Analytical summary - Partnerships for health development
The National Health Policy of Ethiopia emphasizes that solving the multifaceted problems of the health sector requires timely collaboration from the Government of Ethiopia, the private sector, nongovernmental organizations, multilateral and bilateral development partners, global initiatives, other sectors and the public at large. In cognizance of this fact, the Government has devised several strategies to collaborate with development partners, nongovernmental organizations and various ministries to improve the health status of its citizens. For instance, the governance structure of the fourth Health Sector Development Programme (HSDP IV) was revised to better coordinate development partners with the Government and other stakeholders within the health sector.
The Joint Consulting Forum is the highest governing body and serves as a joint forum for dialogue on sector policy and reform issues between the Government, development partners and other stakeholders and to oversee the implementation of the International Health Partnership (IHP+), the Millennium Development Goal (MDG) performance fund, Protection of Basic Services fund, GAVI Alliance and other donor-supported projects. The Joint Core Coordinating Committee serves as the technical arm of the Joint Consulting Forum.
The Consortium of Christian Relief and Development Association is an umbrella nongovernmental organization that coordinates nongovernmental organizations and civil society organizations in Ethiopia. The Government welcomed public–private partnerships for health initiatives in 2009 and developed guidelines to enhance the private sector’s role and its contribution in delivering quality health services in the country.
Over the years, the health sector has made major strides in mobilizing the resources coming into the country from different donors. Although this is encouraging, the numerous plans, budget channels and reporting requirements by donors is recognized to have caused serious burden to Ethiopia's already weak health system and capacity.
To combat this problem, the Government has embarked on a journey following the global agenda on harmonization and alignment as set out in the Paris Declaration. This was reflected at country level when Ethiopia became a signatory of the Global IHP+ and was the first country to develop and sign a country-based IHP+ Compact. The Government follows One Plan, One Budget, One Report in line with IHP+ principles whereby the health sector has one countrywide and shared strategic plan, that all stakeholders will finance the plan by making all financial and non-financial resource available and to use specific set of indicators for performance reporting without duplicating channels of reporting. Significant progress has been achieved in all three areas.
As part of the same harmonization efforts, the Federal Ministry of Health and its partners signed an agreement for and endorsed the HSDP harmonization manual to be used as a practical document on institutionalizing One Plan, One Budget, One Report in the health sector. This manual was developed in recognition by both Government and donors of the fragmented decision-making and its effects and is intended to harmonize and align the way in which Government and donors work together.
According to the HSDP harmonization manual, harmonization is the “coordination of activities among all stakeholders to reduce the transaction cost of delivering aid and services” and is intended to avoid the large volume of extra work created when donors set up separate channels for their resources. It is in this spirit that the Health Pooled Fund and the MDG Performance Package Fund were established.
The ultimate goal of harmonization is to have an effective planning system that makes decisions about how all resources are used and that monitors overall implementation in a simple way, using One Plan, One Budget, One Report. As part of its one plan, the health sector developed its fourth 5-year strategic plan (HSDP IV) using a top-down and bottom-up planning approach and balanced scorecard framework, in consultation with a wide range of stakeholders.
Ethiopia has applied the Joint Assessment of National Strategy, a tool developed under IHP+ to help countries move towards one plan. The major success towards one budget was the establishment of the MDG Performance Fund in 2007, which is the Government’s preferred mode of funding due to its lower transaction cost. It provides flexible resources for underfunded areas of the HSDP and is managed by the Federal Ministry of Health using Government procedures. However, although there are currently seven signatories of the Joint Financing Arrangement to join the MDG Performance Fund, a significant proportion of resources still flows into other channels such as Channel1b (earmarked), Channel 2 and 3 (off budget) that lack flexibility and have high transaction costs.
Ethiopia has also actively participated in the South–South collaboration, which is a new type of development approach with China as the centrepiece. This approach devises more appropriate strategies by considering the specific vulnerability and structural constraints of least-developed countries to alleviate poverty.
In November 2010, the first China–Africa Poverty Reduction and Development Conference was co-hosted in Addis Ababa by the Government of Ethiopia and the United Nations Development Programme. Two important letters were signed between the United Nations Development Programme and the Government of China, demonstrating China’s interest in sharing its poverty alleviation experience by strengthening and promoting trilateral cooperation with African countries on food security and poverty. This is a promising collaboration for the Government of Ethiopia to meet MDGs and for the country to graduate from the group of least-developed countries.
The way forward
- Strengthen coordination mechanisms with partners, intersectoral, private–public mix and South–South cooperation by tracking the quality of partnership over time.
- Track the progress of each partner using IHP+ indicators, in line with One Plan, One Budget, One Report indicators.
- Strengthen the capacity of the Consortium of Christian Relief and Development Association to better coordinate nongovernmental organizations and civil society organizations in the country.