EuropeAid
Workshop Towards shared principles for reporting health
impacts of development aid; Brussels February 6th, 2012:
The aid policy framework - Interntional
agreements and aid policy context
Walter Seidel - European Commission
Directorate General for Development and Cooperation – EuropeAid
Unit D4 – Health Sector
1. Introduction: Aid Effectiveness
What do we mean by "aid effectiveness"?
• The EU citizen's view: Does aid work? Is my money well
spent?
• The LIC citizen’s view: Does health care get better?
• The public health scientist’s view: How can we measure aid
effects in terms of health impact [mortality, morbidity]?
• The aid professionals' view: Have we progressed on our
commitments as stated in the Paris Declaration and
the Accra Agenda for Action?
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2. Aid Effectiveness (AE) (Paris 2005, Accra
2008, Busan 2011)
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• Paris and Accra address essentially the problems of
“Northern” aid to aid dependent low income countries with
emerging institutional capacities; in Busan, the “BRICS” and
the issue of South-South- Cooperation have been included
into the AE agenda.
• 3 key elements relevant for our discussion:
o harmonisation (among donor agencies)
o alignment (to national policies, mechanisms and
systems; respecting national ownership)
o managing for results
3. Aid Effectiveness commitments –
Practical consequences for EC health aid
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• Sector Policy Support Programmes (SPSP) => « Sector
Reform Contracts »
• Wherever possible as predictable budget support
• Where criteria not fulfilled: Pooled fund with other donors,
aligned forms of project support
• Accompanied by a structured sector policy dialogue and
sector performance monitoring
• EC health aid is currently roughly 600 million EUR p.a.; 4/5th
direct bilateral aid; 1/5th global funds and initiatives
4. Reporting Results: Lives saved (LS):
(GF web site accessed Nov 9th, 2011)
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5. Known problems with LS-Approach
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• Over-simplification of the model used (one or several of the
following not considered)
o Quality of care / provider compliance
o Patient or user compliance
o Drop out
o Concurrent mortality
o National variability in the above
• Double Counting (linked to attribution) – some of the lives
saved my have been claimed by other donors, or could be
claimed by the Ministry of Health
6. Emerging problems with the LS Approach
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• Lives saved has become a public accountability issue
• As such, it potentially shapes the views and underlying
assumptions that are at the basis of funding decisions of
the public and the political level:
o
o
E.g.: It looks as if it would just need some products to
fight the disease
E.g.: It looks, as if the Global Health Initiatives can save
lives, whereas comprehensive systems support at
country level can’t
7. Aid at the country level: Complicated ...
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... nevertheless: Results at country level
(1/3)
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Indicator: Proportion of births attended in health facility
• There is a slight improvement on the births attended at the health facility from 51% in
2007 to 52% in 2008 ; result for 2009? 2010?
... nevertheless: Results at country level
(2/3)
Indicator: Percent of TB Treatment success/completion rate
• Great improvement in treatment success rate from of 84.7% in 2006 to 87.7% in 2008;
the achievement surpassed the global target set at 85%.
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... nevertheless: Results at country level
(3/3)
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Indicator: Outpatient attendance per capita
• The Tanzania Mainland OPD per capita is 0.68 in 2008 (below Diagram); it
increased to 0.74 in 2009
OPD Attendances per Capita
1.30
1.40
1.20
1.00
0.80
0.60
0.40
0.28
0.37 0.38
0.51
0.46 0.48 0.49
0.65
0.58 0.60 0.62
0.73 0.74
0.81 0.84 0.84
0.94
0.89 0.91
1.01
0.20
Mtwara
Kilimanjaro
Kagera
Dar-es-salaam
Tanga
Tabora
Manyara
Iringa
Singida
Pwani
Mara
Morogoro
Mwanza
Arusha
Mbeya
Lindi
Dodoma
Kigoma
Ruvuma
Rukwa
Shinyanga
0.00
8. Consequences for results reporting by
donor agencies
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From Global Fund’s High Level Review Panel
Report (September 2011):
• “… international organizations to refine their methodologies
for tracking results as a critical measure of performance."
• "In the end, the Global Fund [and indeed any other
development agency W.S.] itself cannot be the guarantor of
accountable results; the recipient countries, especially their
Governments, must be."
• Final Recommendations: "Getting serious about
results ...Measure outcomes, not inputs: ...v. Coordinate
much more closely with other donors on data, including joint
analyses to attribute results more precisely, and avoid
double-counting"
9. Apply health impact reporting to the
country level first – the method
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Implementing the HLRP recommendation:
• Apply the impact algorithm (in analogy to GF / GAVI
method) to a broader spectrum of diseases / interventions,
• Apply it to the outputs of the entire health system at country
level (for countries where output reporting is of reasonable
quality, e.g. where there are established SWAps, compacts),
• Agree on an attribution key at he country level first (e.g.
based on the proportion of financing),
• ... and then take home „your“ impacts and report to your
constituency.
10. Apply health impact reporting to the
country level first – the feasibility
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Principles:
• Build on the achievements of established SWAps, allowing
for more comprehensive aid impact reporting
• Build on the work already done by done by specialised
agencies, partnerships and academia (WHO, Health Metrics
Network, International Health Partnership IHP+, GF, GAVI …)
Next steps:
• Further examine feasibility; agree among major donors
• Further develop the method(s) – mobilise resources to get
started
• get volunteer countries on board for test-run
• Cross-check computed impacts against survey data (DHS,
etc.)
Apply health impact reporting to the
country level first – the AE criteria
o
o
o
harmonisation (among donor agencies)
alignment (to national policies, mechanisms and
systems; respecting national ownership)
managing for results
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