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The Health Sector and the Transitional Policy and Funding Gap: A Question of Aid Effectiveness. Ann Canavan, Health Advisor KIT Petra Vergeer, Health Advisor KIT Jacob Hughes, Independent Consultant Nadine Ezard, Independent Consultant. Study conducted by: Royal Tropical Institute.

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The Health Sector and the Transitional Policy and Funding Gap: A Question of Aid Effectiveness

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The health sector and the transitional policy and funding gap a question of aid effectiveness l.jpg

The Health Sector and the Transitional Policy and Funding Gap: A Question of Aid Effectiveness

Ann Canavan, Health Advisor KIT

Petra Vergeer, Health Advisor KIT

Jacob Hughes, Independent Consultant

Nadine Ezard, Independent Consultant

Study conducted by:

Royal Tropical Institute


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Introduction

Aim of study: to build an evidence base concerning the nature and extent of the transitional funding gap in the health sector

Transition is defined as; “when official overseas development aid (ODA) flows change from humanitarian to development funding lines”

This influences the modalities and nature of services delivered

Amsterdam, The Netherlands www.kit.nl


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Transitional funding gap and needs

  • Merely focusing on funding gaps in service delivery (post conflict) may not be reflective of the needs in a post conflict country.

  • Of course, needs are much greater than humanitarian funding, so there is a bigger problem (health financing gap)

Amsterdam, The Netherlands www.kit.nl


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Key Questions

  • What were the finance gaps as identified by stakeholders? And what was reported impact on the health service delivery?

  • What aid instruments were deployed in the transition phase? Do they hinder/facilitate the availability of funding?

  • What were other perceived determinants of aid effectiveness in the country during the transition?

Amsterdam, The Netherlands www.kit.nl


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Methodology

  • Study Level of effort – 57 day

  • Literature review

  • Ten year retrospective of secondary data sources: Afghanistan, East Timor, Southern Sudan, DRC and Sierra Leone with a Liberia country case study

  • Key informant interviews: 28 Global and 23 Liberia

Amsterdam, The Netherlands www.kit.nl


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Problems with the Databases: Global versus country level aid flow for health sector in DRC

  • Figure 1: DRC (Global sources)

  • Figure 2: DRC (WB, UN and MOH, based on info WB PER)

Amsterdam, The Netherlands www.kit.nl


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Liberia: The Potential Transition Gap as identified in 2006: The increasing red dots indicate health facilities losing NGO support and which may have to close if additional resources are not available. (MoHSW data)

Amsterdam, The Netherlands www.kit.nl


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Liberia Funding

  • Threat of transitional gap end 2006

  • Gap averted

  • Funds increased- ECHO and OFDA extended, DFID and Irish Aid increased, while vertical funding quadrupled

Amsterdam, The Netherlands www.kit.nl


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Transition from relief to development

  • Delaying development funding potentially extended the relief approach

  • Pooled funding commenced in 2008

Amsterdam, The Netherlands www.kit.nl


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Predictability of aid

  • Challenges for longer term planning and health system rebuilding

  • Importance of aid flow tracking in country

Amsterdam, The Netherlands www.kit.nl


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Other countries

  • Sierra Leone – not possible to determine but probable as agencies withdrawing due to funding despite high levels of need

  • South Sudan – difficult to determine but probable as MDTF slow to disburse, other donors respond

  • DRC- transition funding gap suggested: increase in development but marked decline humanitarian funding, led to withdrawal humanitarian INGO’s.

  • Afghanistan - no discernable transitional funding gap; development aid eclipses humanitarian aid

  • Timor Leste – no funding gap; lots of donor interest and small population

Amsterdam, The Netherlands www.kit.nl


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Key determinants of transitional funding gap

  • “ … the funding gap is manufactured by the way that aid agencies are structured, with different rules and regulations, different units disbursing funds, with limited coordination” (Donor)

  • Government legitimacy & capacity

  • Transition relief to development NGO’s

  • Donor Behaviour & Policy

Amsterdam, The Netherlands www.kit.nl


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“Development”

Systems building

Direct budget support

Technical Assistance

SWAp

State avoidance

State partnership

MDTFs

Global funds

Bilateral bridging

Pooled humanitarian funds

Project funding

Service delivery

“Humanitarian”

Aid Mechanisms in Transition

Amsterdam, The Netherlands www.kit.nl


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Recommendations

  • Need to improve aid tracking in-country to support improved planning, harmonisation and predictability of aid

  • More work needed on flexibility of aid mechanisms and the possibilities to mix and sequence of aid mechanisms, with donors complementing each other to prevent funding delays and/or gaps

Amsterdam, The Netherlands www.kit.nl


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