Innovations for Enhanced AidHarmonization and CoordinationA case study of NepalBjorn-Soren Gigler, World Bank Institutebgi...
1) Background2) Challenges& Lessons3) Open AidMapAGENDA1. Overview2. Key Challenges1) Aid Effectiveness2) Aid Harmonizatio...
NepalLandlocked, diverse country with an average $470 (GDP per capita)• Population (million) : 29.3• GDP per capita : $470...
NepalSource: UNDP (2011)Human Development Index : Trend 1980 – present
Nepal – Health SectorHighest Infant Mortality and HIV prevalence in South Asia• Wide disparity in health conditions.• HIV ...
KEY REGIONAL DIFFERENCES IN TERMS OF POVERTYData availableIndicator Poverty incidenceTime period 2001Source CBSMAP: POVERT...
Aid in Nepal52.80%34%* country programmable aid as a % of total gov expenditure (Action Aid 2011)Aid dependency *• ODA has...
SWApSWAp$ millions 2004 2005 2006 2007 2008 2009All 726.0 528.7 528.3 817.8 736.4 994.8DAC countries 378.9 369.5 345.3 260...
Aid Flows to Nepal in Health SectorDifferences in Priority of Health Sectors (multi-lateral- bilaterals)• Health expenditu...
SWAp (Sector-Wide Approach)• characterized by a set of operating principles rather than a specific package ofpolicies or a...
SWAp for Health in NepalStatement of intent to guide the partnership in health sector in Nepal(initiated in Feb, 2004)• To...
• December 2003 : Health Sector Strategy: An Agenda for Reform• February 2004 : SWAp• July 2004 : Letter of sector develop...
 Launched to support developing countries in achieving health sector MDGsthrough health system strengthening, supporting ...
 Every year two Joint Annual Reviews (JAR) are held one for annual work plan andbudget and another for review of sector p...
1) Background2) Challenges& Lessons3) Open AidMapAGENDA1. Progress andAchievements2. Key Challenges1) Aid Effectiveness2) ...
Key Achievementssome key words• Improved health outcomes and increased capacity on financial expenditure led toavailabilit...
Key Challenges for Aid EffectivenessAid Effectiveness …• Governance and accountability• Financial management and financial...
Key Challenges for Aid Harmonization• Donor efforts at monitoring and evaluation are fragmented• China and India are big p...
Key Challenges for Civil Society Participation• Limited Information about the role of CSOs in Healthsector• Lack of coordi...
 Health sector SWAP has increased ownership, harmonization and aidalignment in general. The capacity of health sector in...
1) Background2) Challenges& Lessons3) Open AidMapAGENDA1. Progress andAchievements2. Key Challenges1) Aid Effectiveness2) ...
World Bank Projects in Nepal
World Bank Projects in Nepal
Projects by Population Density
Enhance Poverty Targeting
SECOND RURAL WATER SUPPLY & SANITATION PROJECT (RWSS)Data availableNumber of districts 73Total observations 2,902MappingLo...
17. SECOND HEALTH SUPPORT PROGRAM (HSSP II)Data availableNumber of districts 75Total observations 4,161MappingHealth cente...
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Innovations for Enhanced Aid Harmonization and Aid Effectiveness

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This presentation focuses on a case study of Nepal on how to use innovative approaches to enhance aid harmonization and aid effectiveness. the presentation provides (i) an overview about the important challenges of aid effectiveness in Nepal, (ii) an analysis and lessons learned form the Sector-Wide Approach in Health, and (iii) innovations in technology to improve aid transparency, donor harmonization and development effectiveness.

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  • GCF: Gross Capital Formation
  • Public expenditures of health=== 35.3%
  • Ministry of Health and Population is implementing agency for the Health Swap
  • Innovations for Enhanced Aid Harmonization and Aid Effectiveness

    1. 1. Innovations for Enhanced AidHarmonization and CoordinationA case study of NepalBjorn-Soren Gigler, World Bank Institutebgigler@worldbank.orgOctober 7, 2011
    2. 2. 1) Background2) Challenges& Lessons3) Open AidMapAGENDA1. Overview2. Key Challenges1) Aid Effectiveness2) Aid Harmonization3) Civil SocietyOrganization3. Lessons Learnt1.2.3.1. Health in Nepal2. Aid in Nepal3. SWAp4. SWAp in HealthSector
    3. 3. NepalLandlocked, diverse country with an average $470 (GDP per capita)• Population (million) : 29.3• GDP per capita : $470 (South Asian average: $1,082)• Poverty : 31% below poverty line• HDI :• Culturally, ethnically and religiously diverse• Political transition in 2006Source: World Bank (2011)
    4. 4. NepalSource: UNDP (2011)Human Development Index : Trend 1980 – present
    5. 5. Nepal – Health SectorHighest Infant Mortality and HIV prevalence in South Asia• Wide disparity in health conditions.• HIV infection : 0.49% (ages 15-49)• Life expectancy (years) : 67• Infant Mortality : 39• Under-five mortality : 48 (per 1,000)• Under-five Child malnutrition : 38.8%• Birth attended by skilled health staff : 19%• Access to an improved water source : 88• Progress in nutrition remains limited.Source: World Bank (2011) & UNGASS (2008)
    6. 6. KEY REGIONAL DIFFERENCES IN TERMS OF POVERTYData availableIndicator Poverty incidenceTime period 2001Source CBSMAP: POVERTY INCIDENCE(DARKER COLOR HIGHER POVERTY)
    7. 7. Aid in Nepal52.80%34%* country programmable aid as a % of total gov expenditure (Action Aid 2011)Aid dependency *• ODA has been increased greatly from 1960 ($8.2M) to 2009 ($994M)• Highest aid dependent county in Asia
    8. 8. SWApSWAp$ millions 2004 2005 2006 2007 2008 2009All 726.0 528.7 528.3 817.8 736.4 994.8DAC countries 378.9 369.5 345.3 260.5 491.5 598.5AusAID 3.2 1.1 5.5 1.7 12.6 10.8DFID 114.3 104.7 58.2 50.8 51.3 140.3GTZ 30.9 47.6 26.8 64.0 44.5 43.2USAID 47.7 55.5 57.9 77.1 105.9 79.4JICA 37.9 110.8 67.8 35.7 58.1 77.0SDC 12.0 12.8 24.9 16.2 40.1 27.7Finland 19.3 6.4 20.8 14.6 17.8 39.6DANIDA 40.1 5.8 32.8 12.1 47.3 45.5NORAD 65.4 8.1 31.0 52.1 33.6 66.2Multilateral 347.2 159.2 183.0 457.3 244.9 396.3IDA (WB) 215.8 35.0 25.0 330.8 158.0 284.2UNICEF 6.5 5.5 6.4 7.7 6.0 7.4UNFPA 3.3 4.8 3.9 4.3 5.6 4.4ILO / WHO 0 0 0 0 0 0AsDF (ADB) 80.0 73.9 97.2 0 0 25.125.3%
    9. 9. Aid Flows to Nepal in Health SectorDifferences in Priority of Health Sectors (multi-lateral- bilaterals)• Health expenditure per capita : $ 25• Public exp. of total health expenditure : 35.3%• Public exp. of total GDP : 5.8%Energy only *Transportation only*
    10. 10. SWAp (Sector-Wide Approach)• characterized by a set of operating principles rather than a specific package ofpolicies or activities.• involves movement over time under government leadership towards:- broadening policy dialogue- developing a single sector policy (that addresses private and public sector issues)and a common realistic expenditure program- common monitoring arrangements- more coordinated procedures for funding and procurement.World Health Organization, World Health Report (2000 )An approach to international development that brings togethergovernments, donors and other stakeholders within any sector
    11. 11. SWAp for Health in NepalStatement of intent to guide the partnership in health sector in Nepal(initiated in Feb, 2004)• To reduce transaction cost to the governmentby aligning external support with Nepal government’s sector planby strengthening harmonization among the development partners in the health sectorSectorWideApproachinHealthDonor Country(5)InternationalOrganization(6)• Australian Development Agency (AusAID)• British Department for International Development (DFID)• German cooperation agency (GTZ)• U.S. Agency for International Development (USAID)• Japan International Cooperation Agency (JICA)• Swiss development agency (SDC)• The World Bank• International Labour Organization (ILO)• UN children’s fund (UNICEF)• UN Population Fund (UNFPA)• World Health Organization (WHO)
    12. 12. • December 2003 : Health Sector Strategy: An Agenda for Reform• February 2004 : SWAp• July 2004 : Letter of sector development policy by GoN• August 2004 : Nepal Health Sector Programme- Implementation Plan (2004-2010)• March 2005 : Signing of Joint Financing Arrangement (JFA) - GoN, DFID and World Bank• June 2009 : Signing of JFA by AusAid as third partner to provide health sector budgetProgressPool Partner Non-signatorySignatory - Project SupportNepal Government• AusAid• DFID• The World Bank• ILO• UNAIDS• UNFPA• UNICEF• WHO• AusAid• DFID• The World Bank• GAVI• GFATM• NLRA• Others
    13. 13.  Launched to support developing countries in achieving health sector MDGsthrough health system strengthening, supporting national health plans and donorcoordination (September 2007) In first phase eight countries including Nepal selected for IHP+ ‘Nepal Health Development Partnership Compact’ signed in February 2009 byMinistry of Health & Population and eight health sector development partners andit further commits to strengthen the SWAP in health sectorInternational Health Partnerships +IHP+Donor Country(2)InternationalOrganization(6)• Australian Development Agency (AusAID)• British Department for International Development (DFID)• The World Bank• UN Children’s fund (UNICEF)• UN Population Fund (UNFPA)• World Health Organization (WHO)• UNAIDS• GDCIHP+ Signatory
    14. 14.  Every year two Joint Annual Reviews (JAR) are held one for annual work plan andbudget and another for review of sector performance and till date nine JARscompleted successful ‘Health sector development partners forum’ chaired by health secretary as agreedin statement of intent signed in 2004 & IHP+ national compact in 2009 All major issues are duly discussed in the above two forumsMajor Coordination with SWAp in Health
    15. 15. 1) Background2) Challenges& Lessons3) Open AidMapAGENDA1. Progress andAchievements2. Key Challenges1) Aid Effectiveness2) Aid Harmonization3) Civil SocietyOrganization3. Lessons Learnt1.2.3.1. Health in Nepal2. Aid in Nepal3. SWAp4. SWAp in HealthSector
    16. 16. Key Achievementssome key words• Improved health outcomes and increased capacity on financial expenditure led toavailability of more funds and vice-versa• Availability of pool fund in significant percentage and joint planning and programmingthrough JAR helped to prepare more realistic and comprehensive health work plan &budget• The government financial & procurement system is gradually improving as SWAPpromotes national system• Availability of more funds in health sector also helped to address the constitutionalprovision of basic health as a fundamental right of the citizens and as an effort toremove the financial barrier and reach to all citizens with a universally availableessential health care package, free health care scheme launched and users feesremoved from primary health care system• SWAP implemented at district level with merging of many program heads into one as“integrated district health program”
    17. 17. Key Challenges for Aid EffectivenessAid Effectiveness …• Governance and accountability• Financial management and financial flows• Frequent changes in government• Lack of effective private sector integration and regulation• Continued off-budget support in health sector (non-governmental)• Higher aid dependency for Nepal Government• In sufficient information systems specially financial, procurement, vitalregistration, physical assets and human resource management
    18. 18. Key Challenges for Aid Harmonization• Donor efforts at monitoring and evaluation are fragmented• China and India are big partners in health sector with significant contribution, butrefused to coordinate so that still alignment and harmonization is a problem• Lack of open Information• HIV is almost completely segregated from the rest of the health sector.Aid Harmonization …
    19. 19. Key Challenges for Civil Society Participation• Limited Information about the role of CSOs in Healthsector• Lack of coordination of national civil society• Political affiliation of civil society organizations• Selective engagement of very few organizations thatare not necessarily representative of people on theground• Civil society is not systematically involved in sectormeetingsLimited CSO’s Participation …
    20. 20.  Health sector SWAP has increased ownership, harmonization and aidalignment in general. The capacity of health sector in context of managing big program such asSWAP or health sector program is gradually increasing However, there are still needs for partners to have better coordination onthe matter of communications, monitoring and evaluation system andgeographical strategy. It is necessary to upgrade the national systems such as financialmanagement, audit of financial expenditures and informationmanagement and inter-agency coordination. Technical assistance and information system with open data is crucial. It is necessary to engage CSOs and citizens more for better monitoring aidflows and projects at the local level. It would be great to establish inter-agency linkage with other SWAPsbeyond health sector (i.e. education, environment) and try to coordinate& address the SWAP related common issues.Lessons Learnt
    21. 21. 1) Background2) Challenges& Lessons3) Open AidMapAGENDA1. Progress andAchievements2. Key Challenges1) Aid Effectiveness2) Aid Harmonization3) Civil SocietyOrganization3. Lessons Learnt1.2.3.1. Health in Nepal2. Aid in Nepal3. SWAp4. SWAp in HealthSector
    22. 22. World Bank Projects in Nepal
    23. 23. World Bank Projects in Nepal
    24. 24. Projects by Population Density
    25. 25. Enhance Poverty Targeting
    26. 26. SECOND RURAL WATER SUPPLY & SANITATION PROJECT (RWSS)Data availableNumber of districts 73Total observations 2,902MappingLocationVDC,Ward, SettlementStatus ?Time period 2002-2006 (?)Source RWSSPMismatched 224VDCsMAP: LOCATION OF WSS AT VDC
    27. 27. 17. SECOND HEALTH SUPPORT PROGRAM (HSSP II)Data availableNumber of districts 75Total observations 4,161MappingHealth centerlocation at theVDCStatus ?Time period ?Source BertMismatched 62VDCsMAP: HEALTH CENTERS LOCATION AT VDC

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