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Harmonization MDBS and SWAPs

Harmonization MDBS and SWAPs. by Dr Eddie Addai. Question. What is the health sector doing to harmonize the MDSB/PRSC and SWAP processes?. Issues. What is MDBS? Benefits of MDBS Implications of MDBS on health sector Experiences Risks Our Response Conclusion. MDBS.

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Harmonization MDBS and SWAPs

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  1. Harmonization MDBS and SWAPs by Dr Eddie Addai Ministry of Health and Partners Summit, Miklin, 13 - 17 Dec 2004

  2. Question What is the health sector doing to harmonize the MDSB/PRSC and SWAP processes? Ministry of Health and Partners Summit, Miklin, 13 - 17 Dec 2004

  3. Issues • What is MDBS? • Benefits of MDBS • Implications of MDBS on health sector • Experiences • Risks • Our Response • Conclusion Ministry of Health and Partners Summit, Miklin, 13 - 17 Dec 2004

  4. MDBS • Multi-Donor Budget Support • Involves pooling of funds from Donors • Allocating funds through the MTEF budget • To support Poverty Reduction Strategy • Use of Government Systems for disbursements, accounting and reporting Ministry of Health and Partners Summit, Miklin, 13 - 17 Dec 2004

  5. MDBS • Multi-Donor Budget Support • Agreements spelt out in progress assessment matrix – the PRSC/MDBS matrix • Performance Review process and timetable • Performance based releases by partners • Process managed by Ministry of Finance Ministry of Health and Partners Summit, Miklin, 13 - 17 Dec 2004

  6. Benefits of MDBS • Government ownership and leadership • Partnership • Collective responsibility rather than attribution • Policy dialogue focused on policies, results and expenditure rather than specific projects • Peer pressure and donor club • Funding • Increased funding • Increased fungibility • Increased predictability of funds Ministry of Health and Partners Summit, Miklin, 13 - 17 Dec 2004

  7. Benefits of MDBS • Government Systems • Strengthened systems including systems for • planning, financial management, procurement, accountability including monitoring, reporting and evaluation • Greater use Government systems • External assistance • Reduced conditionalities • Greater harmonization of donor support • Better alignment of support to national policies, strategies and systems • Conditionalities closely linked to National Polices and Plans Ministry of Health and Partners Summit, Miklin, 13 - 17 Dec 2004

  8. Benefits of MDBS • Overall • Reduced transaction cost • Greater coherence in support to the country • Improved quality of services and achievement of targets and goals Ministry of Health and Partners Summit, Miklin, 13 - 17 Dec 2004

  9. What MDBS means for the health sector? • Ownership and Leadership at sector level • Our Experience • Not automatic that Government will lead particularly in the absence of sector dialogue • Depends on MOH engagement in the process • Risk • Disconnect between SWAP and MDBS processes • Response • High level participation in MDBS • Focal point appointed in the sector and MDBS secretariat to coordinate MDBS activities • Establish MoH-Partners group to coordinate activities • Active engagement of sector Ministries by Finance in MDBS process Ministry of Health and Partners Summit, Miklin, 13 - 17 Dec 2004

  10. What MDBS means for the health sector? • Funding • Will it increase? • Will it be predictable? • Will funding be more fungible? Ministry of Health and Partners Summit, Miklin, 13 - 17 Dec 2004

  11. Will funding increase? Depends on whether MDBS provides extra resources e.g. World Bank PRSC or re-channels donor funds and MoH ability to negotiate with Finance BMC Ministry of Health and Partners Summit, Miklin, 13 - 17 Dec 2004

  12. Funding • Our Experience • Improved predictability in flow of GOG funds observed this year • All partners have maintained funding to the sector • Will this pattern continue? • Uncertain Ministry of Health and Partners Summit, Miklin, 13 - 17 Dec 2004

  13. Funding • The risk • A significant reduction in proportion of funds allocated through health fund could: • potentially dismantle the health fund • Increase relative allocation of earmarked funding to the sector • and undermine some of the gains made in the health SWAp • Response • A guarantee that the health sector will not be worse off as partners move upstream (Working towards Abuja) • Maintain the health sector policy dialogue • Revise CMA to reflect the changing trends Ministry of Health and Partners Summit, Miklin, 13 - 17 Dec 2004

  14. Policy Dialogue • Will the SWAp mechanisms and policy dialogue be sustained under MDBS? • Our experience • No major threat as yet • but this could change • MDBS Partners may remove their health specialists and disengage from the sector • Replace them with Generalists or Economists Ministry of Health and Partners Summit, Miklin, 13 - 17 Dec 2004

  15. Policy Dialogue • Risk • Reduction in the quality of sector policy dialogue • Absence of sector specialists in the Finance dialogue • Sector policy dialogue may be dominated by Partners whose support are not harmonized Response • Protect the policy dialogue in the health sector • Use the SWAp process to determine health component MDBS/PRSC matrix and for assessing achievement of triggers and targets • Consider retaining sector specialists even if funds are in MDBS Ministry of Health and Partners Summit, Miklin, 13 - 17 Dec 2004

  16. Transaction Cost • Will it be reduced? • Depends on our ability to harmonize MDBS and SWAP process • The signs are good • Potential areas of disharmony • What is assessed? • How it is assessed? • Who assesses? • When are assessed? Ministry of Health and Partners Summit, Miklin, 13 - 17 Dec 2004

  17. Transaction Cost • Disharmony in reality • MDBS matrix and Programme of Work • MDBS Triggers and targets versus the POW indicators and targets • Timetable for agreeing performance matrix and for assessing performance and the SWAP timetable • MDBS/PRSC and SWAp policy dialogue • If nothing is done • High transaction cost • Frustration among managers of MDBS and health sector • Management of two discrete systems instead of integrating SWAP into the MDBS process Ministry of Health and Partners Summit, Miklin, 13 - 17 Dec 2004

  18. Transaction Cost • Our experience and Response • Triggers and targets (What is assessed) • Sector wide indicators and targets adapted and used in the 2004/2005 matrix • Process and other activity indicators incorporated into the 2005 POW • Revising measurement and reporting system to provide disaggregated data required under MDBS • Timetable for MDBS planning and reviews – When assessed? • Timetable for sector wide review and summit revised to ensure that summit is before MDBS review Ministry of Health and Partners Summit, Miklin, 13 - 17 Dec 2004

  19. Transaction Cost • Our experience and Response • Participation in the Policy dialogue – Who assesses? • Involving MDBS managers more closely in the sector dialogue • Using the health sector summit to assess achievement of targets and triggers for the health sector • Summit aide memoire to recommend whether the targets and triggers have been achieved • 2005 programme of work incorporated MDBS activities and targets • MDBS trigger of review HR incentive package is an in-depth review for 2004 • Appointment of MDBS focal points for sectors Ministry of Health and Partners Summit, Miklin, 13 - 17 Dec 2004

  20. Transaction Cost • Our experience and Response • Triggers and targets (What is assessed) • Sector wide indicators and targets adapted and used in the 2004/2005 matrix • Process and other activity indicators incorporated into the 2005 POW • Revising measurement and reporting system to provide disaggregated data required under MDBS • Timetable for MDBS planning and reviews – When? • Timetable for sector wide review and summit revised to ensure that summit is before MDBS review Ministry of Health and Partners Summit, Miklin, 13 - 17 Dec 2004

  21. Conclusion • MDBS/PRSC process is changing the way we do business as a nation and in the health sector • The health sector has engaged and continues to engage after a slow start • The policy dialoguing is becoming increasingly focused on the poor and on results • We are now dialoguing more closely with finance and NDPC Ministry of Health and Partners Summit, Miklin, 13 - 17 Dec 2004

  22. Conclusion • Already through the health SWAp mechanism, the MOH and Partners have acquired experience in doing business along the lines of the MDBS • The MDBS could either consolidate the gains in the SWAP or undermine it • We seem to be on the right track towards harmonizing MDBS and SWAP • Partner behavior will influence our ability to sustain the SWAP in MDBS Ministry of Health and Partners Summit, Miklin, 13 - 17 Dec 2004

  23. Thank You Ministry of Health and Partners Summit, Miklin, 13 - 17 Dec 2004

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