Innovations for Enhanced Aid Harmonization and Coordination

A case study of Nepal

Korea/ADB Conference on Knowledge Sharing and Development Effectiveness in the Asia and Pacific Region Bjorn-Soren Gigler, World Bank Institute bgigler@worldbank.org October 7, 2011

Agenda

1) Background SWAP in Nepal

2) Challenges Lessons &

3) Open Aid Map

1.
2.

Health in Nepal
Aid in Nepal

1.
2.

Achievements
Key Challenges i) Aid Effectiveness ii) Aid Harmonization iii) Civil Society Organization Lessons Learnt

1.

World Bank Projects in Nepal Mapping for Results

2.

3.
4.

SWAp
SWAp in Health Sector 3.

Nepal
Landlocked, diverse country with an average $470 (GDP per capita) •
• • • • • Population (million) : 29.3 GDP per capita : $470 (South Asian average: $1,082) Poverty : 31% below poverty line Human Development Index : 0.428 Culturally, ethnically and religiously diverse Political transition in 2006
Source: World Bank (2011)

Nepal
Human Development Index : Trend 1980 – present

0.428

Source: UNDP (2011)

Nepal – Health Sector
Highest Infant Mortality and HIV prevalence in South Asia

• • • • • • • • •

Wide disparity in health conditions. HIV infection : 0.49% (ages 15-49) Life expectancy (years) : 67 Infant Mortality : 39 Under-five mortality : 48 (per 1,000) Under-five Child malnutrition : 38.8% Birth attended by skilled health staff : 19% Access to an improved water source : 88 Progress in nutrition remains limited.

Source: World Bank (2011) & UNGASS (2008)

Aid in Nepal
52.80%

34%

Aid dependency *

* country programmable aid as a % of total gov expenditure (Action Aid 2011)

• •

ODA has been increased greatly from 1960 ($8.2M) to 2009 ($994M) Highest aid dependent county in Asia

$ millions
All DAC countries
AusAID DFID

2004
726.0 378.9
3.2 114.3 30.9 47.7 37.9 12.0 19.3 40.1

2005
528.7 369.5
1.1 104.7 47.6 55.5 110.8 12.8 6.4 5.8

2006
528.3 345.3
5.5 58.2 26.8 57.9 67.8 24.9 20.8 32.8

2007
817.8 260.5
1.7 50.8 64.0 77.1 35.7 16.2 14.6 12.1

2008
736.4 491.5
12.6 51.3 44.5 105.9 58.1 40.1 17.8 47.3

2009
994.8 598.5
10.8 140.3 43.2 79.4 77.0 27.7 39.6 45.5

SWAp

GTZ USAID JICA SDC Finland DANIDA

25.3%

NORAD

65.4

8.1

31.0

52.1

33.6

66.2

Multilateral
IDA (WB) UNICEF UNFPA ILO / WHO AsDF (ADB)

347.2
215.8 6.5 3.3 0 80.0

159.2
35.0 5.5 4.8 0 73.9

183.0
25.0 6.4 3.9 0 97.2

457.3
330.8 7.7 4.3 0 0

244.9
158.0 6.0 5.6 0 0

396.3
284.2 7.4 4.4 0 25.1

SWAp

Aid Flows to Nepal in Health Sector
Health

Energy only * Transportation only*

• • • •

Differences in Priority of Health Sectors (multi-lateral-bilaterals) Health expenditure per capita : $ 25 Public exp. of total health expenditure : 35.3% Public exp. of total GDP : 5.8%

SWAp (Sector-Wide Approach)
An approach to international development that brings together governments, donors and other stakeholders within any sector

• characterized by a set of operating principles rather than a specific package of policies or activities. • involves movement over time under government leadership towards: - broadening policy dialogue - developing a single sector policy (that addresses private and public sector issues) and a common realistic expenditure program - common monitoring arrangements - more coordinated procedures for funding and procurement. World Health Organization, World Health Report (2000 )

SWAp for Health in Nepal
Statement of intent to guide the partnership in health sector in Nepal (initiated in Feb, 2004)
• • • • • •
• • • • •

Donor Country (5)

Australian Development Agency (AusAID) British Department for International Development (DFID) German cooperation agency (GTZ) U.S. Agency for International Development (USAID) Japan International Cooperation Agency (JICA) Swiss development agency (SDC)
The World Bank International Labour Organization (ILO) UN children’s fund (UNICEF) UN Population Fund (UNFPA) World Health Organization (WHO)

• To reduce transaction cost to the government

Sector Wide Approach in Health

International Organization (6)

by aligning external support with Nepal government’s sector plan by strengthening harmonization among the development partners in the health sector

KEY REGIONAL DIFFERENCES IN TERMS OF POVERTY
MAP: POVERTY INCIDENCE (DARKER COLOR HIGHER POVERTY)
Data available
Indicator Time period Source Poverty incidence 2001 CBS

YS

2001
Data available
Indicator Time period Source 2001 CBS

World Bank Projects in Nepal

Nepal Health SWAP and development indicators

SECOND HEALTH SUPPORT PROGRAM (HSSP II)
MAP: HEALTH CENTERS LOCATION AT VDC
Data available
Number of districts Total observations Mapping Status Time period Source Bert 75 4,161 Health center location at the VDC

Mismatched

62 VDCs

Projects by Population Density

Progress
• December 2003 : Health Sector Strategy: An Agenda for Reform

• • • • •

February 2004 : SWAp July 2004 : Letter of sector development policy by GoN August 2004 : Nepal Health Sector Programme- Implementation Plan (2004-2010) March 2005 : Signing of Joint Financing Arrangement (JFA) - GoN, DFID and World Bank June 2009 : Signing of JFA by AusAid as third partner to provide health sector budget
Pool Partner Signatory - Project Support Non-signatory

• AusAid • DFID • The World Bank

• • • • •

ILO UNAIDS UNFPA UNICEF WHO

• AusAid • DFID • The World Bank

• • • •

GAVI GFATM NLRA Others

Nepal Government

International Health Partnerships +

• •

Launched to support developing countries in achieving health sector MDGs through health system strengthening, supporting national health plans and donor coordination (September 2007) In first phase eight countries including Nepal selected for IHP+ ‘Nepal Health Development Partnership Compact’ signed in February 2009 by Ministry of Health & Population (MHP) and eight health sector development partners and it further commits to strengthen the SWAP in health sector.

Donor Country (2) IHP+ International Organization (6)

• Australian Development Agency (AusAID) • British Department for International Development (DFID) • • • • • • The World Bank UN Children’s fund (UNICEF) UN Population Fund (UNFPA) World Health Organization (WHO) UNAIDS GDC
IHP+ Signatory

Major Coordination with SWAp in Health
• Every year two Joint Annual Reviews (JAR) are held one for annual work plan and budget and another for review of sector performance and till date nine JARs completed successful

‘Health sector development partners forum’ chaired by health secretary as agreed in statement of intent signed in 2004 & IHP+ national compact in 2009
All major issues are duly discussed in the above two forums

Agenda

1) Background SWAP in Nepal

2) Challenges Lessons &

3) Open Aid Map

1.
2.

Health in Nepal
Aid in Nepal

1.
2.

Achievements
Key Challenges i) Aid Effectiveness ii) Aid Harmonization iii) Civil Society Organization Lessons Learnt

1.

World Bank Projects in Nepal Mapping for Results

2.

3.
4.

SWAp
SWAp in Health Sector 3.

Key Achievements
• Improved health outcomes and increased capacity on financial expenditure led to availability of more funds • Joint planning and programming through JAR helped to prepare more realistic and comprehensive health work plan & budget • The government financial & procurement system is gradually improving • It helped to address the constitutional provision of basic health as a fundamental right of the citizens • SWAP implemented at district level with merging of many program heads into one as “integrated district health program”

Key Challenges for Aid Effectiveness
• • • • • • • Governance and accountability Financial management and financial flows Frequent changes in government Lack of effective private sector integration and regulation Continued off-budget support in health sector (non-governmental) Higher aid dependency for Nepal Government In sufficient information systems specially financial, procurement, vital registration, physical assets and human resource management

Key Challenges for Aid Harmonization
• Donor efforts at monitoring and evaluation are fragmented • China and India are big partners in health sector with significant contribution, but refused to coordinate so that still alignment and harmonization is a problem • Lack of open Information • HIV is almost completely segregated from the rest of the health sector

Key Challenges for Civil Society Participation
Limited CSO’s Participations

• • • •

Limited Information about the role of CSOs in Health sector Lack of coordination of national civil society Political affiliation of civil society organizations Selective engagement of very few organizations that are not necessarily representative of people on the ground • Civil society is not systematically involved in sector meetings

Lessons Learnt
• Health sector SWAP has increased ownership, harmonization and aid alignment in general. • The capacity of health sector in context of managing big program such as SWAP or health sector program is gradually increasing • However, there are still needs for partners to have better coordination on the matter of communications, monitoring and evaluation system and geographical strategy. • It is necessary to upgrade the national systems such as financial management, audit of financial expenditures and information management and inter-agency coordination. • Technical assistance and information system with open data is crucial. • It is necessary to engage CSOs and citizens more for better monitoring aid flows and projects at the local level. • It would be great to establish inter-agency linkage with other SWAPs beyond health sector (i.e. education, environment) and try to coordinate & address the SWAP related common issues.

Agenda

1) Background SWAP in Nepal

2) Challenges Lessons &

3) Open Aid Map

1.
2.

Health in Nepal
Aid in Nepal

1.
2.

Achievements
Key Challenges i) Aid Effectiveness ii) Aid Harmonization iii) Civil Society Organization Lessons Learnt

1.

World Bank Projects in Nepal Mapping for Results

2.

3.
4.

SWAp
SWAp in Health Sector 3.

Open Aid Partnership

Open Aid Partnership visualizes the sub-national location of donor-financed projects

Open Aid Partnership- Objectives
• Improve Aid Transparency: increase transparency through Open Data on aid flows and public service delivery • Enhance Results: Better target, monitor, and coordinate aid flows within countries • Establish Feedback Loop: Empower citizens and CSOs to provide direct feedback on project outcomes

Increase Aid Transparency and Citizen Engagement for Better Results

What we have done so far: Mapping for Results
• All Bank-financed projects are mapped • Maps for all 142 IBRD and IDA countries developed

• More than 30,000 project locations mapped combined with sub-national MDG indictors (poverty, infant mortality, malnutrition)
• Visualized geographic locations for 1,600 active Bank projects
maps.worldbank.org

Mapping at Various Levels
Regions Countries

Sectors

Projects

maps.worldbank.org

Key Components of Partnership
• Open Aid Map a common platform to show locations of donor programs • Country Platforms for open aid flows and public expenditures • Citizen Feedback Loops to promote citizen engagement in the delivery of public services • Capacity Development to empower CSOs and Citizens to effectively use and generate data • Impact Evaluations to assess the impact of open aid on development outcomes

Nepal Country Platform Pilot
Poverty and WB projects
WB and USAID projects

Public Expenditures

Feedback Loop

1) Open Aid Map
• Geo-coding of donor-financed projects based on IATI standard • Joint Open Aid Map for better aid coordination (AidData) • Visualize projects of 27 donors combined with poverty data

2) Country Mapping Platform

Enable governments to collect, make openly available and visualize data on development assistance, budgets and public service delivery

3) Citizen Feedback Loops

• Build pilots to enable two-way information flows between citizens & governments • Citizen generated data, i.e. CheckMySchool.org