Supporting Integrated Health Systems Strengthening

1. Supporting Integrated Health Systems Strengthening A CIDA Perspective

2. CIDA’s Institutional Context • Mixed Approach • Vertical (CEAs, INGOs, global initiatives) • Horizontal (PBAs, SWAps) • Shift to PBAs • 2002 Policy Statement on Strengthening Aid Effectiveness • Institutional Branch Structure • Separation between bilateral and multilateral programming • Africa, Americas, Asia, EMM Branches (Bilateral) • Multilateral and Global Programs Branch (Multilateral) • Canadian Partnership Branch (Canadian NGOs)

3. CIDA experience with Vertical Vs. Horizontal Programming • Vertical: • Accountability • Attribution of Results • Technical expertise • Target underserved populations • Horizontal: • Alignment of donor policies with country priorities • Use of local procedures and systems. • Shared accountability

4. Challenges with PBAs and SWAPs • Requires partner country leadership • Initiate national health strategy, SWAp, etc… • Health system capacity constraints: • Human resource shortages • Governance issues-absorption issues • Coordination difficulties: • Among donors, key actors outside common arrangements

5. Africa Health Systems Initiative(AHSI) • 3 focus areas 1. Front-line health workers 2. Health information systems 3. Equitable service delivery • Primarily bilateral funding • Multi-bi component (UNICEF 2007-2012) • Based on government priorities: train 40 000 community health workers and deliver basic health services

6. Multi-donor Initiatives • International Health Partnership (IHP) • Mobilizing donor countries and other development partners around a single country-led national health strategy • Agreeing with governments on the sources and amounts of funding for the health plan • Joint assessment • CIDA signatory in Mali and Mozambique

7. Country Example: Mali Bilateral Funding – Africa Branch • Project (2003): reproductive health project in Kayes region via Canadian Executing Agency • Programme-based approach (PBA): 2004/2005 • earmarked funds for the reg: 1. operational plans in 3 regions of North Mali 2. paramedic training support –national. • SWAp: 2006–2012 • direct budget support • incorporation of 3 projects and regional epidemiological surveillance support project • International Health Partnership (IHP) – 2009 • Country Compact

8. Mali (Cont.) • Strengths: • Biannual joint monitoring and evaluation reports on national and regional health indicators • Common operational plans, joint annual review, joint monitoring and evaluation, common results indicators • Detailed HRH strategy and budget • Long-term commitments (programs renewed) • Sustainability Weaknesses: • Some key players outside the SWAp • Attribution not possible

9. Country Example: Bangladesh • Health sector support since 1976; SWAp since 1998 • Support national priorities through parallel projects identified in SWAp (2005-2010) • Strengths: • Challenges: • Issues of systems and governance capacity eg.slow disbursements • External procurement • Smalll contribution to pooled funds within SWAp ($5m)

10. Summary • Mixed approach -varying levels of country leadership and capacity. • Sector and donor coordination needed -takes time and effort. • SWAPs have worked best in sectors (with strong public investments and) where government is the main service provider. • Adopting a sector development perspective as the basic point of departure.