Programme Approach

1. Health Sector Programme Approach

2. Outline • Background • What is programme approach? • Perceptions of the feasibility team • What is recommended by the feasibility study team? • What are the implications to NGOs/INGOs?

3. The Paris Declaration on aid effectiveness • Ownership: Partner countries exercise effective leadership over their development policies and strategies and coordinate development actions. • Alignment: Donors base their overall support on partner countries’ national development strategies, institutions and procedures. • Harmonization: Donors’ actions are more harmonized, transparent and collectively effective. • Managing for results: Management of ODA should be carried out from the results side and then decide on inputs and activities • Mutual accountability: to establish joint evaluation and planning cycles based on government systems.

4. Three methods of collaboration between government and development partners • Project-based approach • Programme approach • Sector-wide approach

5. Definition of programme approach The Paris Declaration defines the term programme approach as: “a way of engaging in development cooperation based on the principles of coordinated support for a locally owned programme of development such as a national development strategy, a sector programme, a thematic programme or a programme of a specific organization.

6. Definition of programme approach Programme based approaches share the following features: (a) leadership by the host country or organization; (b) a single comprehensive programme and budget framework; (c) a formalized process of donor coordination and harmonization of donor procedures for reporting, budgeting, financial management and procurement, and (d) efforts to increase the use of local systems for programme design and implementation, financial management, monitoring and evaluation.

7. Key Points on Programme Approach summarized by the Feasibility Team • Agreement on one plan and budget (for a particular sector or part of that sector) • Simplified procedures using Government systems wherever possible, and • Government in control

8. Recommendations by the team • All involved stakeholders should move to a programme based cooperation. • MoH invites development partners for the sector as a whole and specifically in different sub-sectors to work in accordance with the pre-requisites of the programme approach as described in the followed steps.

9. Steps recommended to establish a programme approach • The MoH opens up the dialogue with its partners about the strategic framework(s) an implementation plans that it envisages for implementing its sector policy and/or subsector policies. It invites comments and suggestions on draft master plans and multi-annual plans. • The MoH takes leadership in this process by setting the agenda of this policy dialogue, submitting plans and projections, calling and chairing meetings; (DPF) • The Government seeks an explicit written commitment from international agencies to refrain from introducing single projects, work through commonly agreed planning, monitoring and implementation procedures and abide to local rules and regulations preferrably by signing a joint code of conduct (HPG to initiate the CoC).

10. Steps recommended to establish a programme approach 4. The Government takes the lead in developing medium-term expenditure frameworks/financing and cost analyses for the sector plan or individual sub-sector plans and seeks external assistance, if judged useful, once completed and adopted, these expenditure frameworks serve for the MoH to solicit donor contributions for these plans. Development partners agree to provide budget support through an agreed Joint Financing Arrangement, stipulated in an MoU. • The MoH and its development partners elaborate a process that lays out how the sector strategy and the annual programmes of work will be implemented, managed, reviewed and adjusted, in a set of common management arrangements. Agreement by both parties will be required on the indicators, targets and mechanisms for performance monitoring.

11. Steps recommended to establish a programme approach • The joint Gov’t/MoH – donor working group on the porgramme initiates a functional analysis on capacity in the concerned sector/sub-sector. • Agreement is sought on a tentative timeframe for the above steps. The above steps could eventually lead to a situation that for the sector as a whole, or for a particular sub-sector, there will be one common plan (and one overall budget), on monitoring system for nationwide implementation and one coordination framework.

12. Specific Recommendations: A.That a service delivery area that involves a certain package of health services be selected as a sub-sector for a pilot intervention to work according to the above mentioned (Chapter 10) and the below steps (Chapter 4). Apart from service delivery areas, health sector support systems can be selected for such pilot interventions.

13. Three steps to the establishment of a sector programme: • Development of joint key agreements in the form of a CoC and a MoU; • Establishment, within that agreement, of an Annual Planning Cycle as the main focal point of joint government donor dialogue (a) on sector performance, strategy and priorities and (b) programme implementation progress and results through joint reviews; • Establishment, within that agreement, of a joint monitoring mechanism that at the same time contributes to a comprehensive health sector performance assessment framework.

14. Specific Recommendations: B. Support to a small number of provincial health administrations to strengthen their conventional planning procedures and to utilize management tools already introduced and those implicitly supported through the new SEDP. The purpose should be to enhance efficiency in resource consumption through new planning instruments and procedures.

15. Specific Recommendations: C. Technical assistance resources at the MoH be allocated to support the Department of Planning and Finance in an attempt to change the current planning procedures of the MoH, especially in relation to development partners. The objective of the TA should be to institutionalize a process where all external involvement in the sector is discussed in accordance with policy and planning procedures established by the Ministry. This means that discussions are held with all donors engaged in a specific programme area and based on a commonly acknowledged policy and planning document.

16. Comments on INGOs by the Team • At least 108 NGOs/INGOs are active in the health sector • Mostly involved in project implementation • Some engage in advocacy and provision of technical expertise • Bring in innovative ideas and approaches • Small in scale and scattered • Overlaps occur particularly in IEC and training • No mechanism in place for INGOs to disseminate their lessons learnt and scale out results • Little effort from the central government to consolidate the efforts of INGOs • Transaction costs are huge, since each INGO has its own project management mechanism and its own M&E system • The 2 INGOs in HPG do not represent the other INGOs and no mechanisms to bring INGO concerns to attention of HPG.

17. Implications if programme approach is adopted • Government will have tighter control over the NGOs, attitude is currently unclear • Better accountability • Work of NGOs will be restricted to agreed programme activities • Much less innovation • Difficult for NGOs to provide additional inputs beyond the agreement • NGOs need to work more closely with the donors

18. Recommendations to NGOs/INGOs • NGOs/INGOs to have representatives in the HPG who can speak on their behalf • NGOs/INGOs should start communicating with donors on their concerns and to work out a strategy to undertake programme activities under the new programme approach • NGOs/INGOs should actively participate in the change process