Collaborative Challenges. The challenges of coordinating Technical and Financial Partners (TFPs) and the question of their alignment with the strategies and priorities of the MSP/P/AS in Niger are part of a complex system. To understand it, considering the great diversity of TFPs (bilateral, multilateral cooperation, agencies, investment banks, NGOs, etc.) and their specific approaches is not sufficient. The field is characterized by a multiplicity of configurations and health financing circuits which attempt to influence public policies through a superposition of initiatives (Common Fund, Global Financing Facility - GFF, thematic groups, etc.) and a multiplication of intermediaries. The multiplication of initiatives and discussion frameworks maintains the logic of multi-positioning of TFPs and cross-participation in funding (WB-GFF, EU and bilateral cooperation, etc.). This fractionation disperses energies and leads to a disinvestment in solutions which had yet provided interesting answers (Common Fund). It makes the issues of coordination more necessary than ever, but also complex, and requires an evolution of their modalities. The alignment of TFPs for health financing is essential and a priority. Bringing this issue onto the political agenda is fundamental. To do this and with a view to proposing common solutions, anchored in reality, and involving the various stakeholders (ownership), an intervention-research approach has been initiated. This approach is based on a series of case studies identified and prioritized in a collegial manner. Each of them constitutes an axis of analysis which aims to illuminate, symmetrically (MSP/P/AS - TFPs), or in a multi-scalar mode (operational/national/global) the challenges of coordination and alignment.
Collaborative Challenges. ● Côte d'Ivoire became a signatory to the IHP+ global compact in 2012 and since then has worked through a highly participatory process involving all the key health actors in the country to establish a country compact and new PNDS25. The compact constituted a useful accountability tool among actors in the health sector, demonstrating their mutual engagement in implementing the PNDS 2016-2020, which was the central strategic framework to guide interventions to improve health indicators. ● WHO fully assumes its coordinating role as the lead agency among technical and financial partners in the health sector in Côte d'Ivoire. WHO is currently in the process of strengthening coordination with national bodies and external partners through the health sector coordination mechanism and fully supports the Government on the basis of the strategic guidelines of the 2016- 2020 Country Cooperation Strategy (CCS). In addition, within the framework of the Delivering as One initiative, WHO support helps to strengthen governance and the national priorities26. ● Coordination mechanisms improved substantially with the appointment of a National Response Coordination Unit within the Prime Minister’s Office. This Unit is in charge of coordinating the national COVID-19 response and overseeing the implementation of the Public Health Response Plan. The WHO coordination group with its 6 sub-groups are functional with the participation of UN agencies, Civil Society and partners under the lead of
Collaborative Challenges. ● HSTP-II is a holistic and multi-sectoral plan designed to address all the determinants of health, e.g. personal, social, environmental, economic, and political, through multi-sectoral collaboration. ● As such, HSTP-II’s management and ownership: (i) Involves entities beyond the health sector: Government bodies, non-government and community organizations, DPs, civil society organizations (CSOs) and professional associations. Key stakeholders in Ethiopia engage public sector, private sector, non-government agencies, civil services and community-level organizations; (ii) Requires action outside the health sector in interrelated fields: education, environment, agriculture, housing and infrastructure, finance and economic. ● Community engagement has been at the core of the national strategy to implement HSTP-I. The Government used the Women Development Army (WDA) to serve as a primary community engagement platform at local level, in particular in agrarian settings62 and, to a lower extent, in urban settings. However, low capacity and acceptability among WDA leaders and low acceptance by community members have recently resulted in under-utilization of other community resources, including those of men, religious leaders, and traditional leaders. 61 EHIA has about 500 employees at the federal and regional level offices. 62 In pastoralist settings, social mobilization committees serve as community engagement platforms. ● To accelerate progress towards UHC and improve health financing, multi- sectoral coordination mechanisms, at national and local levels, need to be strengthened among Government ministries, competent authorities, non- governmental organizations, and non-state actors. ● While stakeholder engagement and partnership with the health sector has already be strengthened through platforms such as the Joint Steering Committee meetings with Regional Health Bureaus, the Executive Committee Meetings with agencies and the regular meetings of the JCF, JCCC, the health, population and nutrition (HPN) partners group, the health financing technical working group (HF TWG), a lot remains to be done. ● Examples of opportunities to strengthen collaborations at country level are the following:
Collaborative Challenges. ● It is imperative that the approach for health financing involves engagement with a wide range of stakeholders within the health sector and beyond to ensure consensus is reached on the way forward, which will be essential for the successful implementation of the country’s action plan for UHC. ● One of the key pre-requisites to improve collaboration on health financing is to adopt a multi-sectoral approach. Health outcomes are often influenced by decisions made outside the health sector itself. It is thus of strategic importance to involve non-health sectors to influence decisions that may impact health outcomes35. ● Main objectives of enhanced collaboration are enhancing accountability and transparency in health financing and reaching consensus among key stakeholders on priorities for health financing. ● One of the biggest challenges affecting collaboration on health financing in Namibia is the lack of technical capacity that characterized the MoHSS. For example, the MoHSS does not have a functional Health Financing Technical
Collaborative Challenges. ● Poor coordination across various health programs and actors should be pointed out in Myanmar. ⮚ Engaging health providers outside MoHS is crucial: they have an important role to play in the country’s move towards UHC since a considerable segment of the population currently seeks care outside the public sector31. All these providers can actually contribute to ensuring that the whole population can access EPHS without suffering financial hardship. Enhanced collaboration across all health care providers is also essential to 29 e.g. underspending, overspending, and poor budget accuracy.
Collaborative Challenges. ● The MoPH has a multitude of coordination and consultation bodies, namely (not exhaustive) the National Health Council, the MoPH Consultation Meeting, the Steering Committees, the PNDS and PACTE Monitoring Committees, the Political Dialogue Monitoring Committee, the Inter Agencies Coordinating Committee (CCIA - Comité de Coordination Inter Agences), the Regional Health Delegation (DSR - Délégation sanitaire régionale) and the Health Districts Steering Committees. Revitalizing these platforms by merging certain coordination mechanisms and clearly redefining their role as well as the periodicity of the holding of sessions in order to make them more effective is today critical. ● Collaboration with DPs should be further enhanced, even if it is already efficient and operative, with a focus on aligning different programmes and fundings with the strategic objectives of the SN-UHC. For example, World Bank Group engagement in Chad is guided by a Country Partnership Framework (CPF) that is reassessed and renewed on average every four years16. Aligned with the Government’s priorities, the current CPF aims at improving public resources management, strengthening human capital (health, nutrition, education) and reducing vulnerability17. 16 The last CPF covered the period 2016-2021. The preparation cycle for the new strategy began with the update of the assessment of the economic and social situation in Chad. The new strategy is expected to be approved by the board of directors in the current fiscal year.
Collaborative Challenges. ● Within a relatively short time Mozambique has developed a well- established Sector Wide Approach (SWAp) which brings together 26 different partner agencies in support of the national strategic plan for health (PESS)29. A number of partners supporting the SWAp provide their support through the pooled funding instrument, e.g., PROSAUDE, with some donors providing their aid as Sector Budget Support (SBS)30. ● Main DPs and stakeholders in Mozambique are the following: (i) WHO, which supports health financing policy processes, in particular regarding health taxes, costing of the strategic plan, and national health accounts; (ii) The World Bank, which basically manage the Global Financing Facility (GFF) operations; (iii) the GFF, newcomer embedded in the structure of the World Bank, interested in health financing in particular Performance- 27 There are exemptions for indigent populations and specific diseases, such as HIV, tuberculosis, malaria, and maternal health. 28 However, it is known that many informal practices occur at the health facility level.
Collaborative Challenges. ● The formal mechanism for consultation and dialogue between the Government and the various DPs is functional in Burundi. The mechanism comprises a strategic forum chaired by the Minister of Finance, which is supposed to meet monthly, and a political forum that is supposed to be held quarterly and chaired by the Second Vice President of the Republic31. In 2018, the technical and financial partners relaunched a consultation and internal coordination framework. They set up a mechanism comprising a three-tier coordination framework bringing together heads of diplomatic missions and heads of agencies, heads of cooperation and sector groups. ● The policy dialogue enabled by the UHC Partnership, which Burundi joined in 2016, helped the MSPLS to extend its second PNDS until 2018. It serves as a strategic framework to strengthen the health system during the political crisis, in line with Burundi’s National Health Development Policy 2016-2025. WHO is playing a brokering role to foster dialogue between the MSPLS and international partners to improve coordination of health aid. WHO played a key role in the elaboration of the third PNDS 2019-2023. ● A priority area for WHO in Burundi is to continue strengthening intra- sectoral dialogue, so that the conversations launched in 2016 can be consolidated in the development of the next PNDS. The key activity will be analysing current coordination frameworks, and existing stakeholders, in particular taking into consideration that the Health and Development Partner Framework (Cadre de Concertation des Partenaires pour la Santé et le Développement - CPSD) could be improved. Lack of coordination is partly related to the lack of leadership and vision on the part of the MSPLS. Weakened and fragmented by post-conflict complexities and depleted of 31 The management of the period following the events of 2015 was not conducive to the continuation of dialogue between the Government and the DPs within the partnership framework defined, even though bilateral dialogue was maintained. resources, the MSPLS did not receive from the donors and from its constituents the necessary trust in order to lead all stakeholders on the path of health sector rehabilitation32. ● As the lead agency for the water, sanitation and hygiene (WASH), education, nutrition and child protection clusters and co-lead of the health sector, UNICEF is adopting a holistic, multi-sectoral approach to address the needs of affected and at-risk populations across its humanit...
