national strategy applications and health systems funding platform (presentation)
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8/2/2019 National Strategy Applications and Health Systems Funding Platform (Presentation)
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National Strategy Applications and Health
Systems Funding Platform
Joint Assessment and Multi-Stakeholder Involvement
Regional Workshop for Civil Society14 October 2010
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Context
Growing complexity of global health aid architecture
Paris Principles (2005) & Accra Agenda for Action(2008)
Creation and growth of
Global Fund
Global Fund initiatives to
simplify and streamline
fundingInternational Health
Partnership (IHP)
New grant
architectureJoint Assessment of
National Strategies (JANS) NSAs
HSFP
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Joint Assessment
National Strategy Applications
Health Systems Funding Platform
Multi-stakeholder involvment
Session Overview
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Background International Health Partnership (IHP), Joint Assessment of National Strategies (JANS)
± Principles for joint assessment
± Attributes of sound national strategies (JANS Tool)
Definition
Joint assessment is a process by which country stakeholders and international partnerscome together to carry out an independent assessment of a national strategy and its
accompanying documentation. It is based on JANS principles and tool.
Scope
Can be applied to national health sector strategies or sub-sector strategies (e.g. disease
strategies).
Purpose
1. provide countries with constructive feedback on the national strategy documentation; and
2. provide international agencies with relevant information to help them make technical
support and/or funding decisions.
What is joint assessment?
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IHP JANS Principles including the following: ± country-demand driven and country-led;
± building as appropriate on existing in-country processes and
experience
± strong independent element;
± inclusive process, involving civil society and other stakeholders;
Joint Assessment
JANS principles
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Civil society consultation on Global Fund initiatives
JANS Tool/Attributes
Commonly agreed basis for assessing technical soundness of national strategiesCategory Focus of attributes (for full language see IHP website)
1. Situation Analysis and
Programming
Sound situational and response analysis
Clearly defined priority areas, objectives and interventions,
contributing to improved health outcomes
Planned interventions, cost effectiveness, sustainability
Risk assesment and mitigation strategies
2. Process Multi-stakeholder involvement in development and
endorsement of national strategy documentation
Consistency with higher and lower level strategies
3. Finance and Auditing Comprehensive budget/costing, financial gap analysis
Specification of allocation of funds
Financial management system4. Implementation and
Management
Operational plans, resource deployment
Procurement policy
Governance, management and coordination framework
5. Results, Monitoring and
Review
Monitoring and evaluation
Joint periodic performance reviews
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Multi-stakeholder 1 involvement in development of
national strategy (which is led by government, with a
transparent consultative/participative process) and multi-stakeholder 1 final endorsement of national strategy.
1: Including government, civil society (according to the UN definition) and the private sector
Joint Assessment
Attribute related to MSI
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Joint Assessment
JANS Principles and Tool
JANS applied so far in two different areas, using same principles and tool:
IHP-led joint assessment
of national health sector
strategies
3-4 countries in 2010 so
far. Process ongoing.
Feeding (in some cases)
into donor funding
decisions.
Global Fund-led
assessments of national
disease strategies
7 assessments in First
Learning Wave of NSAs
in 2009
5 NSA grants approved
November 2009
Some differences in emphasis and details of process
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Joint Assessment
National Strategy Applications
Health Systems Funding Platform
Multi-stakeholder involvment
Session Overview
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A pplication
(³NS A´)
C ountries
National
strategy
documentation*
Joint assessment
report
³National strategy application´ to Global Fund
(= jointly assessed national strategy
+ minimal additional information)
G rant
management
Funding decision-making process for other funder(s)
* National strategy documentation = national strategy + complementary documents (e.g., operational plan)
National strategy
µjoint assessment¶
National Strategy Applications
NSA concept
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Puts focus on development, financing and implementation of robustnational disease strategies aimed at improving health outcomes and
supports Paris aid effectiveness principles and Accra Agenda for Action
Anticipated benefits:
Alignment with country priorities, national programmatic andbudgetary timeframes;
Reduced transaction costs and paperwork for countries;
Improved harmonization with other donors;
Opportunity to extend multi-stakeholder inclusion to the scope of
the national strategy;
A focus on managing for results and accountabilitywithin national
disease strategies;
Improved quality and credibility of national strategic frameworks
National Strategy Applications
Anticipated benefits of NSA approach
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Unique characteristics:
C
ompressed timeline (to be ready in same timeframe as R9 proposals) Limited number of countries (22 countries invited)
Review of national disease strategies by TRP only (exceptional since
no j oint mechanism in place)
5 NSAs approved in November 2009
At the end of 2008, Global Fund Board decided to launch a phased roll-outof NSAs, beginning with a ³First LearningWave´ of NSAs in 2009, with
aim to draw lessons to inform the future, broader roll-out of NSAs
National Strategy Applications
First Learning Wave of NSAs
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C onducted by Scope
TRP All NSA countries
UNAIDS- commissioned
consultants
The 3 countries that submitted NSA for HIV
McKinsey, commissioned by GF
12 countries, spanning all three diseases anddifferent FLW outcomes
National Strategy Applications
Reports on FLW & message on value of NSA approach
All 3 reports indicate perceptions of value of NSA approach
from both country- and global-level stakeholders to be
broadly positive
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In April 2010, Global Fund Board approved the initiation of a Second Wave of NSAs, drawing on the lessons from the First Learning Wave, with the following
characteristics:
Timing
± allow countries more time for key process steps
± have NSA funding decisions at end of 2011 Approach to country participation
± include a limited but incrementally larger number of countries than the First
Learning Wave
± move towards longer-term vision of open ³self-selection´ process
National strategy assessment
± move towards a credible, j oint assessment approach
Multi-stakeholder involvement
± strengthen approach used in First Learning Wave
+ also ensure consistency with new Global Fund grant architecture
National Strategy Applications
Second Wave of NSAs
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The long-term vision of the joint assessment in the NSA approach is to move towardsa truly µjoint¶ process. This is currently in evolution:
First Learning Wave: GF-driven, GF-organised, TRP conducted
Purpose: learn about assessment of national disease strategies and link with GF NSA
funding application
Second Wave: GF/donor-driven, jointly-organised, jointly conducted
Purpose: learn how to do a country-driven
j oint assessment of a national disease strategy that can form the basis of
funding/support decisions of international agencies
Intended future model: country-driven, jointly organised, jointly conducted
Purpose: enable countries to conduct joint assessment at time that bests suits their
national calendar , and use it as basis of funding/support requests as these arise.
Second Wave of NSAs
Joint assessment for Second Wave of NSAs
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Will follow JANS Principles and use JANS Tool.
In addition, joint assessment of national disease strategies needs to besufficiently reliable to allow the Global Fund and other donors to use itsoutcome as the basis of their technical support and/or funding decisions.
Hence, some key requirements (agreed by Multi-Partner Working Group), including:
All joint assessment team members independent (no involvement in drafting the
national strategy and no conflict of interest with regards to assessment outcome);
µnational facilitators¶ possible in addition;
Assessment team leader external to country;
A few experts nominated and paid for by donors included in team; At least one member with expertise in multi-stakeholder involvement;
Agenda developed consultatively;
Assessment report to present strengths and weaknesses of national strategy.
Second Wave of NSAs
Joint assessment approach
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Key steps
1. Nominate a joint assessment organizing body;
2. Identify a joint assessment team leader and assessment dates;
3. Prepare the joint assessment (define scope and focus; identify other
assessment team members; prepare agenda);
4. Provide an update on joint assessment preparations;
5. Conduct the in-country joint assessment.
Second Wave of NSAs
Joint assessment process
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Joint Assessment
National Strategy Applications
Health Systems Funding Platform
Multi-stakeholder involvment
Session Overview
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Health Systems Funding Platform (the Platform) is a joint partner initiative of the
G AVI Alliance (G AVI), the Global Fund and the World Bank, with facilitation from the
World Health Organization (WHO)
Goes back to a letter from the Global Fund ED and the G AVI CEO in March 2009 to
the co-Chairs of the High Level Taskforce on Innovative Financing for Health
Systems proposing collaboration on HSS funding
High Level Taskforce welcomed proposal and recommended Platform as amechanism to ³«coordinate, mobilize, streamline and channel the flow of existing
and new international resources to support national health strategies.´
Aim is to make better use of new and existing funds for health systems
strengthening (HSS) through simplification of countries¶ access to HSS sup-
port, and through harmonization and alignment of the way this support is
provided
Principles of the Platform are in line with those of the Paris Declaration, the Accra
Agenda for Action on Aid Effectiveness and the International Health Partnership
(IHP+) .
Health Systems Funding Platform (HSFP)
Background
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1
2
3
Aligning partner support to national plans and
strategies, through an inclusive process
Reduced transaction costs (for both funders and
implementers)
Coordinated funding for HSS
Improvement of
Aid Effectiveness
(Paris and AccraPrinciples)
Health Systems Funding Platform
Anticipated benefits
Greater Value for Money Improved outcomes for the three diseases
and immunization
Contributing to MDGs 4, 5 & 6
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Global Fund Board Decision from April 2010:
Continue rapid implementation of Track 1
Development of joint proposal form for HSS with G AVI (for Round 11)
Design pilot for 4-5 countries to submit funding requests based on jointly assessed
national health strategies (parallel to Round 11)
Scope of GF HSS support to be maintained for the purposes of the Platform
Health Systems Funding Platform (HSFP)
Platform applies to existing and new HSS funding
Track 1
³Existing
financing´
Track 2³New
financing´
Harmonization1 of existing HSS grants/credits
Access via joint proposal form
Access via jointly assessed
national health strategy
Grant/creditmanagement1
O
p t 1
O p t 2
1 Harmonized monitoring & evaluation and fiduciary frameworks (incl. procurement)
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Cambodia:
First joint country mission (with G AVI, WB and WHO representatives) in early
June 2010
Ministry of Health approved approach in August 2010, and has given
permission for work to go ahead.
All three Platform funding partners have harmonized performance indicators
with those of national strategy and have agreed to strengthen country¶s health
information system.
Further work planned to support upcoming mid-term review of the national
health strategy
DRC:
Mission in August 2010 to discuss harmonization of performance frameworks
(G AVI and GF grants managed by same MoH project management unit)
Benin:
Joint partner work started to harmonize and align, with a potential focus on
performance frameworks and financial management.
Health Systems Funding Platform (HSFP)
Track 1 - Existing funding: Progress to date
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Health Systems Funding Platform (HSFP)
Track 2.1: Joint proposal form with GAVI
Joint process
(but not in all instances)
Based on joint
mechanism/framework
Separate
Proposal
Development
Submission
of
joint
proposal
Independent
review
by
TRP/IRC
Board
approval
Financial
arrange-
ments
Step 1 Step 2 Step 3 Step 4 Step 5
Grant
manage-
ment
Step 6
Key elements (current thinking):
One form to request HSS funding from G AVI and/or Global Fund (same structure, same M&E and
financial management framework) ± this will reduce transaction cost
Applicants still requested to delineate amounts requested from each of the agencies
Possible to submit joint requests to G AVI and the Global Fund, but could also be individual
requests to either agency (form is replacing current GF 4B/5B for HSS cross cutting component)
Joint requests will be developed and signed off by CCM and health sector coordinating body ±
strong coordination required
Joint request and joint review by TRP/IRC (for joint requests) enables holistic view on HSS
needs in country
Grant management based on harmonized M&E and financial management procedures (if
requested within the parameters of a joint financing agreement)
Work in progress
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Health Systems Funding Platform (HSFP)
Track 2.2: Pilot for funding based on assessed strategy
Joint process
(but not in all instances)
Based on joint
mechanism/framework
Separate
Joint
Assessment
Funding
request
Independent
review
Board
approval
Financial
arrange-
ments
Step 1 Step 2 Step 3 Step 4 Step 5
Grant/credit
manage-
ment
Step 6
World Bank project appraisal
process
Key elements (current thinking):
Joint assessment of national health strategy based on IHP+ JANS tool and
process including all relevant stakeholders (incl. civil society)
Light funding request predominantly consisting of existing documentation (could
be joint request to G AVI/GF) ± therefore directly aligned with country priorities
Development and submission of funding request by CCM under strong coordination
with health sector coordinating body
Joint review by TRP/IRC (for joint requests)
Grant management based on harmonized M&E and financial management
procedures (if requested be within the parameters of a joint financing agreement)
Pending PSC approval
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Health Systems Funding Platform (HSFP)
Next steps
Continue joint partner work and consultations (including
monthly phone calls with civil society representatives of all
three Platform funding partners)
Policy and Strategy Committee reviewing proposed design
for HSFP pilot for approval (25/26 October )
Portfolio and Implementation Committee reviewing draft
joint proposal form for sign off (Feb 2011)
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Joint Assessment
National Strategy Applications
Health Systems Funding Platform
Multi-stakeholder involvement
Session Overview
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Multi-stakeholder involvement (MSI) is an absolutely essentialprinciple for GF. Application of joint assessment in Global Fund
context needs to be designed in accordance with this core principle.
The question is not whether but how we should achieve this.
NSA approach in fact provides an opportunity to extend MSI todevelopment of a national strategy (as opposed to just development
of a GF-specific proposal ± as in regular rounds-based approach)
Need to see this as an evolutionary process; learn as you go
Key objective in µearly¶ NSA waves and HFSP pilot is to learn whatmechanisms are appropriate and effective to achieve this more
ambitious level of MSI over time (including via positive incentives)
Multi-stakeholder involvement
Context
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Strategy development process
Decision to participate in joint assessment
Joint assessment team and processDecision to develop and submit NSA
Grant implementation and oversight
Multi-stakeholder involvement
Various entry points for MSI
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Multi-stakeholder involvement
Joint assessment stage (NSA)
Requirements on joint assessment of national disease strategies for purposes of NSA Second Wave:
Requiring that joint assessment organizing body incorporates multi-
stakeholder representatives and/or consults them systematically during
preparation process
Assessment of national strategies against IHP+ attributes of sound nationalstrategies, including attribute focusing on ³multi-stakeholder involvement
in the development [«] and final endorsement of a national strategy´;
At least one assessment team member with specific responsibility and
expertise for examining MSI;
Joint assessment team discussions with civil society stakeholders as partof in-country visit;
Requiring that details of the joint assessment (including organizing body, agenda, and outcome briefing) are published transparently
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Multi-stakeholder inclusion
Global Fund application stage (NSA and HSFP Pilot*)
Existing Global Fund mechanisms maintained:
Development of funding request:
Maintaining role of CCM and eligibility criteria for CCMs (ensuring appropriate multi-
stakeholder representation)
CCM decides on how to apply for funding:
For NSA Second Wave:CCM to decide whether to submit NSA (based on jointly
assessed national disease strategy) or whether to apply through regular proposal
For HSFP Pilot: CCM to decide whether funding request should be based on jointly
assessed health strategy or whether regular proposal should be developed
Submission of funding request:
Submission by CCM
In addition: In case of joint assessment showing insufficient multi-stakeholder inclusion in
development of the strategy, need for CCM to describe Äremedial actions³
Selection of PRs:
Maintaining of Dual-Track Financing policy
*Current thinking ± input required
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1. How to ensure joint assessment organizing body at country level
incorporates civil society as part of preparation process?
2. How to ensure selection of an appropriately qualified and unbiased
µcivil society expert¶ for assessment team?
3. How to ensure consistent and thorough assessment of µMSI
attribute¶ across countries?
4. What mechanism to support development and application of
appropriate µremedial actions¶ where weaknesses found in µMSI
attribute¶, and follow up on these?
Multi-stakeholder involvement
Issues requiring further elaboration