Effective Implementation for Achieving theMDGs
Overview
• Elements of RB/PSM Implementation• Country experiences• Horizontal cross-sectoral• Vertical cross-sectoral• Challenges to implementation
Principles for better implementation/service delivery
• Horizontal linkage: plan priorities, budget support, and monitoring and evaluation systems and processes are effectively linked between central and sector agencies at the Subnational or local government ; multi-sectoral coordination
• Institutional priorities are aligned to budget deliverables.• Policies, people, and processes are oriented to deliver intended results• Service delivery standards are established• Service delivery is aligned to budget with measurable performance
indicators to facilitate results monitoring• Vertical linkage: plan priorities, budget support, and monitoring and
evaluation processes are effectively linked from National to the Subnational or local government, with diverse options for local implementation
Horizontal Implementation• Sector Specific:
One entity (agency or ministry) makes all policy and funding decisions • Split responsibility:
A Ministry sets policy and sometimes provides core funding to local or regional government, with a separate entity for earmarked funding and partnerships for specific implementation
• Split objectives: Two ministries or agencies with mandates for different areas of action set policy and provide funding individually
• Multiple actors: Delivery through multiple branches of government, and often also through municipal structures
Extreme Poverty• Halve, between 1990 and 2015, the
proportion of people whose income is less than $1 a day.
• Halve, between 1990 and 2015, the proportion of people who suffer from hunger.
Safe Water & Sanitation• Halve by 2015 the proportion of people without
sustainable access to safe drinking water.
• By 2020, achieve significant improvement in the proportion of people with access to sanitation.
Child & Maternal Health• Reduce by two thirds, between 1990 and 2015,
the under-five mortality rate.
• Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio.
Primary & Girls' Education• By 2015, boys and girls everywhere
complete a full course of primary schooling.
• Eliminate gender disparity in primary and secondary education, preferably by 2005, and in all levels of education no later than 2015.
Communicable Diseases By 2015, halt and begin to reverse the spread of:
• HIV/AIDS• Malaria & • Other major diseases.
Horizontal Linkages: Multi-sectoral Approaches to Investments in Health
Social Funds
• Necessarily cross-sectoral mechanisms• Require cooperation of several ministries at
the national level• Require coordination between ministries and
local governments for implementation
Social Funds
Kalahi: • National: National Steering Committee • ( DSWD, NAPC, DBM, DOF, NEDA, DILG and three rep. From NGOs, Chairperson-
League of Barangays ) National: Project Management Team • Regional : Regional Project Management Team • ( Replication of the national member agencies ) • Provincial : Provincial Inter-Agency Committee ( Replication )
KDP: • National Level ; Government ; Inter- Ministerial Coordination Team;
National KDP Secretariat ; consultant/ facilitators ; Management Consultants (NMC)
Behavior of Individuals/Households
IncomeEducation
WaterSanitationNutrition
Performance of Health System•Clinical Effectiveness•Accessibility and Equity•Quality and Consumer Satisfaction•Economic Efficiency
Health Status Outcomes•Fertility•Mortality•Morbidity•Nutritional Status
Macro-economic Environment Health Care System
Delivery Structure•Facilities (public & private)•Staff (public & private)•Information, Education, & communication
Institutional Capacity•Regulatory & Legal Framework•Expenditure & Finance•Planning & Budgeting Systems•Client & Service Information/Accountability•Incentives
Projects and Policy Advice
Governance
Multi-sectoral: Achieving Change in Health
People, Policies, processes: enabling breastfeeding in the workplace
• Enabling workplace conditions for breastfeeding are important for the health of mother and child.
• The Philippines example of multisectoral action:– Key stakeholders involved:
• Department of Labour and Employment and DoH• Trade Union Congress of the Philippines (TUCP) • Employers Confederation of the Philippines (ECOP) • NGOs• WHO support
– Benefits• health benefits for mother and child, lower cost of infant feeding, improved
bonding,• lower absenteeism and higher productivity, enhancement of employer–employee
relationship.
Service delivery standards
• Afghanistan BPHS: focuses on health interventions including child immunizations, nutrition care; TB and malaria control; prenatal, obstetrical, and postpartum care; disability; familyplanning, and other curative services.
• MoPH and its international partners to contractwith NGOs to deliver the BPHS in 31 of the 34 provinces
• Maintain service delivery standards in difficult environment
• Enabled the MoPH to develop key indicators of public health impact and building blocks for monitoring and evaluation of the BPHS including the household surveys, and health facility assessments such as the “Balance Scorecard.
Institutional priorities/delivering results
Tamil Nadu Health Systems project • The Project has utilized several innovative and effective
measures • 80 comprehensive emergency obstetrics and neonatal centers • health education, nutritional support, and HIV/AIDS testing
and counseling• 385 ambulances have been provided under the project,
managed under a public private partnership, increasing emergency transport services in rural areas.
• public private partnerships have also provided mobile out-reach health services as well as other services.
Vertical Linkages: Unbundling the sectors & functions
Sector Intra-Sector Infrastructure & Services
Delivery Functions
Water Point facilities (rural); networked facilities (urban)
Standards; Monitoring; Investment; rehabilitation; routine maintenance
Education Pre-school; primary; secondary; Curriculum & standards; teacher hiring, training & management; books; school investment & rehabilitation; inspection
Health Health posts; clinics; referral hospitals; vaccination campaigns; public health education
Policy & standards; personnel hiring, training & managementt; drugs; cold chains; investment & rehab of facilities; O&M; inspection
Vertical implementation
• Governments choose between different mechanisms for implementation
• There are trade offs that differ by sector and by context
• Decentralized Sectors• Local Government• Community Mechanisms
Comparing ApproachesDecentralized
SectoralLocal
GovernmentCommunity Mechanisms
LessonsHow to deliver infrastructure and services
How to allocate resources flexibly and formalize accountability
How to empower people and get resources to beneficiaries
Limitations
Ensuring allocational efficien-cy, coordination, and accountability.
Ensuring service delivery and empowerment
Ensuring coordination and sustainability
• The three approaches share good practices involving common principles • Lack of a clear common language and consistent methods often makes linkages and
collaboration among approaches difficult • Tensions among approaches reflect different entry points as well as coordination problems
among sectors/organizations promoting them
Integrating Approaches to Local Implementation
DecentralizedSectoral Approaches
Local Government Approaches
Community Support Approaches
Linked Approaches
Examples of Linked Approaches
Community – Sectoral Links
Sectoral – Local Gov’t Links
Community –Local Gov’t Links
CBOs that govern and oversee service delivery units (e.g. parent-teacher organizations, village health committees, user-directed water services)CBOs that own their own infrastructure (e.g. water user groups, farmer-managed irrigation/drainage systems and grain stores )
Budget reforms emphasizing multi-sector local planning (e.g. devolution of investment decisions for primary schools, clinics, water points, and latrines)Sector policies dele-gating service delivery to LGs (e.g. mandated & centrally financed social service delivery or social safety nets)
CBOs as service or infrastructure co-producers in municipal systems (e.g. user-run standpipes in piped water systems, community mgmt of LG regulated schools)LGs as intermediaries in social fund programs (e.g. municipally administered grants to CBOs)
A Framework for Local Implementation
Local Gover-nance
Local Public Service Provision
Local Non-State Provision
Improved human development outcomes
Enabling National Policy and Institutional Environment
Capacity Enhancement and Resource Transfers
A simple conceptual basis which allows integration of the strategic elements and methods developed by the three complementary approaches
RB-PSM
Challenges to Integrating Local Implementation
• Managing complex processes across institutional boundaries – at both local and national levels
• Realigning power relations – central-local, state-society, and donor-client
• Reconciling different interests & values
• Changing attitudes and practices– donor, national, local, community
Implementation challenges
• Cross-sectoral• Exclusion• MDGs not static• Regional disparities: horizontal• Urbanization: vertical
Regional disparities: Horizontal/multi-sectoral approaches
• Chittangong• Mindanao• West Papua• Balochistan• Southern Thailand• “Extremist Affected States”
Regional disparities
Best Seven (2008-09 estimates) Worst Seven (2008-09 estimates)State IMR ((per ‘000’ live
births)State IMR (per ‘000’live births)
Kerala11
Tripura56
Puducherry19
Uttarakhand56
Daman & Diu21
Assam61
Goa24
Rajasthan78
Manipur28
Orissa79
Nagaland31
Uttar Pradesh81
Himachal Pradesh31
Madhya Pradesh86
Addressing regional disparities
We have two worlds of education, two worlds of health, two worlds of transport and two worlds of housing, with a gaping divide in between… In general, the contradiction between the tribal community and the State itself has become sharper, translating itself into open conflict in many areas … people feel a deep sense of exclusion and alienation, which has been manifesting itself in different forms. The failure to provide infrastructure and services … is one of the many discriminatory manifestations of Governance here. (Government of India, 2008, Development in Extremist Affected Areas, Report of An Expert Group to Planning Commission).
Urbanization: Vertical Multi-sectoral implementation
• Why focus on urban poverty? • Because of population growth, migration and recent
increase in urban poverty rate, the number of poor people living in urban areas in the developing world is increasing compared to those in rural areas
• The poor in urban areas have different characteristics than the rural poor
• People in urban areas face specific covariate and individual risks
• There is a gap between the needs of poor people and programs in urban areas
Urban Programs
• Lack of sufficient poverty alleviation policies and programs that effectively reach the intended beneficiaries
• Most of the existing urban programs and policies focus mostly on the improvement of physical infrastructure and delivery of basic services in low income areas and urban slums
• CCT experiences• UNDP/Bangladesh studies
Concluding issues
• Changes/adaptation of policies and procedures to fit multi-sector tasks, programs, and financial instruments;
• Enhanced institutional framework to support multi-sector teams such as allocation of staff time and budgets, incentive systems, and accountability mechanisms.;
• Learning and teaming practices across departments• Reviewing lessons from experiences in RB-
Implementation