PARTNERSHIP GAVI & GFATM – HSS

PARTNERSHIP GAVI & GFATM – HSS Capacity building workshop on Health System Strengthening For Country office & MOH StaffIn GAVI HSS Eligible countries08- 12 December, 2008Hotel Palestine - Alexandria , Egypt Dr. Mounir Farag GAVI & GFATM- HSS WHO/EMRO

Outline • Health System Strengthening • Reasons for Partnership • GAVI & GFATM HSS partnership, working together and importance of HSS • HSS Task Team & Forum • WHO/ HSS Coordination Role • EMRO Region Experience • Conclusion

1- Health System strengthening • Strengthening health systems means addressing key constraints related to health system building blocks. • The world's political and international health leaders recognize the urgent need to make a major, sustained commitment to strengthening health systems. • This renewed political interest presents the important opportunity needed to make sustainable improvements that benefit across disease areas and health programs, and redouble global efforts to meet the challenge of achieving the MDGs.

Few Facts & FiguresHSS Everybody’s Business • Large health inequalities persist: even within rich countries such as USA and Australia, life expectancy still varies across the population by over 20 years. • Recent essential medicines surveys in 39 mainly low- and low-middle-income countries found that, while there was wide variation, average availability was 20% in the public sector, and 56% in the private sector. • Each year, 100 million people are impoverished as a result of health spending. • In over 60 countries, less than a quarter of deaths are recorded by vital registration systems. • An estimated 50% of medical equipment in developing countries is not used, either because of a lack of spare parts or maintenance, or because health workers do not know how to use it

Few Facts & FiguresHSS Everybody’s Business • Private providers are used by poor as well as rich people. For example, in Bangladesh, around ¾ of health service contacts are with non-public providers. • Extreme shortages of health workers exist in 57 countries; 36 of these are in Africa. • In 2000, less than 1% of publications on Medline were on health services and systems research. • There has been a rapid increase in global health partnerships. More than 80 now exist, of which WHO houses over 30.

Health System strengthening • 'Scaling Up for Better Health‘ initiative has been prepared by WHO and the World Bank, in consultation with the partner international health agencies (UN Population Fund, UNAIDS, Global Fund to Fight AIDS, Tuberculosis and Malaria, GAVI Alliance, and Gates Foundation). The work-plan consists of four elements: • Enabling countries to identify, plan and address health systems constraints to improve health outcomes in a sustainable and effective manner • Generating and disseminating knowledge, guidance and tools in specific areas • Enhancing coordination and efficiency • Accountability and monitoring performance

2- Why Partnership??? • Donors need to work better together to improve support to poor countries: • First, global health assistance is over-complex (40 bilateral donors and 90 global health initiatives). Support comes through separate aid channels, leading to fragmented health provision on the ground and a reduction in the effectiveness of much of the aid. They also compete for limited trained staff. • Secondly, countries find it costly and time consuming to deal with so many partners. • Thirdly, not enough focus has been put upon building strong sustainable health systems in poor countries. Impressive results have been seen combating HIV/AIDS, Malaria & TB (MDG6) but other health issues, such as the health of children & women (MDG 4 and 5) and support for building stronger health systems (HRD, Logistics, organization& management, …) have not been addressed.

Partnership • Partner countries will invest further in their own health systems, address policy constraints to progress, strengthen planning and accountability mechanisms to make them more inclusive and transparent, and better link external support to improvements in health outcomes • The performance of all parties will be subject to a joint high level review at country , regional and global levels.

3- GAVI partnership, working together and why HSS is crucial • Strengthening the capacity of the health system to deliver immunisation and other Newborn, Child & maternal health services in a sustainable manner • Accelerate the uptake and use of underused and new vaccines and associated technologies and improve vaccine supply security • Increase the predictability and sustainability of long-term financing for national immunisation programmes • Increase the added value of GAVI as a public-private global health partnership through efficiency, advocacy and innovation

GAVI HSS principles • Country driven • Country aligned • Harmonized • Predictable • Additional • Inclusive and collaborative • Catalytic • Innovative • Results orientated • Sustainability conscious

Golden opportunity for HSS • International Health Partnership (UK, Norway, Germany, France, Italy) - 7 countries • MDG 4+5 business plan, • Joint WHO-WB work plan • GFATM • Catalytic initiative • High Level Commitments • Stimulate urgency for MDGs • Modify institutional ways of doing things • Knowledge management and learning • Health Systems Strengthening • Role of civil society and private sector GAVI HSS - PATHFINDER

4- HSS task team ToRs: a) Take work forward, according to a joint GAVI & GFATM HSS work plan b) Advisory and consultative body to shape and refine the GAVI & GFATM HSS policies and procedures Membership: WB, UNICEF, WHO, DFID, NORAD, USAID, dev country rep, civil society, GAVI & GFATM , secretariat Global: Meet quarterly -Regional : Biannual Videoconferences & and Regular information's’ exchange

GAVI led HSS forum ToR:acts as a forum to share information and lessons learnt, generate ideas and suggestions and mobilise and sustain commitment Membership: HSSTT, GFATM, Global Health workforce alliance, Alliance for health systems research, civil society, other bi-laterals, PMNCH, stop TB, UNAIDS, HMN

Regional HSS Work shops, RWG & Joint Missions • EMRO, SEARO, PAHO EURO since April 2007 • In - country and regional peer group review mechanisms • Use existing RWGs structures more Pro-actively inviting other partners like WB, bilaterals and CSOs • Immunisation – HSS balance

5- WHO / HSS Coordinating Role among Partners • Consistent communications to RWGs • Harmonise GAVI & GFATMHSS activities • Monitoring IRC & TRC consultation • Papers on ‘observatories’ and tracking studies • Knowledge bank dissemination and management • Documenting fund flows • Share point management • Work with countries to strengthen OR • Proposal analysis disseminate • Request for more funds & Channel

6- EMRO Region Experience • January 1st GAVI HSS meeting June workshop & December Course • Collaboration DHS,DCD, DHP, EHA,… • Continuous Coordination with WHO/HQ and through country office with Partners (UNICEF,WB, Agencies) • All countries had formed NHSCC • Applications ( Afghanistan, Pakistan, Yemen, N Sudan…Implementation • S Sudan,Djibouti (HSS )CSOs(Af&Pak) • GFATM/ HSS 1st meeting march for Round 8

GAVI HSS Experience Preparatory phase& Policy Dialogue • Highlighting HS barriers / bottlenecks as a platform for GAVI HSS priority activities was achieved in concrete terms ( Data collection & interviews – HS Weakness), to provide a coherent approach for HSS; • Based on DHS HS Review Mission to AFG,PAK and SUD;Yemen Policy Dialogue highlighted official Political Will & Commitment as general principle; • Health system assessment was performed added to existing National HS strategies, surveys or assessments( States/ Provinces).

Application Development Process(1)WHO Coordinating Role • Political & Partners’ Commitment : Strong Start • HSS activities are designed in the context of overall national HS plans, policies and strategies and are aligned with national priorities; • HSS focusing at provincial , districts and sub districts level Priorities; • Continuous Monitor and Evaluation as a very important component involving All NHSCC members at all stages; • Setting Important base lines, achievement indicators and trends in HS performance.

Adapting the WHO / HS Building Blocks scale-up priority programmes • Theme 1:Health work force mobilization, distribution, and motivation targeted at those engaged in immunization and other health services at the district level and below • Theme 2:Logistic issues: Supply distribution and maintenance systems for drugs, equipment, and infrastructure for PHC • Theme 3:Organization and management of health services at the district level and below (incl. financial management) • OTHER Themes……

Lessons Learned • All GAVI HSS applications were built on existing HS initiatives : Example in Pakistan we built on MNCH , LHWs , EPI , HSR ,... for bridging the gaps between the health systems and Disease and Health interventions programmes; • Inclusiveness ( ALL Partners) and Participative : Involving District and Provincial DG health, Planning and EPI in application development, setting priorities, review and consensus workshops to ensure successful implementation; • GFATM HSS Round 8 Building on GAVI HSS

GAVI / CSO & GFATM HSS Opportunities • GAVI HSS is not in isolation but in a broad HSS concept scope as strong horizontal integration platform; • MOH /Planning taking the Lead for National HSS innovative concept and PHC Implementing; • Integration & Collaboration with Disease Programs ; • Participative & inclusiveness role at provincial & district and sub district levels; • Leverage for Strengthening Relation between Partners concerning integrated HSS harmonized efforts. • Maximize expertise TS utilization at regional and country levels ( Afghanistan, Yemen, Pakistan, S Sudan, Somalia etc…. ) • IMPLEMENTATION OBSTACLES FACED & HOW OVERCOMED ……..

CONCLUSION Building technical and policy capacity in countries Situation analysis – inclusiveness Assess existing capacity with partners Establish ways to ensure involvement of all partners including private sector Based on above recommend action : Identify suitable TA and policy skills Mobilizes support for framework of inclusion Mobilizes resources – institutions, etc. Establish a mechanism (national, regional, global) for application submission & implementation

Building technical and policy capacity in countries Focus on GAVI & GFATM eligible countries mainly Strengthen designated agency to support Health System Strengthening and policy formulation Establish in-country capacity through Partners & institutions ( universities, learning institutions, research centers ,etc) Inter-country and inter-regional collaboration ( July in Sharm Elsheikh) Involve partner agencies and maximize the use of their comparative advantage (s)

THANK YOU mounir faragfaragm@emro.who.int

PARTNERSHIP GAVI & GFATM – HSS