Download Harmonisation and Alignment of Aid for HIV/AIDS in the SADC

Teresa Guthrie
Centre for Economic Governance and AIDS in Africa
Inaugural Conference of the African Health Economics and Policy Association
Accra - Ghana, 10th - 12th March 2009
PS 02/5
 To
assess the progress of SADC countries
towards harmonisation & alignment of
funds for HIV and AIDS
 To review the existing declarations &
instruments
 To identify the blocks and challenges
 To make suggestions for required actions.
 Literature
review
 Interviews with key respondents from
various SADC countries
 Used data from country NASA reports,
where available
 Incidence
of HIV/AIDS has been steadily
increasing in the SADC region for the last two
decades
 15 million HIV-positive people in SADC Region
 51% of all the infections in Africa are in SADC
 37% of the global total are in SADC
 Thus SADC region is the worst affected in the
world
 Member
states have put in place measures at
both national & regional levels for treatment,
prevention & mitigation
 Multi-sectoral strategic plans (NSPs) and strong
leadership response
 Commitment to Abuja Declaration and Plan of
Action, the New Partnership for Africa's
Development (NEPAD), the Millennium
Development Goals (MDG) and the UN General
Assembly Special Session of HIV/AIDS
 Increasing partnerships with International
Cooperation Partners (ICPs) - Donor coordination
meetings, partnership framework, ICP framework
 Increasing
role of civil society
SADC HIV/AIDS Strategic Framework and Plan of
Action: 2003-2007 adopted
 Underscored the importance of resource
mobilization in the fight against HIV/AIDS
 Approved the establishment of a regional fund for
the implementation of the SADC HIV/AIDS Strategic
Framework and Programme of Action 2003-2007
 Urged International Cooperating Partners and
international development finance institutions to
generously contribute to the fund
 Appealed for a relaxation in the stringent
requirements attached to accessing these funds on
the part of ICPs
 Members to continue efforts towards allocating at
least 15% of their national budgets to health,
consistent with the Abuja Declaration.

Difficult to get a regional picture, requires
country level analysis and reporting to SADC
 Not all countries have undertaken NASAs nor
accurately costed their NSPs
 Some countries not aware of all the commitments
and disbursements made to HIV/AIDS, and very
few aware of the actual expenditure
 So do not have a clear picture of the resources
required, the resources available, and therefore
cannot estimate the resource gap & mobilise
funds
 Limited evidence on the extent of absorptive
capacity (undermined by above points)

 From
external, domestic, and some
private/ business sector resources
 Increasing
number of actors –
confusion, fragmentation, duplication,
undermining a coherent response
 Varying
funding mechanisms &
reporting requirements – varying
complexity and strengths &
weaknesses
 Authority
 National
 M&E
is dispersed
priorities are weakened
is fragmented
 Implementation
is slowed
 Duplication, gaps, wastage
 Poor
absorption
 Impact
is limited
of resources
 Aid
Effectiveness
 Harmonisation and alignment
 Existing declarations, instruments, tools
 Country efforts
From OECD/DAC
 “Aid
harmonisation refers to the creation of
common arrangements for managing foreign
aid. It requires that donors should work together
to ensure that their systems and processes are
standardised to reduce transaction costs to the
recipient government”.
(AFRODAD, 2007).
 The
adoption of common procedures:
• Use the national government budget process
(direct budget support)
• Use the government accounting and
procurement systems,
• Undertake joint:
 aid missions to a country
 diagnostic studies (sit.analysis)
 monitoring, auditing and evaluation processes
2002 Monterrey - conference on Financing for
Development
 2003 Rome: High-Level Forum on Harmonization
 2003 ICASA: The Three Ones conceptualized
 2003 Maseru: HIV/AIDS Summit
 2004 Washington: Harmonization of International
Funding
 2004 Tanzania: Africa Region Workshop on
Harmonization, Alignment and Results
 2005 Paris: Declaration on Aid Effectiveness
 2005 London: Global Task Team established
 2005 Rio: Three Ones Consultative Workshop
 2006 Paris:Innovative Financing for Development
 2006 Rwanda: Harmonisation, Alignment and Aid
Management

 “goes
beyond previous agreements by
attempting to lay down a more practical, actionoriented roadmap to improve the quality of aid
and its impact on development” (AFRODAD, 2007).
5
•
•
•
•
•
•
five key principles:
ownership
alignment
harmonisation
managing for results
mutual accountability
establishes a commitment to track and set targets
against 12 indicators of progress.

Joint Assistance Strategies (JAS) or Development Aid
Strategies (DAS) for aid mobilization, coordination and
utilization (eg. Zambia, Malawi, Tanzania).
• Aim at increasing efficiency and effectiveness in the
mobilisation and utilisation of aid to achieve development
goals
• Number of reforms, such as the establishment of new aid
coordination mechanisms, which causing an increase in
the number of structures that that manage aid in the
country.





Aid and Debt Policies
Public Financial Management (PFM) reform
Support for the PFM agenda/ Action Plan
Regular stakeholder dialogue forums, partnership
forums
Increasing joint approaches:
• Planning, Reviews and analytical work, SWAp, Direct
budget support, Pooled funding – common funds.
Plenary Session Wed!
Spending Priorities 2005
1,200,000,000
Community Development & Enhanced
Environment
1,000,000,000
Social mitigation
800,000,000
Pula
HIV- and AIDS-Related Research
Human Resources for HIV and AIDS
activities
600,000,000
Prog.Devmt & HSS strengthening
400,000,000
Orphans and Vulnerable Children
(OVC)
200,000,000
Treatment and care components Total
0
Public sector Internat.Orgs
Grand Total
Prevention Programmes
NSF Goals
Strengthen Legal &
Ethical Enviro.
0
0.5
Psychosocial &
Economic Impact
17
22.2
Mgmt of National
Response
7
14.4
Care & Support (incl
ARVs)
54
49.4
10
Prevention
NSF %
Actual Spending %
13.6
0.0
10.0
20.0
30.0
%
40.0
50.0
60.0
Factors undermining “One National Framework”:
 NSP is often disregarded by the various actors
 National target setting might be unrealistic
• May be due to accommodating civil society demands
 NSP
are not well costed, leading to an under- or
over-estimation of resources required
 Donors continue to fund direct projects, which
may be on or off the plan, and which they may or
may not report on
 Civil society groups may not buy-in to the NSP nor
feel the need to report on their activities and
expenditure
Factors undermining “One National Coordinating
Authority”
 Donors still have their own agendas and
interests, not consulting with NACs
 Duplication and parallel systems of CCMs and
National AIDS Authority
 Staff shortages and gaps in the NAC, in the MoH
and MoF
 Civil society has role to hold govt and donors
accountable, but should also be accountable to
NAC
 Power is not given to NACs to manage the funds
250,000,000
200,000,000
150,000,000
Amount
125,448,618
External Agents
Other Local Agents
100,000,000
Public Agents
95,275,143
33,975,810
50,000,000
19,005,985
48,484,816
26,285,518
0
2005
2006
Year
Factors undermining “One M&E system”:



Lack of capacity in M&E
Financial reporting weak - Many NACs are not aware of
what has been spent on the HIV/AIDS national
priorities
Donors continue to have individual programme
monitoring & reviews, and separate auditing
requirements imposed on recipient Governments
Failure of national budget & accounting systems to
link expenditure with HIV/AIDS priorities
 The activities & outputs of civil society are
generally not included in the national M&E system
(eg. Swaziland has specifically developed the
SHAPMoS but CSOs are resisting)

Factors undermining unified systems and
procedures:





The Public Finance Management reform is progressing
slowly, leading to a lack of trust in Govt. systems &
donor cynicism
The national procurement, auditing and accounting
systems are weak, or perceived to be weak by donors
Some donors’ systems are inflexible, preventing rapid
alignment
Governments do not provide clear guidelines on
scheduling and conduct of missions, nor demanding
joint missions
Creating an optimal combination of DBS, Sector
Support, Basket Funding (what really contributes to
harmonisation?)
NAC/ governmental roles:
 NSP should be a “living document” that guides the
national response (responsive, involving all
stakeholders, buy-in, engendered)
 Governments to own and lead the response to
HIV/AIDS
 Governments to better define the “rules of
engagement” with partners
 Develop a clear agenda for action, reflecting mutual
accountability, building on countries' own systems, with
clear allocation of responsibilities for all parties (govt,
donors, civil society)
 NSP should be realistically costed, and expenditure
against the priority activities should be tracked
 Establish and maintain structures for regular dialogue
with all stakeholders

Increase/ demand for more joint approaches:
• Planning, Reviews and analytical work, Direct budget support,
SWAp, Pooled funding, baskets





Government and donors and civil society to agree on a
common framework for financial performance
monitoring, strengthen economic governance systems
Design and implement a system of assessing donors
based on Paris Declaration norms – eg. Donor Score
Card
Government to formulate and implement an Aid
Coordination Calendar (donors to align their fiscal
year)
Sector ministries to articulate work plans for their
contribution to the HIV/AIDS national priorities
All levels of govt to enhance their own accounting,
reporting and transparency regarding fund utilisation –
this will increase donor confidence and willingness to
align and encourage civil society accountability
ICP’s roles
 Increase predictability of donor funding (longer-term
commitments), with greater flexibility
 More funding for general health systems strengthening
 More support for the construction of solid national
authorities and coordination capacity
 Emphasis on human and institutional capacity building
 Accept and use the national M&E and reporting
systems
 Harmonize reporting requirements, tools and indicators
 Donors to use national systems for procurement,
accounting and auditing
 Closer exchange and effective dialogue between
Global Fund and UN
 Emphasis on strengthening govt. financial information
systems, so as to enable electronic timeous reporting
on expenditure and easily available data
(computerised systems reporting according to NASA
categories)
SADC Roles:
 Strengthened communication channels and
mechanisms for sharing info across SADC and between
NACs – sharing best practices
 Strengthened position if negotiating as SADC
 Spearhead the development of a Code of Conduct for
all partners, particularly relating to ICPs alignment with
NSPs (eg. Donor Score Card)
 Fund for the response to HIV/AIDS?
 Hold joint annual reviews of progress towards
harmonisation and alignment – with all stakeholders
 Request regular commitment & expenditure reports
from Members – to create the regional funding picture
 Regional group to consider/ monitor regional funding
issues
 Encourage Members’ use of the RNE, NASA and CHAT
tools
Civil Society’s roles:
 Civil society could broaden its advocacy focus to include
processes such as alignment and harmonization
 Generate more public debate on alignment to drive the
“access” agenda – delivery of Universal Access relies on
effective architecture – “making the money work”
 Demand the govt and ICP reveal their actual expenditure
in-country
 Reveal their own activities and expenditure leading to
improved governance and greater transparency (eg.
recent Declaration on Good Governance and
Leadership)
 Demand greater transparency of adherence to promises
 Increased financial contribution from the private sector
•
International Health partnership and
related initiatives (IHP+) is a collective
commitment to work together in more
effective ways to improve health care
– Rationalising of the health architecture
– Change in the way donors work together with
partner countries through coordinated efforts of
all stakeholders
– the strengthening of in-country health system
services
– under the leadership of the Government, acting
with the representatives of civil society

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To prove the impact of the IHP+ will require strong,
transparent financial information & accounting systems
by governments.
Spending of pooled funds is difficult to track to the
specific donor ~ adoption of single reporting by govt
without individual outputs reflected.
Public contributions to health are key to sustainability of
programmes, and therefore donor-dependency must be
addressed.
Evidence of basket funding for HIV/AIDS and
Partnership Forums – donors maintain dominance in
determining spending priorities, and can ‘gang up’
against govt.
Are donors ready to allow governments full
determination of the use of funds?
Will funding for critical NGO services reduce?
Teresa Guthrie
Centre for Economic Governance and AIDS in Africa
[email protected]
+27-82-872-4694