Sector-wide Management in health Review of progress and key issues
Cecil Haverkamp International consultant 31 January 2007
CDC
COM MOP
CAR
MEF
MOH
ADB KfW GTZ
DFID
CDC
FC/AFD
USAID
WB
HSSP
AusAid
JICA
UNICEF
COM MOP
UNDP
UNFPA
WHO
EC
MOH UNAIDS
RACHA
SRC
MEDiCAM
RHAC
URC
KHANA
HU HNI MSF
CARE
CAR
MEF
WFP
BTC
CHAI
CDC
ADB KfW GTZ
DFID
CDC
FC/AFD
USAID
WB
HSSP
AusAid
JICA
UNICEF
COM MOP
UNDP
UNFPA
WHO
EC
MOH UNAIDS
RACHA
SRC
MEDiCAM
RHAC
URC
KHANA
GFATM
HU HNI MSF
CARE
HMN
GAVI
CAR
MEF
WFP
BTC
CHAI
CDC
ADB KfW GTZ
DFID
CDC
UNDP
UNFPA
UNICEF
MEF TWGTWGF/N F/N
WFP
BTC
WHO
EC HPM HPM
SRC
MEDiCAM
RHAC
URC
TWG-H TWG-H UNAIDS
RACHA
CHAI
CAR
GDCC GDCC
FC/AFD
USAID
COM MOP
WB
HSSP
AusAid
JICA
CDC
CCM CCM KHANA
GFATM
HU HNI MSF
CARE
HMN
GAVI
TWGTWGH/A H/A
MOH
ADB KfW GTZ
DFID
CDC
UNDP
UNFPA
UNICEF
MEF TWGTWGF/N F/N
WFP
BTC
AOP (3y-rp)
MTEF
WHO
EC HPM HPM
SRC
MEDiCAM
RHAC
URC
TWG-H TWG-H
MOH
UNAIDS
RACHA
CHAI
CAR
GDCC GDCC
FC/AFD
USAID
COM MOP
WB
HSSP
AusAid
JICA
CDC
TWGTWGH/A H/A
CCM CCM
JAPR-NHC
KHANA
GFATM
HU HNI MSF
CARE
HMN
GAVI
NSDP HSP
Where we are: H&A of aid in Cambodia
CDC ODA database 472 aid projects by close to 40 external donors Some 400 donor missions per year 100+ international and many more national NGOs Involvement in AE agenda as DAC pilot country CG mechanism with GDCC and 18 TWGs
Where we are: H&A of aid in Cambodia 2006 Paris Declaration baseline survey
Aid reported in the national budget (79%) TA coordinated through country programmes (36%) Use of country systems (17% budget execution; 9% financial reporting; 3% auditing; 6% procurement) Parallel implementation structures (49 PIUs) Predictability of aid – disbursements (69%) Share of untied aid (58%) Share of programme-based aid (24%) Coordinated donor missions (26%), joint analysis (60%)
Where we are: H&A of aid for health
Despite overall progress, Cambodia’s health sector still characterised by
a high degree of fragmentation a multitude of largely uncoordinated actors a lack of predictability severe imbalances and distortions in funding donor projects operating around government…
Looking at SWiM by component I
Are all significant funding agencies supporting a shared, sector wide policy and strategy?
II
Is there a medium term expenditure framework or budget which supports this policy?
III
Is the partnership sustained by Government leadership?
IV
Are there shared processes and approaches for implementing and managing the sector strategy and work programme, incl. reviewing sectoral performance against jointly agreed milestones and targets?
V
Is there a commitment to move to greater reliance on Government financial management and accountability systems?
Selected findings
Lack of regular, open donor dialogue on ‘SWiM issues’ has led to inner/outer circle of donors
Lack of informal fora to discuss broader issues of aid delivery beyond just technical aspects
Frustration over the current mode of working with Government – and a sense of ‘being stuck’
Perceived lack of effective rather than only nominal government leadership
Possibilities for greater progress are perceived as depending on broader government reform efforts
Great interest in exploring common approaches
Common questions Are there better ways of working in the sector – with government, with others – and what are they? How could common, more harmonised approaches look like in areas with shared interests? How to deal with limited capacity in MOH, how to overcome the current dependency on external TA? How could vertical programmes be better integrated without risking decreasing performance? What is in ‘it’ – incentives for both donors and Government to change the modus operandi?