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MADAGASCAR ECONOMIC UPDATE: AID EFFECTIVENESS DURING
POLITICAL INSTABILITY –A LOOK AT SOCIAL SECTORS
World Bank – April 1, 2011


    In Madagascar, donors have traditionally counted for almost half of the Government’s budget
    and have been, by far, the main source of funding in social sectors. Since the beginning of the
    crisis, official aid toward education, health and social protection surged, reaching almost
    US$260 million in 2010 against US$180 million in 2008. This increase failed nonetheless to
    improve significantly social indicators. Does it mean that (i) aid works but the country did not
    get enough of it to counterbalance the effects of the current political and economic crisis, or
    (ii) aid effectiveness has been limited and there is a need to improve its quality rather than its
    quantity?


Official aid flows have been cut since the beginning of the political crisis except to social sectors
where donors have increased significantly their disbursements between 2008 and 2010. This
increase has been justified on humanitarian grounds, to respond to the growing social distress
of the population. Unfortunately, most social indicators have continued to fall, as evidenced by
the recent drop in net registration rate in primary schools, the rate of births attended by
medical staff, and the use of external medical consultations. For some observers, this
deterioration is viewed as an argument for more external funding: aid works; we just do not do
enough of it. For others, it reveals the need to improve not only the quantity but also the
quality of foreign assistance. Both sides have good arguments. Although more social aid will be
necessary to account for the pressing needs of the population (which itself growing fast), this
note will subscribe to the second view and, ultimately, argue that aid effectiveness must be
improved in priority if donors want to contribute significantly to Madagascar’s development
both in the short and longer terms.

Lower aid but not to social sectors

Since the beginning of the political crisis, donors have reduced their disbursements toward
Madagascar by about US$200 million per year (Table 1).1 This decrease is the result of the non-
recognition of the Transition Government by the international community and the quasi-
absence of new projects that are not directly justified on humanitarian grounds. The most
significant drops were observed in the areas of infrastructure, productive activities, and
institutional support.



1
 All figures on aid reported in this note are based on the information provided by donors and collected by the
Coordinating Unit in the Prime Minister Office. It has to be acknowledged that this base might not be fully
accurate, adjusted on a continuous basis, and that some key partners are still missing, including China, India and
most Arab countries. For more details, see www.amp-madagascar.gov.mg.

                                                                                                        1|Page
Contrary to this global trend, the amount of official aid toward social sectors surged from
US$180 million in 2008 to US$260 million in 2010.2 This increase is the combination of growing
support in health (up by 75%), social protection (42%), and the relative stagnation in education
(down by 6%).3 A closer look at the composition of official aid in each of these social areas
helps to understand better the quantitative and qualitative changes that occurred over the past
couple of years (Annex 1 for fuller details).

                 Table 1: Lower Aid inflows except in social sectors (in US$ millions)
                                                             2008              2009              2010
  Education, health, social protection                       179.8             182.9             255.8
  Water, transports, energy, communication                   168.6             77.6              79.9
  Financial sector, mines, industry, commerce,               43.4              14.9              11.3
  employment, tourism
  Agriculture, fishery                                       42.2              69.9              50.8
  Environment                                                50.1              24.4              16.2
  Institutional support                                      45.7              25.7              27.0
  Non allocated budgetary support                            96.6              5.7               5.5
  Total                                                      626.4             401.4             446.5
Source: Database of the Prime Minister office/UN.

       Education: The level of external financing remained almost stable, varying from
        US$61.7 million to US$57.8 million between 2008 and 2010. Before the crisis, foreign
        assistance was consolidated around “three” donors: the Education-For-All Catalytic
        Fund/World Bank (US$24 million), Norway (US$15 million) and the African Development
        Bank (US$8.3 million). In 2010, aid become more fragmented, with the emergence of
        new donors such as UNICEF (US$28 million, including the taking over the management
        of the Catalytic Fund), Agence Française de Développement (4.5 million), OPEP (US$3
        million), and the International Labor Organization (US$2 million).

       Health: The level of external financing jumped from US$92 million to US$160 million
        between 2008 and 2010. In 2008, USAid, the World Bank and the Global Fund (VIH,
        Malaria, and Tuberculosis) accounted for 80% of donors’ assistance. In 2010, USAid and
        the Global Fund remained top funders but new donors emerged such as the Global
        Vaccine Initiative (US$9 million), the UNFPA (US$10 million), and UNICEF (US$5.8
        million).

       Social Protection: External assistance increased from US$26 million to almost US$38
        million between 2008 and 2010. The main donors have been the World Bank, the World

2
  The external support toward agriculture and fisheries also increased between 2008 and2010 but not by the
magnitude observed in social sectors.
3
  It can be argued that part (but not all) of the budget support provided by donors in 2008 (US$89.5 million) was
allocated to the social sectors and, so, its quasi-elimination has affected social sectors in 2009 and 2010. This
argument will be taken into account in the next section of this note by observing that the total expenditures spent
by the Ministries of Education and Health declined between 2008 and 2010 but not as much as the increase in
external funding directly allocated to these social sectors.

                                                                                                         2|Page
Food Program, and France but the number of donors and projects increased significantly
         over this period.

More aid as the response to social distress

The political and economic crisis has produced an undisputable increase in social distress in
Madagascar. Such deterioration has to be expected during an economic slowdown when
people are losing jobs and revenues. More recently, the surge in international prices of food
and crude oil has also worsened the situation of many vulnerable households. The recent
household survey confirms that poverty is 9 percentage points higher in 2010 than in 2005
(reaching 77% of households) and that many social indicators have deteriorated, including the
ratio of births attended by skilled health workers (down from 51% in 2006 to 44% in 2009),
external consultations to health services (down by 8 percentage points between 2005 and
2010), and the net enrollment rate in primary schools (down from 83% in 2005 to 73% in
2010).4 Recent evidence collected by UN agencies in Antananarivo and Toliara also reveals
that: (i) many households have suffered from significant financial losses and so are less able to
finance their education and health expenses;5 and (ii) the public health and education systems
are lacking of funding and materials, especially in rural areas.6

Furthermore, the State has shown limited capacity to respond to the pressing social needs of
the population in view of its budgetary constraint. The Ministries of Education and Health have
seen their non-wage and capital expenditures (funded on their own resources) declined by 20
and 70% respectively between 2008 and 2010 (Figure 1). Such cuts explained lower
maintenance and equipments shortages (such as books and medicine) reported in many
schools and health centers over the past two years.7

Consequently, the combination of higher social distress and limited capacity of the State has
motivated the increase in aid toward social sectors. During the crisis, donors have often acted
as “the lender of last resort”, and without them, the social situation in Madagascar could have
been arguably worse than it is today. The truth is that a large fraction of teachers are now paid
directly by the Education-For All Catalytic Fund managed by UNICEF, a growing number of
health centers are funded by donors, and emergencies in children malnutrition and climatic
disasters are increasingly covered by targeted programs financed by external funds.


4
  The sources are the Households survey of 2005 and 2010 and the SOWC of 2008 and 2011.
5
  The cost of school materials can be difficult to bear for families with many children and few resources: A basic
package of school materials for one first grader (notebooks, pencils/pens, etc.) costs approximately 4,100 Ariary
(around 2 USD), while a second grader needs around 5,000 Ariary (or 2.5 USD) to cover basic school materials.
6
   In the South, it is observed that less than one out of two basic health facilities are staffed according to national
norms and as much as one out of three basic health centers considered operational are managed by support staff
only. A recent survey carried out in six regions shows that there are no antibiotics available in 30 % of basic health
centers (source: UNICEF newsletter, N. 3, September 2010).
77
   In 2009, the government reduced the budget covering operational costs of health centers at district level by
30%.

                                                                                                           3|Page
Fig.1 : Cuts in non wage and capital                            600       Fig.2: Total social spending has
                                  500   expenditures in the Ministries of Education                             increased since the beginning of the
                                  450   and Health                                                      500                     crisis
                                  400
    Billion of Ariary (current)




                                                                                   440                  400




                                                                                          US$ million
                                  350
                                          352                 366
                                  300                                                                   300
                                  250
                                  200                                                                   200
                                  150                         188
                                          168                                                           100
                                  100                                              139
                                   50                                                                    -
                                           67                  67
                                   -
                                                                                    19                        Domestic Social Official Aid to   Total spending in
                                          2008                2009                 2010                        expenditures social sectors        social sectors
                                                 wages
                                                 non wages
                                                 investments (internally funded)                                          2008     2009     2010

Sources: Ministry of Finance and Prime Minister Office/PNUD
Notes :
1/ Domestic social expenditures are defined as the total spending of the Ministries of Education and Health
excluding investment funded by external resources.
2/ Official aid is defined as the disbursed amounts reported by donors.


What about aid effectiveness?

Aid has helped to reduce the impact of the current crisis on households and preserve at certain
level of social services. Yet, one has to wonder if this assistance has been optimal, or, in other
words, more could have been expected from the recent increase in foreign assistance.

Two evidences support such questioning. First, the total resources allocated to social sectors
are 20% higher today than in 2008 since the increase in foreign funding has more than
compensated for the decline in the Government’s budget (Figure 2). Second, social needs were
already pressing before the crisis. In 2008, the Government and donors, with less money, were
able to contain the impact of six tropical storms/cyclones in the first four months8 and of the
global financial crisis as well as the surge in international food and crude oil prices. The
argument is not to compare the magnitude of social distress before and during the crisis but
rather to examine more carefully if aid has been effective over the past two years.

Since the beginning of the crisis, the delivery mechanisms of aid in social sectors can be
captured through the following shifts:




8
  The quasi-absence of major climatic disasters over the past two years has to be contrasted with the huge
damages produced by the 2008 cyclones estimated to more than US$330 million by the UN/World Bank affecting
more than 300,000 people.              Source: Joint Damage, Loss and Needs Assessment (JDLNA).
http://www.gfdrr.org/gfdrr/sites/gfdrr.org/files/documents/Madagascar_PDNA_GLANCE.pdf

                                                                                                                                                        4|Page
               Donors’ intervention has become increasingly fragmented since the number of
                          externally funded projects in social sectors skyrocketed from 52 to 102 between 2008
                          and 2010 (Figure 3). The median size of those projects declined by 54% in social
                          protection, 26% in health, and 22% in education. Such a trend makes it more difficult to
                          coordinate external support and to align it on the country’s priorities, with a risk of
                          duplication.9

                         A growing share of external support has been channelized outside of the public sector
                          since less than 10% of donors’ disbursements in social areas were executed by the
                          Ministries of Education and Health in 2010 against 30% in 2008 (Figure 4).10 Such
                          decline captures the shift toward Non-Governmental Organizations and local
                          communities adopted by several donors to reduce their fiduciary and political risks. As a
                          result, the public social system is now almost excluded from donors’ money distribution
                          channels.

                         The good performance of the health and education sectors requires not only effective
                          targeted programs in these areas but also good infrastructure (water and roads), decent
                          sources of revenues (otherwise households cannot spend on social services), and good
                          institutional capacity. For example, the lack of access to safe water, and its implications
                          on diarrhea related illnesses, is estimated to generate 5 millions of lost working days per
                          year and is the second cause of children mortality among children under 5 years. Those
                          interconnections are essential but failed to materialize because of the dramatic decline
                          of aid toward those last three pillars since the beginning of the political crisis (Figure 5).

                               Fig.3: The number of projects financed                                                 Fig. 4: Less donors' projects are executed by
                         120                                                                                       50.0%               the Budget
                                       by donors has multiplied
                                                                          % of donors' disbursements executed by




                         100
                                                                     22                                            40.0%
    Number of projects




                         80
                                                     29                                                            30.0%
                         60                                          45
                                                                                           budget




                                      10             35                                                            20.0%
                         40
                                      24
                         20                                          35                                            10.0%
                                      18             25
                          0                                                                                         0.0%
                                     2008            2009          2010                                                        2008            2009      2010
                               Education    Health    Social Protection                                                    Total   Education    Health




9
   Of course, small projects in themselves are not bad. They are an important source of experimentation and
innovation. They may be able to provide exactly what is needed in isolated communities where small amounts of
money can make a significant difference in people’s lives. However, the fragmentation of aid comes at a heavy
price. Each project must be prepared, negotiated, supervised, and reported on.
10
   These figures might also reflect reporting gaps between donors and the Government as well as within the
Government, as some disbursements executed at the Ministerial level are not included in the budget.

                                                                                                                                                         5|Page
Fig. 5: Unbalanced Aid Allocation (USD
                                                        million)
                                                        Social sectors
                                                        300

                                                        200

                                                        100
                                     Institutional
                                                         -                 Infrastructure
                                       Support




                                                         Productive
                                                          activities
                                                 2008        2009        2010


Those shifts have been partly motivated by the current political context since the absence of
recognition of the Government by the international community has obliged many donors to go
around public administration. Political instability and interferences have also justified the use
of “second best” channels, relying on local communities and NGOs in the absence of any
credible public alternatives, to reach out vulnerable groups.

Unfortunately, the recent international experience and empirical evidence has showed that too
high projects’ fragmentation, the lack of coordination between donors and the public sector,
and an unbalanced allocation of resources across sectors are bad for aid effectiveness.11 The
lessons from the field have stressed that too many projects increase administrative and
coordination costs for both donors and the recipient country: think about the difficulties to
manage and coordinate, over 40 projects and 17 donors in the health sector. Envisioning a
performing and sustainable education and health system is hard when almost all external funds
are executed outside of budgetary procedures. These sectors require a strong public
administration, not only to deliver those public services but also to supervise and regulate
them. Finally yet importantly, the excessive concentration of aid in a few sectors can be
counterproductive because it might exceed the absorptive capacity of the recipient country
(possibly leading to corruption and the misallocation of funds) and it fails to account for
intersectoral synergies.

The bottom-line is that foreign aid works well when it is done right. Yet, since the beginning of
the political crisis, aid delivery mechanisms have deviated from the recommendations of the
2005 Paris Declaration. 12 If those deviations might be temporary and “second best”, partly
justified in the current context, they have contributed to lower the impact that might be
expected from aid on people and institutions. The key is to learn lessons to improve aid
effectiveness.



11
   For references, see Delivering Aid differently—Lessons from the Field by Wolfgang Fengler and Homi Kharas,
2010.
12
   Paris Declaration on Aid Effectiveness, 2005. www.oecd.org/dataoecd/11/41/34428351.pdf

                                                                                                     6|Page
Looking for more aid effectiveness

Few people would disagree that official aid has helped to reduce social distress in Madagascar,
and more of it will be necessary to respond to the growing need of the population in the short
and longer terms. The recent experience in social sectors however illustrates that more
external funding is not enough to generate automatic positive outcomes. Education, health,
and social protection benefited from 40% more external resources in 2010 than in 2008 but
social indicators failed to improve significantly. The quality of aid largely matters.

Improving aid effectiveness should be a priority for both donors and the Government. We
advocate that success will require open information and stronger cooperation, first among
donors, and second between donors and the authorities.

      Open information is a key element for achieving scalability of projects, predictability of
       aid flows, efficient division of labor, and low transaction cost. If donors are given
       information on what projects are achieving notable outcomes, they will be able to pool
       their resources to scale up those projects to reach more people. Projects that duplicate
       each other’s efforts will be identified and adapted to reflect a more logical division of
       labor, either by splitting up different stages of the work or by operating in different
       geographic areas. In that sense, the new database on donors’ projects gathered by the
       UN and the Prime Minister Office has been a major step forward in providing
       information on what donors have been doing. This information still needs to be
       matched with a single list of the country’s needs and to alert donors to gaps.

      While a stronger cooperation with the authorities might have to wait for the full
       recognition of the Government by the international community, the coordination
       between donors should be strengthened immediately. NGOs should also be included in
       this effort, as their role has become even more important in these last two years. The
       objective should be to work together so to scale up projects that work well rather than
       adding many small new projects. Such cooperation might also help to improve the
       intersectoral allocation of aid by identifying gaps that go beyond social sectors but that
       affect their performance.

      Operating outside the purview of the Government may generate islands of success
       through dedicated non-governmental agencies and provide the fiduciary and political
       comfort needed for donors. However, this practice may also mask the fact that at the
       same time the generic public delivery system is let to collapse, with much greater
       negative impact on the population. This is not say that one system is superior to the
       other but they have to be complementary and that a broader perspective is needed in
       assessing coverage and efficiency.

Partly because of the special context of the current political crisis, donors have had to modify
the way they deliver aid to Madagascar. Over time, restoring trust between donors and

                                                                                      7|Page
government officials (at the policy and technical levels) will have to be at the center of the
development agenda. A new consensus can be built around the ideals of information sharing
and stronger collaboration. At the end of the day, the common goal is that aid money that is
intended to help poor people will reach them in more efficient and equitable ways.




                                                                                    8|Page
ANNEX: AID DISBURSED BY DONORS AND PROJECTS –2008-2010

Table A-1: Aid Disbursed in the Education Sector, US Million

BAILLEURS        PROJETS                                                              2008     2009     2010
                 TOTAL                                                               61.751   51.082   57.814
AFD              Education de base à Madagascar. N° convention CMG 1164 01            0.779    0.889    0.548
                 EDUCATION POUR TOUS (VOLET MINESEB)/convention n°:CMG                1,651    9.560    4.506
                 3002 01)
GERMANY/KFW      Projet Ny Voary Vintsy. (n° convention:2003 65 056)                  0.414             0.285
AFRICAN          Education III. (n°convention:2100 1500 00548/ 2100 1550 00194)       8.373    2.355    2.013
DEVELOPMENT
BANK
WORLD BANK (*)   Education for all Catalytic Fund I                                  24.940   14.197    1,692
ARAB             APPUI A L'ENSEIGNEMENT GENERAL                                       0.431    1.042    0.489
DEVELOPMENT
BANK
                 Projet de construction et d'équipement de l'institut national des             0.031    0.007
                 sciences comptables et de l'administration des entreprises.
                 (INSCAE)
                 AEP Ambalavao                                                                          0.054
ILO              Projet MEN / BIT MAG/05/M02/MAG                                     1.071     0.002    0.014
                 Projet MEN / BIT MAG/07/M01/MAG                                     0. 516    0.066    0.030
                 Projet MEN /BIT MAG/08/M01/MAG                                      0.453     2.013
                 Construction d’écoles primaires à Madagascar                                           0.022
                 MAG/05/M02/MAG
                 Construction d’écoles primaires équipées à Madagascar                                  0.105
                 (Fabrication de mobiliers scolaires)- Phase II MAG/07/M01/MAG
                 Construction d’écoles primaires à Madagascar – Phase III                               1.987
                 MAG/08/M01/MAG
                 Construction d’écoles primaires à Madagascar – Projet                                  1.005
                 MEN/UNICEF/BIT MAG/10/01M/CEF
UNICEF           Préparation et réponse aux urgences dans l'éducation YE202                    5.713   4.,575
                 Projet 4
                 Education de baseProgramme YE202 Projets 1,2 et 3                             4.160   22.596
JICA             Projet de Suivi "In-Service Training" pour Enseignants                                 0.015
                 Education Primatologicale                                                              0.011
NORWAY           Projet HIMO Bâtiments MAG/05/M01/NOR                                 1.751
                 Projet HIMO Bâtiments MAG/08/M04/NOR                                          0.377    2.501
                                                                                          -
                 MAG-07/013 ILO School Construction 2008-2012                         1.680             2.770
                 MAG-07/014 UNICEF - ensuring the right to quality primary            1.680    2.001    1.979
                 education
                 MAG-09/015 UNICEF - minimizing the negative impact of the                     2.931    2.364
                 crisis on education
                 MAG-05/012 NMS - FLM educational programme - ProVert                 1.680    0.960    1.004
                 MAG-04/016 Support to Education Department MAG-09/003               15.126    0.284    0.216
                 Addendum to MAG-04/016 MAG-09/012 Support to Education
                 Dep. Rest payment UQAM
                 MAG-09/017 Appui au programme de cantines scolaires                           0.480    0.510

                                                                                              9|Page
MAG-09/016 Inclusion of Blind and Deaf                                                    0.668
                   MAG-10/0003 Midterm review UNICEF 2010                                                    0.003
OPEP               Deuxième projet education                                                                 1.524
                   Amélioration de l'éducation                                                               1.319
UNDP               APPUI A L'ALPHABETISATION                                          0.395      0.207       0.023

FRANCE               MADES. (n°convention:2007000100)                                 0.315      0.529       0.505
                     Appui au bilinguisme à Madagascar.(n°convention:2002009600)      0.465      0.027
                     SIST.(n°convention:2002007000)                                   0.023      0.057
                     Programme de bourses (Enseignement supérieur)                               0.404       0.305
                     Programme d''interventions ponctuelles (Enseignement supérieur              0.140       0.080
                     et recherche)
                     Assistance technique (Enseignement supérieur et recherche)                  2.723       1.773
EU                   EIDHR 2010 Annual Action Programme - CBSS (Country Based                                0.299
                     Support Schemes)
Source: www.amp-madagascar.gov.mg.
(*) This project was not included in the Prime Minister/UN database




                                                                                              10 | P a g e
Table A-2: Aid Disbursed in the Health Sectors, US Million

DONORS              PROJETS                                                         2008      2009      2010
                    TOTAL                                                            92.105    91.110    161.214
ONUSIDA             APPUI A LA MISE EN OEUVRE DU PLAN STRATEGIQUE                               0.006      0.020
                    NATIONAL 2007-2012
                    APPUI AUX POPULATIONS CLÉS A HAUT RISQUE ET AUX                   0.134     0.259      0.088
                    PERSONNES VIVANT AVEC LE VIH
UNDP                LUTTE CONTRE LE VIH-SIDA                                                   0.170       0.179
FAO                 Assistance d'urgence pour la surveillance de la fièvre de la               0. 223      0.097
                    Vallée du Rift
AFD                 Santé. (n°convention: CMG 6009 01)                                                     2.156
                    AT et d'expertise au plan de développement Sectoriel Santé.       0.182     0.103      0.036
                    (n°convention: CMG 6008 01)
KFW                 Centre de Santé de Base Mahajanga II. (n° convention:1998 67                0.022
                    052)
WORLD BANK          NUTRITION II (ONN)                                                3.660     2.430      2.190
                    LUTTE CONTRE LE VIH-SIDA ET LES MALADIES SEXUELLEMENT             9.250     1.430      4.680
                    TRANSMISSIBLES (MST)
                    DEVELOPPEMENT D'UN SYSTEME DE SANTE DURABLE                       8.510     1.120      0.060
AFRICAN             Santé II. (n°convention:2100 1500 00562/ 2100 1550 00196)         4.774     2.922
DEVELOPMENT
BANK
                    Appui à la Lutte contre les MST/SIDA. (n°convention:2100          1.832     2.390      0.399
                    1550 03674)
FONDS MONDIAL       Intensification de la lutte contre le VIH/SIDA : une approche     0.133     0.208
TUBERCULOSE,        combinant réponse local et rôle charnière
MALARIA, SIDA       (n°convention:MDG-304-G04-H)
                    Action communautaire pour combattre la malaria.                   1.232     0 800
                    (n°convention:MDG-304-G05-M)
                    Passage à l'échelle des mesures de prévention et de               0.715
                    traitement de la malaria à Madagascar (1).
                    (n°convention:MDG-405-G06-M, (G2))
                    Passage à l'échelle des mesures de prévention et de               1.291     8.610     12.299
                    traitement de la malaria à Madagascar (2).
                    (n°convention:MDG-405-G07-M, (G3))
                    Réduction de la morbi-mortalité causée par la tuberculose au      1.906     1.059
                    niveau des populations pauvres. (n°convention:MDG-404-
                    G08-T)
                    Du controle à l'élimination de la malaria (2007-2012) - 1.        9.712     2.846      8.586
                    (n°convention:MDG-708-G09-M)
                    Du controle à l'élimination de la malaria (2007-2012) - 2.        2.150                3.874
                    (n°convention:MDG-708-G10-M)
                    Réponse au VIH et aux MST à Madagascar: une approche                        2.166      2.586
                    impliquant les populations les plus à risque dans les zones
                    vulnérables (MDG-809-G11-H)
                    Réponse au VIH et aux MST: une approche impliquant les                      1.565      1.514
                    populations à risque dans les zones vulnérables - Volet PSI
                    (MDG-809-G12-H)
                    Tuberculose Pact (MDG-810-G14-T)                                                       1.429
                    Centrale d'Achat de Médicaments Essentiels et Matériels                                1.106


                                                                                                11 | P a g e
Médicals (MDG-910-G15-M)
                     Speed up malaria control activities with a view to eradication                        5.761
                     in Madagascar (MDG-910-G17-M)
                     speed up malaria control activities with a view to eradication                        3.666
                     in Madagascar (MDG-910-G18-M)
                     speed up malaria control activities with a view to eradication                        9.355
                     in Madagascar (MDG-910-G19-M)
                     Speed up malaria control activities with a view to eradication                        9.822
                     in Madagascar (MDG-910-G16-M)
                     Nutrition(MDG-810-G13-T)                                                              1.631
UNICEF               Fourniture des services de santé de base YK201 Projet 4                    5.427      5.043
                     Appui à la lutte contre les maladies sexuellement                          1.144      0.770
                     transmissiblesYJ203 Projets 1,2 et 3
                     Appui à la politique de survie de la mère et enfant YK201 -                0.708     0. 418
                     Projet 1
                     Améliorer les standards de nutrition YK201 Projet 2                        3.578      4.311
FNUAP                Composante santé de la reproduction                               2.950    6.653      5,493
GLOBAL ALLIANCE      Soutien aux nouveaux vaccins (SVN)                                0.197    5.394      7.671
POUR
VACCINATION
                  Soutien aux services de vaccination (SSV)                            1.181
                  Renforcement des systèmes de santé (RSS)                             0.810               1.704
JICA              Amélioration des services de la santé maternelle et infantile à               0.812      0.029
                  Madagascar (Projet « FAMI »)
                  RENFORCEMENT DE LA PREVENTION DU VIH/SIDA                                     0.648      0.851
                  FOURNITURE DES EQUIPEMENTS DANS LE CADRE DU                                   2.546
                  PROGRAMME ELARGI DE VACCINATION
                  Projet 5S aux CHUs et CHRRs                                                             0.046
                  Projet de Suivi Mère-Enfant à Mahajunga                                                 0.040
OMS               Appui au renforcement institutionnel (secteur sante)                         0. 205     0.098
                  Appui à la lutte contre les maladies autre que IST/VIH                       0.943      1.421
                  Appui a la lutte contre les MST                                              0.265      0.044
                  Appui a la politique de survie de la mère et de l'enfant             0.569   0.318      0.893
                  URGENCES                                                             0.453   0.698      0.029
                  APPUIS DIVERS                                                                           0.024
OPEP              Appui à la Lutte contre les Maladies Transmissibles .                0.051    0.075     0. 279
                  (n°convention:6540 6540 00332)
FRANCE            ASPIC. (n°convention:2005001800)                                     0.248    0.101      0.256
EUROPEAN UNION Call for proposals of RH 2003 (SANTE/2003/005897)                                           0.500
USAID             Utilisation Accrue des Services et des Produits de Santé            40.172   33.251     59.769
                  Sélectionnés et des Pratiques Améliorées.(n°convention:687-
                  0050)(n°PIP:21-250-138)
Source: www.amp-madagascar.gov.mg.




                                                                                                12 | P a g e
Table A-3: Aid Disbursed in Social protection, US Million

DONORS                 PROJECTS                                                          2008     2009       2010
                       TOTAL                                                             25.989    40.722    36.791
FRANCE                 Programme d'aide alimentaire et humanitaire                                  3.779     2.133
PAM                    Programme pays du PAM                                              0.802
                       Programme pays du PAM                                              2.500      3.646       0.952
                       Programme pays du PAM                                              0.445
                       Programme pays du PAM                                              1.389      2.025       0.529
                       Programme pays du PAM                                              0.535
                       Programme pays du PAM                                              1.667      2.431       0.635
FAO                    Fourniture d'intrants aux populations vulnérables dans le cadre               0.073
                       de l'initiative aux flambées des prix des denrées alimentaires
                       Distribution of rice and bean seed to the most vulnerable rural               0.040
                       families affected by increased food prices.
                       Réponse aux catastrophes naturelles récurrentes et à               6.767      9.492       1.545
                       l'insécurité alimentaire à Madagascar
                       Coordination and technical support to local production of                     0.387
                       improved rice seed in disaster-prone areas affected by cyclone
                       Ivan.
KFW                    Fonds d'Etude et d'Experts IV. (n°convention:1995 70 011)                     0.195
WORLD BANK             FONDS D'INTERVENTION POUR LE DEVELOPPEMENT                        10.051               0.020
                       PROJET D'URGENCE RECONSTRUCTION ET SECURITE                                   3.120   21.600
                       ALIMENTAIRE
FNUAP                  Composante population et développement                             1.550      1.139       1.769
NORWAY                 MAG-10/0005 Conférence Nationale-Alliance Voahary Gasy                                    0.022
                       MAG 10/0006 Support to Alliance Voahary Gasy – Pilot                                      0.119
                       GESTION DES RISQUES ET CATASTROPHES NATURELS                       0.279   0.644          1.244
JICA                   Programme de volontaires japonais                                          1.313          1.185
UNICEF                 Droits et protection des enfants (ex-services urbains de                   1.838          1.329
                       base)YS204 Projets 1 et 2
                       Planification et suivi YI205 Projet3                                       0.564          0.687
UNDP                   MSDLP - Moyens de subsistance durables et lutte contre la
                       pauvreté                                                                                  0.520
                       MSDLP - Moyens de subsistance durables et lutte contre la                                 0.346
                       pauvreté
                       Appui à la promotion du genre                                                 0.239       0.003
                       PROJET D'APPUI A LA REGION ATSIMO ANDREFANA                                   0.008
                       PROJET D'APPUI A LA REGION ATSIMO ANDREFANA                                   0.033
                       PROJET D'APPUI A LA REGION ATSIMO ANDREFANA                                   0.008
                       PROJET D'APPUI A LA REGION ATSIMO ANDREFANA                                   0.033
                       PROJET D'APPUI A LA REGION VATOVAVY FITOVINANY                                0.009
                       PROJET D'APPUI A LA REGION VATOVAVY FITOVINANY                                0.039
                       PROJET D'APPUI A LA REGION VATOVAVY FITOVINANY                                0.009
                       PROJET D'APPUI A LA REGION VATOVAVY FITOVINANY                                0.039
ILO                    Programme d'Appui à la Mise en Œuvre de la Déclaration                        0.046       0.094
                       (Lettre d'accord en date du 31 octobre 2008)
                       Tackling child labour through education (TACKLE)                              0.038       0.445
                       Contribuer à l’abolition du travail des enfants en Afrique                                0.074
                       Francophone (IPEC) RAF/06/06/FRA

                                                                                                  13 | P a g e
EUROPEAN UNION      Assistance humanitaire en faveur des populations vulnérables       1.405
                    au sud du Madagascar souffrant des effets de sécheresse
                    Travaux routiers post cycloniques suite aux dégâts YVAN 9 ACP       2.24
                    RSA 042. Contrat de Subvention FER 002/FER/SUB2.UE
                    Programme d'appui à la sécurité alimentaire - ONGAllocations       6.093       1.532
                    de 1999 à 2006
Source: www.amp-madagascar.gov.mg.




                                                                                    14 | P a g e

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Madagascar economic update March 2011

  • 1. MADAGASCAR ECONOMIC UPDATE: AID EFFECTIVENESS DURING POLITICAL INSTABILITY –A LOOK AT SOCIAL SECTORS World Bank – April 1, 2011 In Madagascar, donors have traditionally counted for almost half of the Government’s budget and have been, by far, the main source of funding in social sectors. Since the beginning of the crisis, official aid toward education, health and social protection surged, reaching almost US$260 million in 2010 against US$180 million in 2008. This increase failed nonetheless to improve significantly social indicators. Does it mean that (i) aid works but the country did not get enough of it to counterbalance the effects of the current political and economic crisis, or (ii) aid effectiveness has been limited and there is a need to improve its quality rather than its quantity? Official aid flows have been cut since the beginning of the political crisis except to social sectors where donors have increased significantly their disbursements between 2008 and 2010. This increase has been justified on humanitarian grounds, to respond to the growing social distress of the population. Unfortunately, most social indicators have continued to fall, as evidenced by the recent drop in net registration rate in primary schools, the rate of births attended by medical staff, and the use of external medical consultations. For some observers, this deterioration is viewed as an argument for more external funding: aid works; we just do not do enough of it. For others, it reveals the need to improve not only the quantity but also the quality of foreign assistance. Both sides have good arguments. Although more social aid will be necessary to account for the pressing needs of the population (which itself growing fast), this note will subscribe to the second view and, ultimately, argue that aid effectiveness must be improved in priority if donors want to contribute significantly to Madagascar’s development both in the short and longer terms. Lower aid but not to social sectors Since the beginning of the political crisis, donors have reduced their disbursements toward Madagascar by about US$200 million per year (Table 1).1 This decrease is the result of the non- recognition of the Transition Government by the international community and the quasi- absence of new projects that are not directly justified on humanitarian grounds. The most significant drops were observed in the areas of infrastructure, productive activities, and institutional support. 1 All figures on aid reported in this note are based on the information provided by donors and collected by the Coordinating Unit in the Prime Minister Office. It has to be acknowledged that this base might not be fully accurate, adjusted on a continuous basis, and that some key partners are still missing, including China, India and most Arab countries. For more details, see www.amp-madagascar.gov.mg. 1|Page
  • 2. Contrary to this global trend, the amount of official aid toward social sectors surged from US$180 million in 2008 to US$260 million in 2010.2 This increase is the combination of growing support in health (up by 75%), social protection (42%), and the relative stagnation in education (down by 6%).3 A closer look at the composition of official aid in each of these social areas helps to understand better the quantitative and qualitative changes that occurred over the past couple of years (Annex 1 for fuller details). Table 1: Lower Aid inflows except in social sectors (in US$ millions) 2008 2009 2010 Education, health, social protection 179.8 182.9 255.8 Water, transports, energy, communication 168.6 77.6 79.9 Financial sector, mines, industry, commerce, 43.4 14.9 11.3 employment, tourism Agriculture, fishery 42.2 69.9 50.8 Environment 50.1 24.4 16.2 Institutional support 45.7 25.7 27.0 Non allocated budgetary support 96.6 5.7 5.5 Total 626.4 401.4 446.5 Source: Database of the Prime Minister office/UN.  Education: The level of external financing remained almost stable, varying from US$61.7 million to US$57.8 million between 2008 and 2010. Before the crisis, foreign assistance was consolidated around “three” donors: the Education-For-All Catalytic Fund/World Bank (US$24 million), Norway (US$15 million) and the African Development Bank (US$8.3 million). In 2010, aid become more fragmented, with the emergence of new donors such as UNICEF (US$28 million, including the taking over the management of the Catalytic Fund), Agence Française de Développement (4.5 million), OPEP (US$3 million), and the International Labor Organization (US$2 million).  Health: The level of external financing jumped from US$92 million to US$160 million between 2008 and 2010. In 2008, USAid, the World Bank and the Global Fund (VIH, Malaria, and Tuberculosis) accounted for 80% of donors’ assistance. In 2010, USAid and the Global Fund remained top funders but new donors emerged such as the Global Vaccine Initiative (US$9 million), the UNFPA (US$10 million), and UNICEF (US$5.8 million).  Social Protection: External assistance increased from US$26 million to almost US$38 million between 2008 and 2010. The main donors have been the World Bank, the World 2 The external support toward agriculture and fisheries also increased between 2008 and2010 but not by the magnitude observed in social sectors. 3 It can be argued that part (but not all) of the budget support provided by donors in 2008 (US$89.5 million) was allocated to the social sectors and, so, its quasi-elimination has affected social sectors in 2009 and 2010. This argument will be taken into account in the next section of this note by observing that the total expenditures spent by the Ministries of Education and Health declined between 2008 and 2010 but not as much as the increase in external funding directly allocated to these social sectors. 2|Page
  • 3. Food Program, and France but the number of donors and projects increased significantly over this period. More aid as the response to social distress The political and economic crisis has produced an undisputable increase in social distress in Madagascar. Such deterioration has to be expected during an economic slowdown when people are losing jobs and revenues. More recently, the surge in international prices of food and crude oil has also worsened the situation of many vulnerable households. The recent household survey confirms that poverty is 9 percentage points higher in 2010 than in 2005 (reaching 77% of households) and that many social indicators have deteriorated, including the ratio of births attended by skilled health workers (down from 51% in 2006 to 44% in 2009), external consultations to health services (down by 8 percentage points between 2005 and 2010), and the net enrollment rate in primary schools (down from 83% in 2005 to 73% in 2010).4 Recent evidence collected by UN agencies in Antananarivo and Toliara also reveals that: (i) many households have suffered from significant financial losses and so are less able to finance their education and health expenses;5 and (ii) the public health and education systems are lacking of funding and materials, especially in rural areas.6 Furthermore, the State has shown limited capacity to respond to the pressing social needs of the population in view of its budgetary constraint. The Ministries of Education and Health have seen their non-wage and capital expenditures (funded on their own resources) declined by 20 and 70% respectively between 2008 and 2010 (Figure 1). Such cuts explained lower maintenance and equipments shortages (such as books and medicine) reported in many schools and health centers over the past two years.7 Consequently, the combination of higher social distress and limited capacity of the State has motivated the increase in aid toward social sectors. During the crisis, donors have often acted as “the lender of last resort”, and without them, the social situation in Madagascar could have been arguably worse than it is today. The truth is that a large fraction of teachers are now paid directly by the Education-For All Catalytic Fund managed by UNICEF, a growing number of health centers are funded by donors, and emergencies in children malnutrition and climatic disasters are increasingly covered by targeted programs financed by external funds. 4 The sources are the Households survey of 2005 and 2010 and the SOWC of 2008 and 2011. 5 The cost of school materials can be difficult to bear for families with many children and few resources: A basic package of school materials for one first grader (notebooks, pencils/pens, etc.) costs approximately 4,100 Ariary (around 2 USD), while a second grader needs around 5,000 Ariary (or 2.5 USD) to cover basic school materials. 6 In the South, it is observed that less than one out of two basic health facilities are staffed according to national norms and as much as one out of three basic health centers considered operational are managed by support staff only. A recent survey carried out in six regions shows that there are no antibiotics available in 30 % of basic health centers (source: UNICEF newsletter, N. 3, September 2010). 77 In 2009, the government reduced the budget covering operational costs of health centers at district level by 30%. 3|Page
  • 4. Fig.1 : Cuts in non wage and capital 600 Fig.2: Total social spending has 500 expenditures in the Ministries of Education increased since the beginning of the 450 and Health 500 crisis 400 Billion of Ariary (current) 440 400 US$ million 350 352 366 300 300 250 200 200 150 188 168 100 100 139 50 - 67 67 - 19 Domestic Social Official Aid to Total spending in 2008 2009 2010 expenditures social sectors social sectors wages non wages investments (internally funded) 2008 2009 2010 Sources: Ministry of Finance and Prime Minister Office/PNUD Notes : 1/ Domestic social expenditures are defined as the total spending of the Ministries of Education and Health excluding investment funded by external resources. 2/ Official aid is defined as the disbursed amounts reported by donors. What about aid effectiveness? Aid has helped to reduce the impact of the current crisis on households and preserve at certain level of social services. Yet, one has to wonder if this assistance has been optimal, or, in other words, more could have been expected from the recent increase in foreign assistance. Two evidences support such questioning. First, the total resources allocated to social sectors are 20% higher today than in 2008 since the increase in foreign funding has more than compensated for the decline in the Government’s budget (Figure 2). Second, social needs were already pressing before the crisis. In 2008, the Government and donors, with less money, were able to contain the impact of six tropical storms/cyclones in the first four months8 and of the global financial crisis as well as the surge in international food and crude oil prices. The argument is not to compare the magnitude of social distress before and during the crisis but rather to examine more carefully if aid has been effective over the past two years. Since the beginning of the crisis, the delivery mechanisms of aid in social sectors can be captured through the following shifts: 8 The quasi-absence of major climatic disasters over the past two years has to be contrasted with the huge damages produced by the 2008 cyclones estimated to more than US$330 million by the UN/World Bank affecting more than 300,000 people. Source: Joint Damage, Loss and Needs Assessment (JDLNA). http://www.gfdrr.org/gfdrr/sites/gfdrr.org/files/documents/Madagascar_PDNA_GLANCE.pdf 4|Page
  • 5. Donors’ intervention has become increasingly fragmented since the number of externally funded projects in social sectors skyrocketed from 52 to 102 between 2008 and 2010 (Figure 3). The median size of those projects declined by 54% in social protection, 26% in health, and 22% in education. Such a trend makes it more difficult to coordinate external support and to align it on the country’s priorities, with a risk of duplication.9  A growing share of external support has been channelized outside of the public sector since less than 10% of donors’ disbursements in social areas were executed by the Ministries of Education and Health in 2010 against 30% in 2008 (Figure 4).10 Such decline captures the shift toward Non-Governmental Organizations and local communities adopted by several donors to reduce their fiduciary and political risks. As a result, the public social system is now almost excluded from donors’ money distribution channels.  The good performance of the health and education sectors requires not only effective targeted programs in these areas but also good infrastructure (water and roads), decent sources of revenues (otherwise households cannot spend on social services), and good institutional capacity. For example, the lack of access to safe water, and its implications on diarrhea related illnesses, is estimated to generate 5 millions of lost working days per year and is the second cause of children mortality among children under 5 years. Those interconnections are essential but failed to materialize because of the dramatic decline of aid toward those last three pillars since the beginning of the political crisis (Figure 5). Fig.3: The number of projects financed Fig. 4: Less donors' projects are executed by 120 50.0% the Budget by donors has multiplied % of donors' disbursements executed by 100 22 40.0% Number of projects 80 29 30.0% 60 45 budget 10 35 20.0% 40 24 20 35 10.0% 18 25 0 0.0% 2008 2009 2010 2008 2009 2010 Education Health Social Protection Total Education Health 9 Of course, small projects in themselves are not bad. They are an important source of experimentation and innovation. They may be able to provide exactly what is needed in isolated communities where small amounts of money can make a significant difference in people’s lives. However, the fragmentation of aid comes at a heavy price. Each project must be prepared, negotiated, supervised, and reported on. 10 These figures might also reflect reporting gaps between donors and the Government as well as within the Government, as some disbursements executed at the Ministerial level are not included in the budget. 5|Page
  • 6. Fig. 5: Unbalanced Aid Allocation (USD million) Social sectors 300 200 100 Institutional - Infrastructure Support Productive activities 2008 2009 2010 Those shifts have been partly motivated by the current political context since the absence of recognition of the Government by the international community has obliged many donors to go around public administration. Political instability and interferences have also justified the use of “second best” channels, relying on local communities and NGOs in the absence of any credible public alternatives, to reach out vulnerable groups. Unfortunately, the recent international experience and empirical evidence has showed that too high projects’ fragmentation, the lack of coordination between donors and the public sector, and an unbalanced allocation of resources across sectors are bad for aid effectiveness.11 The lessons from the field have stressed that too many projects increase administrative and coordination costs for both donors and the recipient country: think about the difficulties to manage and coordinate, over 40 projects and 17 donors in the health sector. Envisioning a performing and sustainable education and health system is hard when almost all external funds are executed outside of budgetary procedures. These sectors require a strong public administration, not only to deliver those public services but also to supervise and regulate them. Finally yet importantly, the excessive concentration of aid in a few sectors can be counterproductive because it might exceed the absorptive capacity of the recipient country (possibly leading to corruption and the misallocation of funds) and it fails to account for intersectoral synergies. The bottom-line is that foreign aid works well when it is done right. Yet, since the beginning of the political crisis, aid delivery mechanisms have deviated from the recommendations of the 2005 Paris Declaration. 12 If those deviations might be temporary and “second best”, partly justified in the current context, they have contributed to lower the impact that might be expected from aid on people and institutions. The key is to learn lessons to improve aid effectiveness. 11 For references, see Delivering Aid differently—Lessons from the Field by Wolfgang Fengler and Homi Kharas, 2010. 12 Paris Declaration on Aid Effectiveness, 2005. www.oecd.org/dataoecd/11/41/34428351.pdf 6|Page
  • 7. Looking for more aid effectiveness Few people would disagree that official aid has helped to reduce social distress in Madagascar, and more of it will be necessary to respond to the growing need of the population in the short and longer terms. The recent experience in social sectors however illustrates that more external funding is not enough to generate automatic positive outcomes. Education, health, and social protection benefited from 40% more external resources in 2010 than in 2008 but social indicators failed to improve significantly. The quality of aid largely matters. Improving aid effectiveness should be a priority for both donors and the Government. We advocate that success will require open information and stronger cooperation, first among donors, and second between donors and the authorities.  Open information is a key element for achieving scalability of projects, predictability of aid flows, efficient division of labor, and low transaction cost. If donors are given information on what projects are achieving notable outcomes, they will be able to pool their resources to scale up those projects to reach more people. Projects that duplicate each other’s efforts will be identified and adapted to reflect a more logical division of labor, either by splitting up different stages of the work or by operating in different geographic areas. In that sense, the new database on donors’ projects gathered by the UN and the Prime Minister Office has been a major step forward in providing information on what donors have been doing. This information still needs to be matched with a single list of the country’s needs and to alert donors to gaps.  While a stronger cooperation with the authorities might have to wait for the full recognition of the Government by the international community, the coordination between donors should be strengthened immediately. NGOs should also be included in this effort, as their role has become even more important in these last two years. The objective should be to work together so to scale up projects that work well rather than adding many small new projects. Such cooperation might also help to improve the intersectoral allocation of aid by identifying gaps that go beyond social sectors but that affect their performance.  Operating outside the purview of the Government may generate islands of success through dedicated non-governmental agencies and provide the fiduciary and political comfort needed for donors. However, this practice may also mask the fact that at the same time the generic public delivery system is let to collapse, with much greater negative impact on the population. This is not say that one system is superior to the other but they have to be complementary and that a broader perspective is needed in assessing coverage and efficiency. Partly because of the special context of the current political crisis, donors have had to modify the way they deliver aid to Madagascar. Over time, restoring trust between donors and 7|Page
  • 8. government officials (at the policy and technical levels) will have to be at the center of the development agenda. A new consensus can be built around the ideals of information sharing and stronger collaboration. At the end of the day, the common goal is that aid money that is intended to help poor people will reach them in more efficient and equitable ways. 8|Page
  • 9. ANNEX: AID DISBURSED BY DONORS AND PROJECTS –2008-2010 Table A-1: Aid Disbursed in the Education Sector, US Million BAILLEURS PROJETS 2008 2009 2010 TOTAL 61.751 51.082 57.814 AFD Education de base à Madagascar. N° convention CMG 1164 01 0.779 0.889 0.548 EDUCATION POUR TOUS (VOLET MINESEB)/convention n°:CMG 1,651 9.560 4.506 3002 01) GERMANY/KFW Projet Ny Voary Vintsy. (n° convention:2003 65 056) 0.414 0.285 AFRICAN Education III. (n°convention:2100 1500 00548/ 2100 1550 00194) 8.373 2.355 2.013 DEVELOPMENT BANK WORLD BANK (*) Education for all Catalytic Fund I 24.940 14.197 1,692 ARAB APPUI A L'ENSEIGNEMENT GENERAL 0.431 1.042 0.489 DEVELOPMENT BANK Projet de construction et d'équipement de l'institut national des 0.031 0.007 sciences comptables et de l'administration des entreprises. (INSCAE) AEP Ambalavao 0.054 ILO Projet MEN / BIT MAG/05/M02/MAG 1.071 0.002 0.014 Projet MEN / BIT MAG/07/M01/MAG 0. 516 0.066 0.030 Projet MEN /BIT MAG/08/M01/MAG 0.453 2.013 Construction d’écoles primaires à Madagascar 0.022 MAG/05/M02/MAG Construction d’écoles primaires équipées à Madagascar 0.105 (Fabrication de mobiliers scolaires)- Phase II MAG/07/M01/MAG Construction d’écoles primaires à Madagascar – Phase III 1.987 MAG/08/M01/MAG Construction d’écoles primaires à Madagascar – Projet 1.005 MEN/UNICEF/BIT MAG/10/01M/CEF UNICEF Préparation et réponse aux urgences dans l'éducation YE202 5.713 4.,575 Projet 4 Education de baseProgramme YE202 Projets 1,2 et 3 4.160 22.596 JICA Projet de Suivi "In-Service Training" pour Enseignants 0.015 Education Primatologicale 0.011 NORWAY Projet HIMO Bâtiments MAG/05/M01/NOR 1.751 Projet HIMO Bâtiments MAG/08/M04/NOR 0.377 2.501 - MAG-07/013 ILO School Construction 2008-2012 1.680 2.770 MAG-07/014 UNICEF - ensuring the right to quality primary 1.680 2.001 1.979 education MAG-09/015 UNICEF - minimizing the negative impact of the 2.931 2.364 crisis on education MAG-05/012 NMS - FLM educational programme - ProVert 1.680 0.960 1.004 MAG-04/016 Support to Education Department MAG-09/003 15.126 0.284 0.216 Addendum to MAG-04/016 MAG-09/012 Support to Education Dep. Rest payment UQAM MAG-09/017 Appui au programme de cantines scolaires 0.480 0.510 9|Page
  • 10. MAG-09/016 Inclusion of Blind and Deaf 0.668 MAG-10/0003 Midterm review UNICEF 2010 0.003 OPEP Deuxième projet education 1.524 Amélioration de l'éducation 1.319 UNDP APPUI A L'ALPHABETISATION 0.395 0.207 0.023 FRANCE MADES. (n°convention:2007000100) 0.315 0.529 0.505 Appui au bilinguisme à Madagascar.(n°convention:2002009600) 0.465 0.027 SIST.(n°convention:2002007000) 0.023 0.057 Programme de bourses (Enseignement supérieur) 0.404 0.305 Programme d''interventions ponctuelles (Enseignement supérieur 0.140 0.080 et recherche) Assistance technique (Enseignement supérieur et recherche) 2.723 1.773 EU EIDHR 2010 Annual Action Programme - CBSS (Country Based 0.299 Support Schemes) Source: www.amp-madagascar.gov.mg. (*) This project was not included in the Prime Minister/UN database 10 | P a g e
  • 11. Table A-2: Aid Disbursed in the Health Sectors, US Million DONORS PROJETS 2008 2009 2010 TOTAL 92.105 91.110 161.214 ONUSIDA APPUI A LA MISE EN OEUVRE DU PLAN STRATEGIQUE 0.006 0.020 NATIONAL 2007-2012 APPUI AUX POPULATIONS CLÉS A HAUT RISQUE ET AUX 0.134 0.259 0.088 PERSONNES VIVANT AVEC LE VIH UNDP LUTTE CONTRE LE VIH-SIDA 0.170 0.179 FAO Assistance d'urgence pour la surveillance de la fièvre de la 0. 223 0.097 Vallée du Rift AFD Santé. (n°convention: CMG 6009 01) 2.156 AT et d'expertise au plan de développement Sectoriel Santé. 0.182 0.103 0.036 (n°convention: CMG 6008 01) KFW Centre de Santé de Base Mahajanga II. (n° convention:1998 67 0.022 052) WORLD BANK NUTRITION II (ONN) 3.660 2.430 2.190 LUTTE CONTRE LE VIH-SIDA ET LES MALADIES SEXUELLEMENT 9.250 1.430 4.680 TRANSMISSIBLES (MST) DEVELOPPEMENT D'UN SYSTEME DE SANTE DURABLE 8.510 1.120 0.060 AFRICAN Santé II. (n°convention:2100 1500 00562/ 2100 1550 00196) 4.774 2.922 DEVELOPMENT BANK Appui à la Lutte contre les MST/SIDA. (n°convention:2100 1.832 2.390 0.399 1550 03674) FONDS MONDIAL Intensification de la lutte contre le VIH/SIDA : une approche 0.133 0.208 TUBERCULOSE, combinant réponse local et rôle charnière MALARIA, SIDA (n°convention:MDG-304-G04-H) Action communautaire pour combattre la malaria. 1.232 0 800 (n°convention:MDG-304-G05-M) Passage à l'échelle des mesures de prévention et de 0.715 traitement de la malaria à Madagascar (1). (n°convention:MDG-405-G06-M, (G2)) Passage à l'échelle des mesures de prévention et de 1.291 8.610 12.299 traitement de la malaria à Madagascar (2). (n°convention:MDG-405-G07-M, (G3)) Réduction de la morbi-mortalité causée par la tuberculose au 1.906 1.059 niveau des populations pauvres. (n°convention:MDG-404- G08-T) Du controle à l'élimination de la malaria (2007-2012) - 1. 9.712 2.846 8.586 (n°convention:MDG-708-G09-M) Du controle à l'élimination de la malaria (2007-2012) - 2. 2.150 3.874 (n°convention:MDG-708-G10-M) Réponse au VIH et aux MST à Madagascar: une approche 2.166 2.586 impliquant les populations les plus à risque dans les zones vulnérables (MDG-809-G11-H) Réponse au VIH et aux MST: une approche impliquant les 1.565 1.514 populations à risque dans les zones vulnérables - Volet PSI (MDG-809-G12-H) Tuberculose Pact (MDG-810-G14-T) 1.429 Centrale d'Achat de Médicaments Essentiels et Matériels 1.106 11 | P a g e
  • 12. Médicals (MDG-910-G15-M) Speed up malaria control activities with a view to eradication 5.761 in Madagascar (MDG-910-G17-M) speed up malaria control activities with a view to eradication 3.666 in Madagascar (MDG-910-G18-M) speed up malaria control activities with a view to eradication 9.355 in Madagascar (MDG-910-G19-M) Speed up malaria control activities with a view to eradication 9.822 in Madagascar (MDG-910-G16-M) Nutrition(MDG-810-G13-T) 1.631 UNICEF Fourniture des services de santé de base YK201 Projet 4 5.427 5.043 Appui à la lutte contre les maladies sexuellement 1.144 0.770 transmissiblesYJ203 Projets 1,2 et 3 Appui à la politique de survie de la mère et enfant YK201 - 0.708 0. 418 Projet 1 Améliorer les standards de nutrition YK201 Projet 2 3.578 4.311 FNUAP Composante santé de la reproduction 2.950 6.653 5,493 GLOBAL ALLIANCE Soutien aux nouveaux vaccins (SVN) 0.197 5.394 7.671 POUR VACCINATION Soutien aux services de vaccination (SSV) 1.181 Renforcement des systèmes de santé (RSS) 0.810 1.704 JICA Amélioration des services de la santé maternelle et infantile à 0.812 0.029 Madagascar (Projet « FAMI ») RENFORCEMENT DE LA PREVENTION DU VIH/SIDA 0.648 0.851 FOURNITURE DES EQUIPEMENTS DANS LE CADRE DU 2.546 PROGRAMME ELARGI DE VACCINATION Projet 5S aux CHUs et CHRRs 0.046 Projet de Suivi Mère-Enfant à Mahajunga 0.040 OMS Appui au renforcement institutionnel (secteur sante) 0. 205 0.098 Appui à la lutte contre les maladies autre que IST/VIH 0.943 1.421 Appui a la lutte contre les MST 0.265 0.044 Appui a la politique de survie de la mère et de l'enfant 0.569 0.318 0.893 URGENCES 0.453 0.698 0.029 APPUIS DIVERS 0.024 OPEP Appui à la Lutte contre les Maladies Transmissibles . 0.051 0.075 0. 279 (n°convention:6540 6540 00332) FRANCE ASPIC. (n°convention:2005001800) 0.248 0.101 0.256 EUROPEAN UNION Call for proposals of RH 2003 (SANTE/2003/005897) 0.500 USAID Utilisation Accrue des Services et des Produits de Santé 40.172 33.251 59.769 Sélectionnés et des Pratiques Améliorées.(n°convention:687- 0050)(n°PIP:21-250-138) Source: www.amp-madagascar.gov.mg. 12 | P a g e
  • 13. Table A-3: Aid Disbursed in Social protection, US Million DONORS PROJECTS 2008 2009 2010 TOTAL 25.989 40.722 36.791 FRANCE Programme d'aide alimentaire et humanitaire 3.779 2.133 PAM Programme pays du PAM 0.802 Programme pays du PAM 2.500 3.646 0.952 Programme pays du PAM 0.445 Programme pays du PAM 1.389 2.025 0.529 Programme pays du PAM 0.535 Programme pays du PAM 1.667 2.431 0.635 FAO Fourniture d'intrants aux populations vulnérables dans le cadre 0.073 de l'initiative aux flambées des prix des denrées alimentaires Distribution of rice and bean seed to the most vulnerable rural 0.040 families affected by increased food prices. Réponse aux catastrophes naturelles récurrentes et à 6.767 9.492 1.545 l'insécurité alimentaire à Madagascar Coordination and technical support to local production of 0.387 improved rice seed in disaster-prone areas affected by cyclone Ivan. KFW Fonds d'Etude et d'Experts IV. (n°convention:1995 70 011) 0.195 WORLD BANK FONDS D'INTERVENTION POUR LE DEVELOPPEMENT 10.051 0.020 PROJET D'URGENCE RECONSTRUCTION ET SECURITE 3.120 21.600 ALIMENTAIRE FNUAP Composante population et développement 1.550 1.139 1.769 NORWAY MAG-10/0005 Conférence Nationale-Alliance Voahary Gasy 0.022 MAG 10/0006 Support to Alliance Voahary Gasy – Pilot 0.119 GESTION DES RISQUES ET CATASTROPHES NATURELS 0.279 0.644 1.244 JICA Programme de volontaires japonais 1.313 1.185 UNICEF Droits et protection des enfants (ex-services urbains de 1.838 1.329 base)YS204 Projets 1 et 2 Planification et suivi YI205 Projet3 0.564 0.687 UNDP MSDLP - Moyens de subsistance durables et lutte contre la pauvreté 0.520 MSDLP - Moyens de subsistance durables et lutte contre la 0.346 pauvreté Appui à la promotion du genre 0.239 0.003 PROJET D'APPUI A LA REGION ATSIMO ANDREFANA 0.008 PROJET D'APPUI A LA REGION ATSIMO ANDREFANA 0.033 PROJET D'APPUI A LA REGION ATSIMO ANDREFANA 0.008 PROJET D'APPUI A LA REGION ATSIMO ANDREFANA 0.033 PROJET D'APPUI A LA REGION VATOVAVY FITOVINANY 0.009 PROJET D'APPUI A LA REGION VATOVAVY FITOVINANY 0.039 PROJET D'APPUI A LA REGION VATOVAVY FITOVINANY 0.009 PROJET D'APPUI A LA REGION VATOVAVY FITOVINANY 0.039 ILO Programme d'Appui à la Mise en Œuvre de la Déclaration 0.046 0.094 (Lettre d'accord en date du 31 octobre 2008) Tackling child labour through education (TACKLE) 0.038 0.445 Contribuer à l’abolition du travail des enfants en Afrique 0.074 Francophone (IPEC) RAF/06/06/FRA 13 | P a g e
  • 14. EUROPEAN UNION Assistance humanitaire en faveur des populations vulnérables 1.405 au sud du Madagascar souffrant des effets de sécheresse Travaux routiers post cycloniques suite aux dégâts YVAN 9 ACP 2.24 RSA 042. Contrat de Subvention FER 002/FER/SUB2.UE Programme d'appui à la sécurité alimentaire - ONGAllocations 6.093 1.532 de 1999 à 2006 Source: www.amp-madagascar.gov.mg. 14 | P a g e