Aid In Mozambique

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James Pfieffer, PhD, MPH
Associate Professor, Global Health

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Aid In Mozambique

  1. 1. James Pfeiffer PhD, MPH
  2. 4. Health Sector <ul><li>Public sector services </li></ul><ul><li>Private sector services </li></ul><ul><li>NGOs </li></ul><ul><li>Traditional/alternative care </li></ul><ul><li>Civil Society </li></ul><ul><li>Black market </li></ul><ul><li>Other sectors related to health (agric, education, water) </li></ul>
  3. 5. Health Care System <ul><li>Public sector health care </li></ul><ul><li>- Human resources </li></ul><ul><li>- Infrastructure (bricks & mortar) </li></ul><ul><li>- Training institutions </li></ul><ul><li>- Pharmacy </li></ul><ul><li>- Laboratories </li></ul><ul><li>- Logistics </li></ul><ul><li>- M&E, SI, data systems </li></ul><ul><li>- Research </li></ul>
  4. 6. Health Sector Funding: Vertical, Horizontal, Diagonal <ul><li>Vertical </li></ul><ul><li>- Disease specific/ project specific </li></ul><ul><li>- Channeled into MOH, external projects, NGOs </li></ul><ul><li>Horizontal </li></ul><ul><li>- Strengthens cross-cutting systems </li></ul><ul><li>- Strengthens admin and basic institutions </li></ul><ul><li>Diagonal </li></ul><ul><li>- Uses vertical funds to strengthen system </li></ul>
  5. 7. Foreign Aid to the Health Sector <ul><li>Bilateral </li></ul><ul><li>Multilateral </li></ul><ul><li>Foundations </li></ul>
  6. 8. Recent Increase in Vertical Funding <ul><li>PEPFAR </li></ul><ul><li>Global Fund </li></ul><ul><li>World Bank (TAP) </li></ul><ul><li>Bilaterals </li></ul><ul><li>Gates Foundation </li></ul><ul><li>Clinton Foundation </li></ul>
  7. 9. DAH from 1990 to 2007 by channel of assistance Source: IHME DAH Database Channels of assistance: New actors
  8. 10. Dramatic growth in DAH from 1990-2007 Source: IHME DAH Database DAH from 1990 to 2007 by source of funding
  9. 11. Mozambique Ministry of Health <ul><li>State budget </li></ul><ul><li>Common Fund </li></ul><ul><li>- Technical assistance </li></ul><ul><li>and provincial support </li></ul><ul><li>- Drugs </li></ul><ul><li>- General </li></ul><ul><li>Vertical Funds </li></ul><ul><li>SWAp process </li></ul>
  10. 12. Donors to the Mozambique Health Sector <ul><li>“ Like-minded ” </li></ul><ul><li>- Western European donors </li></ul><ul><li>- Multilaterals </li></ul><ul><li>Single-minded </li></ul><ul><li>- United States </li></ul><ul><li>Foundations </li></ul>
  11. 13. Mozambique: Relative Weight of Vertical Funding
  12. 14. 2007: Total funding by Agency ($ 157 mln.)
  13. 15. Vertical Funding to the MOH ($ 29 mn.)
  14. 16. Who gets the rest of the vertical funds? <ul><li>ICAP </li></ul><ul><li>EGPAF </li></ul><ul><li>HAI </li></ul><ul><li>Vanderbilt </li></ul><ul><li>Save </li></ul><ul><li>Care </li></ul><ul><li>World Vision </li></ul><ul><li>PCI </li></ul><ul><li>PSI </li></ul><ul><li>And on and on…… </li></ul>
  15. 17. Do NGOs Strengthen Health Systems? <ul><li>Our critique: </li></ul><ul><li>Divert aid funds from public sector health care system </li></ul><ul><li>Fragment the provision of services/difficult to coordinate </li></ul><ul><li>Foment disruptive turf wars </li></ul><ul><li>Push pet projects of questionable value </li></ul><ul><li>Contribute to brain drain </li></ul><ul><li>Not sustainable </li></ul>
  16. 18. Distribution of Health Workers in Selected Countries
  17. 19. What is to be done? <ul><li>Will an “NGO Code of Conduct for Health System Strengthening” help? </li></ul>
  18. 20. Obrigado!! www.healthallianceinternational.org October 30, 2009

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