Dr. Ndack Wadjii  Ly

Along with representatives from all five MLI countries, MLI Country Lead for Senegal, Dr. Ndack Wadjii Ly, recently participated in a workshop on improving aid effectiveness sponsored by the World Health Organization and the World Bank.  Below she shares a brief report of the meeting, including key recommendations that emerged throughout the two days.

Created in 2007, the International Health Partnership (IHP+) is intended to accelerate progress toward the Millennium Development Goals. The effort organizes donors and development partners in support of country-led national health strategies. The 49 signatories include 24 developing countries, 13 donor governments, United Nations agencies and other donor organizations. The IHP+ Global Compact incorporates the principles of the 2005 Paris Declaration on Aid Effectiveness and the 2008 Accra Agenda for Action. Both documents, widely supported by donors and recipient countries, emphasize country ownership of health priorities, alignment of donor support around country objectives and a focus on measureable results.

IHP+ gathered signatories in Brussels from December 9 -10, 2010, to look at the progress towards the application of the Paris principles on aid efficiency in the health sector. As MLI was involved in designing the compact in Senegal and because MLI has also shown great commitment to supporting the country in the area of donor aid alignment, I was asked to attend as part of the Senegalese delegation.

The two-day session in Brussels focused on assessing progress made in better coordinating aid with national health systems and the impact that has had on countries.  Country representatives, including myself, discussed the challenges we faced in implementing IHP+ and how the problems were overcome. We also considered possible adjustments in country approaches to IHP+ and developed recommendations aimed at improving IHP+ compliance for both countries and development partners.

I was pleased to see that contributions made by MLI country delegations during presentations and group discussions were greatly appreciated.  Indeed, of the presentations given, MLI countries dealt with issues that are at the heart of aid efficiency in the health sector

The Ethiopian delegation gave a presentation on their use of Joint Assessment of National Health Strategies (JANS). The tool, developed by an IHP+ interagency group in 2009, assesses national plans with the goals of strengthening them, improving partner confidence and reducing transaction costs by implementing a single assessment and reporting process.  Introduction of the JANS effort in Ethiopia was positive, as it contributed to a strengthening of the national plan, a reduction of transaction costs and better coordination resulting from development partner trust in the health system. Two MLI countries, Nepal and Ethiopia, are among three countries that have used JANS in finalizing their health sector plans.

Nepal’s presentation focused on unifying and simplifying aid. It highlighted the fact that Nepal was the first country to successfully apply the joint financing system that consisted of arrangements to pool government and Global Fund finances, allowing Nepal to reduce transaction costs and better consolidate management procedures, including controls and audits.

Representatives from Mali discussed whether the global economic downturn had decreased the emphasis on aid effectiveness. The goal of the discussion was to refocus aid on countries and national plans. Admittedly, aid has exploded for the last 10 to 15 years, but we need to question how efficient it has been. The panel concluded that health system fragility is perpetrated by funding parallel strategies. Overall, countries need to devote more resources to health, improve accountability and bolster leadership to ensure development partners are supporting national goals.

Sierra Leone and Senegal representatives debated the role of agreements and pacts in building and monitoring partnerships. Both countries discussed why they joined IHP+, indicating the commitment was driven by a desire to strengthen their health ministries’ leadership in resource allocation, improve communication with development partners and improve budget alignment and predictability.

Overall, workshop participants concluded that application of aid improvement principles assumes a consensus around a unified national strategic plan from all sectors of government. It also requires a single framework to measure results, and mechanisms for encouraging on-going communication between the government and development partners. To ensure those processes are in place in countries, several recommendations emerged including a need for improved human resources capacities, developing a national compact to outline government and donor commitments to IHP+ principles, encouraging participation from all development partners, and emphasizing mutual accountability and strengthening the leadership capacity of the Ministry of Health in allocating resources and communicating with donor partners. Panels also recommended working with Ministries of Economy and Finance to ensure development of a single budget for health programs. They also supported strengthening JANS.

In developing recommendations for technical and financial partners, participants said donors should put resources toward national priorities, unify fiduciary regulations and improve aid predictability. They also should commit to implementing and funding JANS and make better use of local capabilities to reduce transaction and technical assistance costs for projects.