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

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

Harmonisation and Alignment of Aid for HIV/AIDS in the SADCTeresa GuthrieCentre for Economic Governance and AIDS in Africa

Inaugural Conference of the African Health Economics and Policy Association Accra - Ghana, 10th - 12th March 2009PS 02/5Study ObjectivesTo assess the progress of SADC countries towards harmonisation & alignment of funds for HIV and AIDSTo review the existing declarations & instrumentsTo identify the blocks and challengesTo make suggestions for required actions.Study MethodsLiterature reviewInterviews with key respondents from various SADC countriesUsed data from country NASA reports, where availableHIV/AIDS in the SADC RegionIncidence of HIV/AIDS has been steadily increasing in the SADC region for the last two decades15 million HIV-positive people in SADC Region51% of all the infections in Africa are in SADC37% of the global total are in SADC Thus SADC region is the worst affected in the world SADC ResponseMember states have put in place measures at both national & regional levels for treatment, prevention & mitigation Multi-sectoral strategic plans (NSPs) and strong leadership responseCommitment 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 frameworkIncreasing role of civil societyMaseru 2003 SADC Summit on HIV/AIDSSADC HIV/AIDS Strategic Framework and Plan of Action: 2003-2007 adoptedUnderscored the importance of resource mobilization in the fight against HIV/AIDSApproved 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.

So what is the Current Funding Situation in the SADC?Difficult to get a regional picture, requires country level analysis and reporting to SADCNot all countries have undertaken NASAs nor accurately costed their NSPsSome countries not aware of all the commitments and disbursements made to HIV/AIDS, and very few aware of the actual expenditureSo do not have a clear picture of the resources required, the resources available, and therefore cannot estimate the resource gap & mobilise fundsLimited evidence on the extent of absorptive capacity (undermined by above points)Although increasing resources...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

Without Harmonisation and Alignment:Authority is dispersed National priorities are weakenedM&E is fragmentedImplementation is slowedDuplication, gaps, wastage of resourcesPoor absorption Impact is limited

Addressing the IssuesAid EffectivenessHarmonisation and alignmentExisting declarations, instruments, toolsCountry effortsThe Aid Effectiveness Pyramid

From OECD/DACCivil SocietyCivil SocietyCivil Society11Institutional chaos & fragmentation not unique to AIDS (though particularly acute here) - OECD attempts to improve harmonisation and alignment to deliver a more effective response.

At country level , there may be little more than coordination happening (represented by the sharing experience segment) , and may be poor understanding of how this differs from harmonisation & alignment. This pyramid helps to clarify the specific meanings and the importance of clear leadership and ownership from the countryAid HarmonisationAid 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).Aid HarmonisationThe 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 countrydiagnostic studies (sit.analysis) monitoring, auditing and evaluation processes Processes/ Declarations2002 Monterrey - conference on Financing for Development2003 Rome: High-Level Forum on Harmonization2003 ICASA: The Three Ones conceptualized2003 Maseru: HIV/AIDS Summit2004 Washington: Harmonization of International Funding2004 Tanzania: Africa Region Workshop on Harmonization, Alignment and Results 2005 Paris: Declaration on Aid Effectiveness 2005 London: Global Task Team established2005 Rio: Three Ones Consultative Workshop2006 Paris:Innovative Financing for Development2006 Rwanda: Harmonisation, Alignment and Aid Management 1414In an effort to address the lack of harmonization, need for effective and efficient use of resources, and rapid action and results based management at country level, the Three Ones principles were developed and approved by developing countries and key donors in April 2004.

Between March and June 2005 a Global Task Team developed recommendations for multilateral institutions and international donors to Make the money work.

Initiatives at global and national level are taking the harmonisation agenda forward.

March 2005, the International HIV/AIDS Alliance and the International Council of AIDS Service Organizations (ICASO) published their Discussion Paper: Civil Society and the Three Ones

Progress report and approval of UNAIDS action plan

Paris Declaration on Aid Effectivenessgoes beyond previous agreements by attempting to lay down a more practical, action-oriented roadmap to improve the quality of aid and its impact on development (AFRODAD, 2007).

5 five key principles:ownership alignmentharmonisationmanaging for results mutual accountability establishes a commitment to track and set targets against 12 indicators of progress.

Efforts at Country LevelJoint 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 goalsNumber 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 PoliciesPublic Financial Management (PFM) reformSupport for the PFM agenda/ Action PlanRegular stakeholder dialogue forums, partnership forumsIncreasing joint approaches:Planning, Reviews and analytical work, SWAp, Direct budget support, Pooled funding common funds.Are Resources Being Aligned with NSPs?Plenary Session Wed!Alignment of Priorities in Botswana (Pula, 2005)

Botswana ~ NSP Priorities Compared to Actual Spending (%, 2005/06)

What is still Blocking Harmonisation and Alignment of Aid for HIV/AIDS?Factors undermining One National Framework:NSP is often disregarded by the various actorsNational target setting might be unrealisticMay be due to accommodating civil society demandsNSP are not well costed, leading to an under- or over-estimation of resources requiredDonors continue to fund direct projects, which may be on or off the plan, and which they may or may not report onCivil society groups may not buy-in to the NSP nor feel the need to report on their activities and expenditure

2020(e.g. donors, GF) who prefer to develop their own separate projects (Examples:Zambia, Nigeria and Kenya) -this weakens the capacity to align their National Action Framework on AIDS to the broader national development and budgeting processes;

A framework that guides and builds into it an annual review mechanism consultative of all partners that would assess performance and results achieved and identify progress and challenges;

Blocks to Harmonisation (2)Factors undermining One National Coordinating AuthorityDonors still have their own agendas and interests, not consulting with NACsDuplication and parallel systems of CCMs and National AIDS AuthorityStaff shortages and gaps in the NAC, in the MoH and MoFCivil society has role to hold govt and donors accountable, but should also be accountable to NACPower is not given to NACs to manage the funds

Zambia ~ Agent Spending (US$, 2005&2006)

Blocks to Harmonisation (3)Factors undermining One M&E system:Lack of capacity in M&EFinancial reporting weak - Many NACs are not aware of what has been spent on the HIV/AIDS national prioritiesDonors continue to have individual programme monitoring & reviews, and separate auditing requirements imposed on recipient GovernmentsFailure of national budget & accounting systems to link expenditure with HIV/AIDS prioritiesThe 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)Blocks to Harmonisation (4)Factors undermining unified systems and procedures:The Public Finance Management reform is progressing slowly, leading to a lack of trust in Govt. systems & donor cynicismThe national procurement, auditing and accounting systems are weak, or perceived to be weak by donorsSome donors systems are inflexible, preventing rapid alignmentGovernments 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?)Possible Actions that could Enhance Harmonisation & AlignmentNAC/ 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 partnersDevelop 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 trackedEstablish and maintain structures for regular dialogue with all stakeholdersPossible Govt Actions (2)Increase/ demand for more joint approaches:Planning, Reviews and analytical work, Direct budget support, SWAp, Pooled funding, basketsGovernment and donors and civil society to agree on a common framework for financial performance monitoring, strengthen economic governance systemsDesign and implement a system of assessing donors based on Paris Declaration norms eg. Donor Score CardGovernment 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 prioritiesAll 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

Possible Actions (3)ICPs rolesIncrease predictability of donor funding (longer-term commitments), with greater flexibilityMore funding for general health systems strengtheningMore support for the construction of solid national authorities and coordination capacityEmphasis on human and institutional capacity buildingAccept and use the national M&E and reporting systemsHarmonize reporting requirements, tools and indicatorsDonors to use national systems for procurement, accounting and auditingCloser exchange and effective dialogue between Global Fund and UNEmphasis 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)Possible Actions (4)SADC Roles:Strengthened communication channels and mechanisms for sharing info across SADC and between NACs sharing best practicesStrengthened position if negotiating as SADCSpearhead 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 pictureRegional group to consider/ monitor regional funding issuesEncourage Members use of the RNE, NASA and CHAT tools

Possible Actions (5)Civil Societys roles:Civil society could broaden its advocacy focus to include processes such as alignment and harmonizationGenerate more public debate on alignment to drive the access agenda delivery of Universal Access relies on effective architecture making the money workDemand the govt and ICP reveal their actual expenditure in-countryReveal 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

29I have adapted these from the end of the Lancet paperThe Latest Effort..IHP+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 architectureChange in the way donors work together with partner countries through coordinated efforts of all stakeholdersthe strengthening of in-country health system servicesunder the leadership of the Government, acting with the representatives of civil society

IHP Opportunities & ChallengesTo 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?

Thank youTeresa GuthrieCentre for Economic Governance and AIDS in Africa [email protected] +27-82-872-4694

32