Presentaion to HEPNEt- Zambia 29th May 2008 1 Consequences of donor aid not Channelled through the...

Presentaion to HEPNEt- Zambia 29th May 2008

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Consequences of donor aid Consequences of donor aid not Channelled through the not Channelled through the

Govt System: the case of Govt System: the case of Global Fund Global Fund

Emily Nyanzi K.(Mrs) Emily Nyanzi K.(Mrs) Economist/TAEconomist/TA

Ministry of Health - UGANDAMinistry of Health - UGANDA


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Outline of PresentationOutline of Presentation

BackgroundBackground Donor FundingDonor Funding Uganda experience (Global fund)Uganda experience (Global fund)

BenefitsBenefits ConsequencesConsequences Way forwardWay forward


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Background-1Background-1

In The late 80’s Uganda’s health In The late 80’s Uganda’s health system, had literally collapsed system, had literally collapsed after many years of civil strife and after many years of civil strife and was characterized by heavy donor was characterized by heavy donor support and multiple projects;support and multiple projects;

This support however did not This support however did not translate into significant translate into significant improvements in health outputs improvements in health outputs and outcomes – thus no and outcomes – thus no improvements in peoples health;improvements in peoples health;


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Background -2Background -2

In Year 2000, GoU and partners In Year 2000, GoU and partners noted a lot of shortcomings noted a lot of shortcomings Donor support and Multiple Donor support and Multiple projects & agreed to introduce projects & agreed to introduce Sector-Wide Approaches (SWAP).Sector-Wide Approaches (SWAP).

This was further strengthened by This was further strengthened by the Paris Declaration 2005 on aid the Paris Declaration 2005 on aid effectiveness.effectiveness.


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Paris Declaration 2005Paris Declaration 2005

Endorsed on 2 Endorsed on 2 ndnd March 2005, an March 2005, an international agreement to which international agreement to which over one hundred Ministers & over one hundred Ministers & Heads of Agencies committed their Heads of Agencies committed their countries and organizations to: countries and organizations to:

1. Increase efforts in AID 1. Increase efforts in AID harmonisation, harmonisation,

2.Align and manage aid for results 2.Align and manage aid for results with a set of monitorable actions with a set of monitorable actions and indicators and indicators


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% of Donor funding to TT % of Donor funding to TT Sector FundingSector Funding

FYFY 2002/032002/03 03/0403/04 04/0504/05 05/0605/06 06/0706/07 07/0807/08

TotalTotal 337.9337.9 375.06375.06 432.018432.018 510.25510.25 381.8381.8 428.2428.2

% % 4242 41.641.6 45.145.1 52.552.5 36.336.3 3535


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% of Donor Funding% of Donor Funding

2006/07 – 36.4%2006/07 – 36.4%

2007/08- 35.2 %2007/08- 35.2 %


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% donor funding from % donor funding from 2002 to 20082002 to 2008

% Growth of Donor Funding from 2002 to date

2002/03

2003 04

2004/ 05

2005 /06

2006/07

2007/08


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Donor Funding Donor Funding ComponentsComponents

1. PAF –Poverty Action Fund1. PAF –Poverty Action Fund General PAFGeneral PAF Earmarked PAFEarmarked PAF2.Budget Support also called SWAp 2.Budget Support also called SWAp

( Sector Wide Approach)( Sector Wide Approach)3. Project Support- Funding for 3. Project Support- Funding for

specific projects in the country at specific projects in the country at central and district level e.g central and district level e.g DANIDA. Global Fund, etc.DANIDA. Global Fund, etc.


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Donor funding from FY Donor funding from FY 2002/03 to 2007/05 Excluding 2002/03 to 2007/05 Excluding

( PAF Funding)( PAF Funding)

2002/2002/0303

03/0403/04 04/0504/05 05/0605/06 06/006/077

07/0807/08

141.96141.96 156.22156.22 195.105195.105 268.38268.38 139.2139.222

150.9150.9


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Global Fund Uganda Global Fund Uganda (GFTAM)(GFTAM)

Started Operation in FY 2004/05 this was the Started Operation in FY 2004/05 this was the first phase of funding by GFTAM in Ugandafirst phase of funding by GFTAM in Uganda

1.Disagreement between MOH & Global Fund 1.Disagreement between MOH & Global Fund Secretariat regarding Budget Support Viz. Secretariat regarding Budget Support Viz. Project SupportProject Support

2. GFTAM opted for project model and 2. GFTAM opted for project model and eventually got into trouble. eventually got into trouble.

1.Funding was project mode 1.Funding was project mode outside the SWAp mainly to outside the SWAp mainly to specific central level projects and specific central level projects and projects at districts & different projects at districts & different Ministries and NGOs)Ministries and NGOs)

2.Funding was for Drugs ARVs for 2.Funding was for Drugs ARVs for HIV/AIDS control, TB and ACT for HIV/AIDS control, TB and ACT for Malaria control programmes & Malaria control programmes & LINSLINS


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Funding- GFTAM 2004/05Funding- GFTAM 2004/05

1.1. There was a Project There was a Project management Unit (PMU) management Unit (PMU) Premised outside MOH Premised outside MOH HeadquartersHeadquarters

2. Characterized by Third Party 2. Characterized by Third Party Procurements and high admin Procurements and high admin costs.costs.


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GFTAM-2005/06GFTAM-2005/06

2005/06 there was suspension of 2005/06 there was suspension of funding and Global fund funding and Global fund activities in Uganda due to.activities in Uganda due to.

Misappropriation of funds and Misappropriation of funds and improper condition of project improper condition of project activities.activities.

Many NGOs most of them new in Many NGOs most of them new in the country, district level the country, district level activities and govt programs had activities and govt programs had not accounted for funds.not accounted for funds.


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GFTAM-2005/06GFTAM-2005/06

Conditionality for lifting the Conditionality for lifting the suspension was to have all suspension was to have all programs/NGOs account for programs/NGOs account for funds received.funds received.

GOU and Global fund had to GOU and Global fund had to agree to conditions of funding agree to conditions of funding modalities, M&E and modalities, M&E and accountability of funds.accountability of funds.


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GFTAM 2007/08 -1GFTAM 2007/08 -1

Funding streamlined with clear and Funding streamlined with clear and stipulated roles for all Ministries/NGOsstipulated roles for all Ministries/NGOs

MFPED is the Principal recipient of MFPED is the Principal recipient of funds and realizes them to different funds and realizes them to different Ministries/NGOs.Ministries/NGOs.

Earnest and Young a private company Earnest and Young a private company oversees MGT of funds at a cost of oversees MGT of funds at a cost of US.Dollars 1m every year.US.Dollars 1m every year.


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GFTAM 2007/08 - 2GFTAM 2007/08 - 2

MOH Coordinating roleMOH Coordinating role M&E by UAC etcM&E by UAC etc Funds are realized in rounds Funds are realized in rounds

after Malaria, TB and HIV/AIDs after Malaria, TB and HIV/AIDs programmes producing and programmes producing and sending acceptable proposals sending acceptable proposals which are sent to Geneva.which are sent to Geneva.


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Benefits - (GFATM)- 1Benefits - (GFATM)- 1

GFATM focuses on the GFATM focuses on the implementation of interventions implementation of interventions related to particular diseases:- related to particular diseases:- Mainly Malaria, HIV/AIDs and Mainly Malaria, HIV/AIDs and Tuberculosis.Tuberculosis.

Free Antimalarial, TB and ARVs Free Antimalarial, TB and ARVs although too much concentration in although too much concentration in specific geographical esp urban specific geographical esp urban areas.areas.

Are characterized by a vertical or Are characterized by a vertical or categorical mode of deliverycategorical mode of delivery


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Benefits of Project Mode of Benefits of Project Mode of Funding (GFATM)Funding (GFATM)

At project level the focus of At project level the focus of attention lies on a relatively attention lies on a relatively narrow range of issues.narrow range of issues.

Essential approach to flexibility Essential approach to flexibility and quick response in health and quick response in health systemssystems

Ownership of project activitiesOwnership of project activities


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Benefits - (GFATM)- 2Benefits - (GFATM)- 2

Demonstrates results in key Demonstrates results in key priority health concernspriority health concerns

Easy and Focused M&EEasy and Focused M&E Fragmentation of the health Fragmentation of the health

system into several sub systems system into several sub systems enables deliveries of different enables deliveries of different interventions to different interventions to different beneficiariesbeneficiaries


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Consequences -1 Consequences -1

High admin costs due to third party High admin costs due to third party procurrementsprocurrements

Difficulties in financial flows from the Difficulties in financial flows from the central government to the districtscentral government to the districts

Limited human resource capabilities Limited human resource capabilities at health facilities and beneficiaries at health facilities and beneficiaries centres/NGOscentres/NGOs

Generally large system constraints Generally large system constraints within the project frameworkwithin the project framework


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Consequences -2Consequences -2

Proliferation of projects, multiple Proliferation of projects, multiple

reporting requirements, lack of reporting requirements, lack of

coherence in donor supportcoherence in donor support

Distortion of spending priorities and Distortion of spending priorities and leading to problems of sustainability, leading to problems of sustainability, with limited scope for preparing with limited scope for preparing comprehensive sectoral budgets;comprehensive sectoral budgets;

Creation of parallel systems Creation of parallel systems undermining organizational capacity undermining organizational capacity buildingbuilding


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Consequences -3Consequences -3

Such international initiatives have a Such international initiatives have a strong political dimension and;strong political dimension and;

decisions (taken outside the country) decisions (taken outside the country) no longer lie at technical level where no longer lie at technical level where emphasis is on harmonization with emphasis is on harmonization with the health system.the health system.

General lack of knowledge of local General lack of knowledge of local realities and ; not in line with locally realities and ; not in line with locally agreed policies.agreed policies.


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GFTAM- Way ForwardGFTAM- Way Forward

All in all GFATAM is considering joining All in all GFATAM is considering joining the SWAP- budget support mode of the SWAP- budget support mode of funding.funding.

Long Term Institutional Arrangement Long Term Institutional Arrangement (LTIA) that HPAC are working on as a (LTIA) that HPAC are working on as a future framework for handling future framework for handling Global Fund, GAVI,Global Fund, GAVI, etc.

Generally SWAp reduces administrative Generally SWAp reduces administrative costs for governmentcosts for government


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SWAp- Budget SupportSWAp- Budget Support

Essentially SWAp was established Essentially SWAp was established to enable governments to:to enable governments to:

Own and coordinate development Own and coordinate development assistance in any given sectorassistance in any given sector

Policy designPolicy design Strategic and operational Strategic and operational

management management Financial pooling, Resource Financial pooling, Resource

allocation and common allocation and common arrangements for M&Earrangements for M&E


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Core elementsCore elementsof Budget Supportof Budget Support

Government in Government in ““driverdriver’’s seats seat”” Sector-wide in scopeSector-wide in scope Agreed policy framework & strategyAgreed policy framework & strategy All/most donors sign onAll/most donors sign on Common/joint work programCommon/joint work program Common management arrangements:Common management arrangements:

1. disbursement and accounting of 1. disbursement and accounting of fundsfunds

2.reviewing performance2.reviewing performance Move to streamline govt. proceduresMove to streamline govt. procedures


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Further readingsFurther readings

Oliveira Cruz. V, et al 2005. sing Oliveira Cruz. V, et al 2005. sing agency theory to analyse agency theory to analyse relationships between recipient relationships between recipient governments and international governments and international development partners.development partners.

Ministry of health ,Uganda Ministry of health ,Uganda 2006.Health systems reforms in 2006.Health systems reforms in Uganda: Processes and Out putsUganda: Processes and Out puts


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Thank you for Your Thank you for Your AudienceAudience

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