in development of the national aid platforms PRSP, SWApetcFacilitate strengthening of the country health systems, in particular management structuresAdvocate for a more predictable aid, aligned with the national priorities
Harmonization implies increased coordination and streamlining of the activities of different aid agencies to be more 'collectively' effective by developing common arrangements; simplifying procedures; and sharing information. (reducing duplication and overlap) Some of the measures that the MoH can undertake to increase harmonization of aid to the health sector:Simplified and common arrangements at country level for planning, funding and M&E. • Development of common standards• Harmonized performance assessment frameworks for country systems. • Shared assessment and research activities. • Joint training and capacity building. Mali had a dramatic improvement in aid effectiveness from 2006 to 2011. One of the factors that contributed to this was simplification and harmonisation of procurement and financial procedures at a national level. A first Public Expenditure and Financial Accountability assessment was conducted in 2006; a government Action Plan for the Improvement and Modernisation of Public Finance Management was approved by the government in April 2005 for the 2006-2009 period and later for 2011-2015. a new government Contracting Code was adopted in 2008 to institute greater transparency and devolution.
The WHO can benefit the aid harmonization process throughFacilitating joint assessments, planning and implementation of joint activitiesBuilding consensus on the common sectorial standardsFacilitating the coordination of development partner assistanceSupport information sharing between agenciesSupport joint training, assessment and capacity building activities
Mutual accountability means that Donors and developing countries must account more transparently to each other for their use of aid funds, and to their citizens and parliaments for the impact of their aid. The Paris Declaration says all countries must have procedures in place by 2010 to report back openly on their development results.Managing for results implies that All parties in the aid relationship must place more focus on the result of aid, the difference it makes in poor people’s lives. They must develop better tools and systems to measure this impact. To strengthen mutual accountability and results based management the health authorities and development partners shall:Accompany national strategies and plans by M&E frameworksAnalyze, disseminate health data and use it in the process of development and evaluation of the national health policies, strategies and plansDevelopment partners shall utilize the national M&E frameworks in the planning and implementation of development aid and feed data for the national policy and strategy planningCountries around the world continue to face problems with the RBM of health programs and accountability: in Indonesia collaborative management of the monitoring and evaluation aspect of development results has not moved as expected. The government still focuses more on evaluating achievements of sectors which takes place yearly. Development partners tend to evaluate their development programs (i.e. grant) against the programs’ defined targets. In particular, monitoring of bilateral off-budget programs has been fully project focused and managed directly by the respective implementing agencies.
To foster mutual accountability and RBM WHO could:Facilitate coordination and information sharing between MoH, development partners and civil societySupport MoH to develop adequate and feasible M&E mechanisms for country health strategies and plansSupport MoH to better manage and utilize data for development and evaluation of the national health policies, strategies and plansAdvocate for greater utilization of the national M&E systems and data for planning and implementation of development assistanceI approached the end of my presentation.In conclusion I would like to say that despite the challenges in implementing the Paris Declaration (and the Accra Agenda for Action) it clearly represents a value added for both recipients and providers of developmental assistance, it acts a useful reminder to all the parties of the key principles and prerequisites of effective aid and is a powerful advocacy and policy tool for harmonization of aid and its alignment with the national goals and objectives.
The Paris Declaration on AidEffectivenessThe relevance for the health system buildingand the WHO role in promoting aideffectivenessV. Harutyunyan M.D.
WHO-oPtThe Paris Declaration - Introduction• Broad agreement on how to achieve effectiveness in development cooperation• Not legally binding• Endorsed in March 2005 by 90 countries and 27 aid agencies• Builds on the previous international efforts – International conference of financing for Development, Monterrey (2002) – Rome Declaration on Harmonization (2003) 2|
WHO-oPtThe Paris Declaration - Principles• Government ownership• Alignment with national development priorities• Harmonization of international assistance/donor practices• Mutual accountability• Results based management 3|
WHO-oPtGovernment ownership• Leadership in health• Development of national health policies strategies and plans• Resourcing and implementation of the strategies and plans• Coordination of aid 4|
WHO-oPtGovernment ownership (WHO role)• Support MoH leadership in development of the national health policies, strategies and plans• Facilitate stakeholder engagement in the NHPSP formulation process• Provide technical support to NHPSP formulation• Advocate for harmonization of aid with the national policies and strategies• Advocate for integration of the right to health into national health policies and agendas and alignment between health and other national strategies 5|
WHO-oPtAlignment with national development priorities• Health priorities included in the national development plans• Effective mechanisms for planning and implementation of the national health programs• Alignment of the donor assistance with the national priorities and strategies• Utilization of the national financial and procurement systems by the development partners• Reduction of the parallel implementation mechanisms 6|
WHO-oPtAlignment (WHO role)• Follow principles aid effectiveness throughout the internal planning cycle• Build MoH capacities in development of strategies, plans and budgets• Strengthen MoH engagement in development of the national aid platforms PRSP, SWAp etc• Facilitate strengthening of the country health systems, in particular management structures• Advocate for a more predictable aid aligned with the national priorities 7|
WHO-oPtHarmonization of international assistance• Improved coordination• Optimization of program planning and implementation arrangements• Joint needs assessments, planning and implementation• Agreement on the common standards and approaches• Harmonized M&E systems 8|
WHO-oPtHarmonization (WHO role)• Facilitate joint assessments, planning and implementation• Build consensus on the common sectorial standards• Participate in the coordination of consolidated development partner assistance• Support coordination and information sharing between agencies• Support joint capacity building activities 9|
WHO-oPtMutual accountability and Results basedmanagement• National strategies and plans are accompanied by M&E frameworks• Health data is used in the process of development and evaluation of the national health policies, strategies and plans• Development partners utilize the national M&E frameworks in the planning and implementation of development aid• Development partners feed data for the national policy and strategy planning 10 |
WHO-oPtMutual accountability and Results basedmanagement (WHO role)• Facilitate coordination and information sharing between MoH, development partners and civil society• Support MoH to develop adequate and feasible M&E mechanisms for country health strategies and plans• Support MoH to better manage and utilize data for development and evaluation of the national health policies, strategies and plans• Advocate for greater utilization of the national M&E systems and data for planning and implementation of development assistance 11 |