Global health cooperation: what is next?

Development Policy04 Jan 2012Olga Golichenko, Annick Jeantet, Sibylle Koenig

In November 2011, Action for Global Health participated in the Busan Aid Effectiveness Civil Society Forum and the High Level Forum together with health advocates from the Busan Health Working group convened by the network. Our goal in the run up to and during Busan was to ensure health was included in development co-operation priorities.

In November 2011, Action for Global Health participated in the Busan Aid Effectiveness Civil Society Forum and the High Level Forum together with health advocates from the Busan Health Working group convened by the network. Our goal in the run up to and during Busan was to ensure health was included in development co-operation priorities. We have been advocating for lessons learnt from aid effectiveness processes in the health sector to be reflected in the Global Partnership for Effective Development Co-operation/Busan Outcome Document and to be applied in related sectors to achieve better health outcomes.

Health and aid effectiveness gains to be sustained

Since 2007, the implementation of aid effectiveness principles in the health sector has been prioritised by development partners. As a result, good outcomes have been achieved. Health has been most progressive with regard to the implementation of Paris and Accra Declarations and now the sector can tell us much about the dos and don’ts of aid effectiveness.

Action for Global Health has worked hard over the years to make it happen: we have been contributing to the work of OECD’s Health as a Tracer Sector cluster, ensuring civil society’s increased participation in aid effectiveness processes, exploring implementation of aid effectiveness at country level and advocating for continued funding for IHP+.

Disappointment for health sector

At the HLF4, health has been mentioned extensively as a success story for aid effectiveness implementation in plenary speeches and discussions on public-private partnerships, elimination of fragmentation adverse effects, efficient use of country systems, alignment with national strategies, multi-sectoral collaboration and achieving results.

However, despite development partners recognised the urgency of reaching the MDGs, the health sector has not been mentioned in the Civil Society Forum and Busan High Level Forum outcome documents.

Several factors contributed to this. Most importantly, references to specific sectors, except for climate change finance, have been avoided. Sectors should be mentioned at country, rather than global level. One may ask why health is different from other sectors and should get special attention? We believe that it is different because health has officially been recognized by the OECD as a tracer sector providing development partners with important lessons learnt on realities of aid effectiveness implementation.

Highlights of Busan

Some of Busan progress includes:

  • Shift from aid to development co-operation. Recipient countries are becoming more equal partners responsible for their development. This creates more space for questioning donors’ priorities and developing priorities based on the countries’ own needs. The Busan Outcome Document states: “development co-operation will refrain from requesting the introduction of performance indicators that are not consistent with countries’ national development strategies”.
  • Increased use of countries’ systems has been identified as central for efforts to build effective institutions. At the same time ‘country systems’ is understood to mostly refer to governmental systems, so more space needs to be created for civil society involvement through community systems strengthening.
  • Shift from risk avoidance to risk management. It is recognised that it is often impossible to completely avoid risk and so a risk management approach is much more effective.
  • Civil society organisations have been recognised as efficient and independent development actors.
  • Medium-term predictability commitments have been re-stated – those who committed to them in Accra should deliver by 2013.
  • Donors committed that efforts to reduce fragmentation will not lead to a reduction in the volume and quality of resources available.
  • Social protection systems for at-risk communities have been mentioned in the context of disaster management.
  • Taxation, governments’ own revenues, innovative financial mechanisms to mobilise private finance are all recognised as levers to support financing for sustainable development. This opens space for continued effort to introduce Financial Transaction Tax for development and global health.

Busan outcomes – a mix

From our perspective, the results of what happened in Busan have been mixed. The launch of the Global Partnership for Effective Development Co-operation can be seen as a major breakthrough as it allowed for the signing on of new partners, such as the private sector, emerging economies and civil society. However, not much progress has been made in Busan in terms of the deepening of aid effectiveness commitments compared to Accra and Paris, except for transparency, fragile states and results. Little progress was made on untying aid. The paragraph in the outcome document exonerating South-South cooperation from complying with any commitment made in Busan is a disappointment.

Evaluations have shown that progress on aid effectiveness has been weak during the last years: out of 14 progress indicators, only 1 on donors’ improved co-ordination has been partly achieved. Clearly the work outlined by the Paris and Accra Declarations has not been completed and cannot be dropped.

The newly agreed framework is not likely to incentivize countries to accelerate progress towards these indicators. The Busan Outcome Document is rather weak on concrete, time-bound commitments and an M&E framework is yet to be defined. By June 2012 development partners shall agree on indicators to monitor progress, along the lines of the so-called “Building Blocks”, a vague framework of broad development principles aimed at guiding the aid effectiveness agenda in future. The outcome document also raises a question on the burden which is going to press on developing partners to follow up the aid effectiveness work at country level.

Last but not least, the drama of the cancellation of Round 11 of the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria, which has been unfolding in parallel to Busan, demonstrates some real world lessons of the importance of countries practicing what they preach: some donors not delivering on their commitments or delivering late has a big impact on global health funding architecture; ambitious agreed global health targets are impossible without sufficient donor funding; and, in the face of external funding crisis, countries need to take more country ownership to ensure lives and health gains are not put at risk.

Post-Busan: health and aid effectiveness

Our main question for the post-Busan era is whether there is a continued energy from development partners to be persistent in the implementation of aid effectiveness in health.

There should be!

Development partners who signed Paris and Accra should continue being accountable for commitments they made. The Busan Monitoring Framework should include indicators on human development and cross-sectoral collaboration that will make it possible to continue monitoring aid effectiveness progress in health and related sectors, such as water and sanitation. If the OECD’s Health as a Tracer Sector cluster stops functioning, another mechanism should be created to ensure continued progress on health aid effectiveness.

The good news is that International Health Partnership (IHP+) has been funded for another three years. IHP+ is the most efficient existing sector tool at country level for aligning partners and aid modalities behind one plan, one budget and one M&E framework. AfGH will advocate for the improved implementation of IHP+ and closer links between IHP+ and country alignment mechanisms of other sectors, such as Water and Sanitation for All.

To get involved in Action for Global Health upcoming activities on aid effectiveness.

Read our Busan posters on IHP+ and best practices on aid effectiveness from HIV sector.