Health Systems Funding Platform

1. Health Systems Funding Platform Mercy Ahun CSO Steering Committee MeetingGeneva, 5 July 2011

2. Agenda • HSFP Update • Update on graduating countries & long-term vaccine sustainability • CSO update

3. Agenda • HSFP Update • Update on graduating countries & long-term vaccine sustainability • CSO update

4. High Level Task Force on Innovative International Financing for Health Systems “More money for health and more health for the money” • Need to raise up to an additional US$10b per year to spend on health in poor countries. • Expand the mandatory solidarity levy on airline tickets and explore the technical viability of other solidarity levies on tobacco and currency transactions. • Expand the use of the International Financing Facility for Immunization and other approaches to ensure predictability. • Provide public catalytic funding for large-scale private giving initiatives such as voluntary solidarity contributions and a proposed ‘de-tax’. • Establish or expand existing funds for results-based ‘buy-down’ funding. • Strengthen the capacity of governments to secure better performance and investment from private, faith-based, community, NGO and other non-state actors in the health sector. • Make the allocation of existing and additional funds in countries more efficient, by filling gaps in costed and agreed national health strategies. • Request OECD/DAC with partners to undertake a review of all current technical assistance, with a view to focusing it on strengthening national and local institutional capacity in priority areas such as public administration and accountability, financing, service delivery arrangements and the non-state actors. • Establish a health systems funding platform for the Global Fund, GAVI Alliance, the World Bank and others to coordinate, mobilize, streamline and channel the flow of existing and new international resources to support national health strategies. • To monitor how well we are doing, a regular forum will be held for countries and partners, building on the IHP+ Ministerial Review.

5. What is the Health Systems Funding Platform? • Initial partners: • A mechanism for mobilizing and making better use of new and existing funds for health – more health for money • Consistent with principles of greater aid effectiveness agreed in Paris and Accra and IHP+ • 4 pillars: One plan, one assessment, one fiduciary framework, one results framework • Country-driven and results-focused • It does not require the pooling of funds • Open to all The World Bank

6. Anticipated Benefits to Countries Country-based Agency-based Proposal-based National strategy based Flexible and aligned to country cycles Multiple deadlines Aligned to the budget cycle Outside the budget cycle Accountable to country's citizens Contract driven 6

7. Access via common proposal form (GF/GAVI) Access via jointly assessed national health strategy (WB/GF/GAVI) Two mechanisms for efficient funding “Existing financing” Harmonization of existing HSS support Grant/credit management “New financing” Opt 1 Opt 2

8. Existing funding: country progress • Goal: • One plan • One fiduciary framework • One M&E framework • Work ongoing in Benin, Cambodia, DRC, Sierra Leone and others • Discussions started in Bangladesh, Guinea, Niger and Senegal

9. Using the Health Systems Funding Platform Proposal development and submission, based on common proposal form Independent review by TRP / IRC Board approval Financial arrangements Grant management Implemen- tation Step 1 Step 2 Step 3 Step 4 #1 Common proposal form Joint Assessmt. of National Strategy In-country discussion (priorities, funding, M&E, etc.) Developmt. of Funding Request Step 1 #2 Funding request based on JANS Separate Based on joint mechanism Joint process

10. New funding: based on a National Health Strategy • JANS • Complete: Nepal, Ethiopia, Ghana, Uganda, Vietnam • Yet to be concluded: Rwanda, Mali, Malawi and Kyrgyzstan • Nepal: new funding via NHS approved • Ethiopia & Vietnam pilots ongoing • Application materials to be launched jointly with the Global Fund in August 2011 Identification of possible sources of financing

11. Pilots • Request Template: Ethiopia & Vietnam • Common Form: Tanzania • Lessons learnt incorporated into final materials • Clearly communicating CSO inclusion to countries

12. Regular updates and consultations • Quarterly stakeholder updates with Board level constituency (including Civil Society) • Monthly CSO conference calls • Country and CSO consultations on common proposal form (i.e. CSO Annex) • Building on existing meetings: • WHO Regional committee meetings • Regional and country meetings

13. Global Timeline

14. Agenda • HSFP Update • CSO update • Update on graduating countries & long-term vaccine sustainability

15. CSO Support Update • Type A extension • Six out of eight eligible countries applied for extension • Afghanistan and Togo approved by an independent committee • Decision letters sent to each country on the outcomes • Type B extension • PPC advised extension up to 12 months • Awaits GAVI Board approval • Regional franco-phone CSO meeting in September in Dakar to strengthen linkages with Francophone CSOs in Africa

16. CSO Support Update • CSO Support Evaluation. • RFP has been announced in April. • Contract negotiation is ongoing • CSO engagement in HSFP • GAVI is systematically promoting CSO engagement through the Platform in those countries expected to apply for support in 2011 • Considering proposal for CSO engagement on the Platform through the GAVI Business Plan. • Options for future engagement will be guided by the outcome of CSO evaluation

17. Agenda • HSFP Update • CSO Update • Update on graduating countries & long-term vaccine sustainability

18. Co-financing policy revised in 2010 • Under the new policy 3 country groupings: Low-Income, Intermediate and Graduating countries • Objectives of the review: • Consistency with agreed Board approved objectives of financial sustainability and ownership • Continuity with current policy wherever possible • Improved alignment with GAVI’s new eligibility policy • Improved alignment with country needs and their ability to pay, Focus change (and implementation effort) on graduating countries, where need to adjust to new Board policy and benefits are greatest

19. Graduating countries Policy objective: financial sustainability • Linear ramp up over four years to reach projected price after GAVI support ends • Avoid “cliff edge” in 2015 • Same support (1+4 years) will apply to future graduating countries • Country co-financing is linked to projected prices • Significant changes with current policy • High but necessary transaction costs to support implementation

20. Graduating countries: projected co-financing as a % of public spending on health, 2015 % of government health exp.

21. GAVI support to graduation countries • Close monitoring of co-financing progress • Development of regional profiles of graduating countries and country-specific briefs • Multi-partner visits in order to: • Engage policymakers to mobilize additional funding • Development of plans/business cases to prepare for the transition to country level financing • Greater engagement of new actors, decision-makers and advocates: • High-level visits to graduating countries (e.g. GAVI CEO) • Advocating for co-financing and financial sustainability during high-level events (e.g. WHA, WB’s Board meeting, etc.) • Engagement of CSOs and Parliamentarians to advocate for financial sustainability

22. Engagement of CSOs • Critical role at country level to advocate for sustainable financing for immunization • A CSO has been included in the Immunization & Financial Sustainability Task Team (Sabin Institute) • Engagement of Sabin’s regional staff too through teleconferences and annual meetings • Need for further engagement of CSO at country level • Suggestions are welcome