The International Health Partnership and Related Initiatives provide an important toolkit for development co-operation, providing a framework for agreement with partner countries to provide sustained support for integrated cross sector programmes of action committing both donor and recipient countries to working together and monitoring the achievement of agreed targets in relation to one agreed national health plan.
IHP Related Initiatives: The “+” symbol attached to the IHP signals the bringing together of a range of other initiatives which were established at around the same time as the IHP, and all of which aim to accelerate the achievement of the health related MDGs in line with the Paris Declaration. These include: Providing for Health (P4H), Harmonization for Health in Africa (HHA), Innovative Results-Based Financing (RBF), Deliver Now for Women and Children, Health Metrics Network (HMN), Global Health Workforce Alliance (GHWA)
Launched in London in September 2007 by UK Prime Minister (PM) Gordon Brown and the PM of Norway, Jens Stoltenberg, the IHP+ is one of the most important global health initiatives of our time. Contrary to the emphasis on vertical programming (i.e. programming that focuses efforts on one or a group of diseases/issues), the IHP+ aims to re-popularise the horizontal health systems strengthening approach which focuses on building up the capacity of aid recipient country health systems and services. The IHP+ also aims to better coordinate global health actors at all different levels, whether international or local. In this respect the IHP+ is a response not only to calls to scale-up donor attention to the health Millennium Development Goals, but also the Paris Declaration on Aid Effectiveness and the G8 Summit commitments to social protection.
The IHP+ is primarily a structure to improve the coordination of existing initiatives and resources. Precisely, the objectives of the IHP+ are:
- to develop ‘country compacts’ that commit development partners to provide sustained and predictable funding and increase harmonization and alignment in support of results orientated national plans and strategies that also tackle health system constraints;
- to generate and disseminate knowledge, guidance, and tools in specific technical areas related to strengthening health systems and services;
- to enhance coordination and efficiency as well as leverage predicable and sustained aid delivery for health;
- and to ensure mutual accountability and monitoring of performance.
The IHP+ aims to achieve these objectives through its mandate for building and coordinating partnerships between major donors, the “Health 8”, recipient country governments and civil society as well as a handful of important other initiatives and institutions.
Donor countries that have become members of the IHP+ are predominantly European with the exception of two out of the current 12 members (including the European Commission). They are: Australia, Canada, the European Commission, Finland, France, Germany, Italy, Norway, Portugal, Sweden, the United Kingdom, and the Netherlands. Recently there has also been news that the USA is preparing to join the IHP+ in 2009.
Aid recipient governments play a central role in the IHP+. There are currently 10 countries which have become fully inaugurated signatories and four “adjunct” countries which are one there way to joining. Once a member, the country begins working with it IHP+ partner institutions to draft a country compact. This document serves in a similar manner as a poverty reduction strategy paper (PRSP) but strictly for the strengthening of national health systems and services. Current IHP+ countries are: Burundi, Cambodia, Ethiopia, Kenya, Madagascar, Mali, Mozambique, Nepal, Nigeria, Rwanda, Uganda and Zambia. Adjunct countries include: Benin, Burkina Faso, Ghana and Niger. In 2008 country compacts where finalised and signed for Ethiopia and Mozambique. At the first Ministerial summit of the IHP+ in February 2009, Nepal became the third country to sign a compact.
International Organisations: In recent years nary an international development of health conference goes by without at least one speaker making reference to how overcrowded the international arena has become. The IHP+ seeks to improve coordination with the plethora of actors which have come on to the stage. The principle group of such actors are referred to as the “Health 8” or “H8”, and these are: the WHO, the World Bank, GAVI, the Global Fund to fight AIDS, TB and Malaria, UNICEF, UNAIDS, UNFPA, the Bill and Melinda Gates Foundation. In addition three other important multilateral organisation are also members of the IHP+, namely the African Development Bank, the European Commission, and the OECD-DAC.
The bulk of the IHP+ work is carried out at country level by inter-agency country health sector teams. These teams are led by representatives of the national government (Ministry of Health), and consist of development partners, including the H8 country-team members, bilateral donor organisations, local civil society, private sector actors, or other implementing bodies at the country level. An inter-agency core team has been set up at the international level which sees to the day-to-day coordination of the IHP partners and responds to the Inter-agency country health teams’ needs for technical and administrative support. The core team is a joint operation of the World Bank and the WHO and its members are based in Geneva, Washington D.C. and Brazzaville. Also at the international level is the scaling-up reference group (SuRG) which provides oversight and strategic direction for the IHP+ process and the core team.
More on IHP and Related Initiatives
Providing for Health (P4H):
The P4H initiative was launched at the G8 Summit in Heiligendamm in June 2007. The main focus of the initiative is improving systems for social protection in developing countries. P4H was a response to issues raised at previous G8 Summits and milestone international conferences in Berlin on social health insurance in December 2005 and in Paris on social health protection, organised by President Chirac in March 2007. The core group of participants consists of Germany, France, Norway, WHO, ILO and the World Bank.
The Objective of P4H is to work with partner countries (upon request) to develop equitable national health financing systems that will be able to attain and maintain universal coverage/social health protection. More specifically the P4H aims to reduce out-of-pocket payments for healthcare by increasing the extent of prepayment and risk pooling; improve the efficiency and equity of available resources, and support countries to raise more funds for health, where necessary. Within the context of IHP, the role of P4H is to strengthen the focus on the sustainability of funding and help to create synergies between the development partners in order to avoid unnecessary duplications. While P4H will be actively involved in the activities of IHP, P4H scope of country activities will not be limited to countries IHP is working with.
Harmonization for Health in Africa (HHA):
The Harmonization for Health in Africa mechanism is consolidating itself as the operational and capacity building support modality to countries and development partners to: facilitate evidence- and country-based planning, costing and budgeting for health outcomes; develop national capacity through training and peer exchange; facilitate alignment of programmes to country processes and harmonization; identify, plan and address health systems constraints to improve health related outcomes; promote the generation and dissemination of knowledge, guidance and tools for specific technical areas including strengthening health service delivery and monitoring health systems performance support countries to leverage predictable and sustained resources for the health sector ensure accountability and assist in monitoring performance, of national health systems, aid effectiveness and the performance of the International Health Partnership enhance coordination to support nationally owned plans and implementation process, helping countries to address the country level bottlenecks arising from constraints within international agencies
The HHA works within existing development and financing frameworks such as SWAps, budget support, poverty reduction strategy papers and IHP+ country compacts. The HHA intervenes upon recipient country demand.
HHA is a regional collaborative effort that has been developed by the African Development Bank (AfDB), UNFPA, UNICEF, UNAIDS, WHO, and the World Bank, the HHA is an Action Framework for ‘tackling the barriers to scaling up in health’. The HHA was formed in response to the recommendations of the Paris Declaration.
Innovative Results-Based Financing (RBF):
Innovative Results-Based Financing (RBF) aims to help governments to achieve their national health goals by organising their health systems in different ways. The goal is to shift the emphasis away from distributing and using resources and move it to results. As defined by the World Bank, “RBF refers to a range of mechanisms designed to enhance the performance of the health system through incentive-based payments. RBF is an umbrella term that includes output-based aid, provider payment incentives, performance-based inter-fiscal transfers, and incentives to households for adopting health-promoting behaviors. What these mechanisms have in common is that a principal entity provides a financial or in-kind reward, conditional on the recipient undertaking a set of pre-determined actions or achieving a pre-determined performance goal.” At its essence, RBF is an experiment to extend the principles of “pay for performance” from the OECD where it has become a popular tool for public management, to international cooperation for development.
In November 2007 the RBF initiative was launched with a $105 million ‘Health Results Grant’ from the Norwegian government to the World Bank to establish a multi-donor trust fund-the Health Results Innovation Trust Fund. Under this initiative the World Bank has been tasked to design, implement and sustain successful results-based financing pilots targeting MDGs 1b, 4 and 5 in six countries. The pilot projects will build on knowledge already gained from Bank projects in results-based financing and are set to begin in 2009.
Deliver Now for Women and Children:
Deliver Now for Women and Children launched in 2007 to increase public awareness and support for achieving the health millennium development goals which focus on maternal and child health. It is an advocacy drive which aims to increase political commitment to the cause. Announced at the Clinton Global Initiative, the campaign is jointly funded by grants from the Netherlands and Norway, and it is coordinated by the Partnership for Maternal, Newborn and Child Health-an umbrella organisation bringing together 260 members together since 2005. The deliver now campaign was first launched in New York, and in 2008 was successfully launched in Chile, Tanzania and India.
Health Metrics Network (HMN):
The Health Metrics Network is a partnership between the African Population and Health Research Centre, the Centers for Disease Prevention and Control in Atlanta (CDC), the Bill and Melinda Gates Foundation, the international development agencies of Denmark, Sweden, the UK and the US (DANIDA, SIDA, DFID, USAID), the European Commission, GAVI, the Global Fund, the World Bank, the Ministry of health of Ghana, Mexico and Thailand, Statistics South Africa, the Ugandan Bureau of Statistics, UNICEF, UNFPA, the UN Statistics Division, the OECD, and the WHO. Its aim is to improve the quality and coverage of information on health at the global, country and local levels. The Network provides added value by promoting donor alignment toward this goal, fostering technical advances and disseminating experiences and good practices. Currently the methods used for to collection and application of data on health are fragmented between and even with countries. The Network strives to align methods around a common framework thereby allowing improved quality and access to health information. As of early 2009 the Network was working in 65 countries.
Global Health Workforce Alliance (GHWA):
Formed in May 2006 the GHWA is a global partnership between the international development agencies of France, Canada, the UK, Ireland, Norway and the US (Agence Française de Développement, CIDA, DFID, Irish Aid, NORAD, USAID), the Bill and Melinda Gates Foundation, the Asia Pacific Action Alliance on Human Resources for Health (AAAH), the African Medical and Research Foundation (AMREF), East, Central and Southern African Health Community (ECSA), the International Council of Nurses (ICN), Realising Rights (The Ethical Globalisation Initiative), Results for Development Institute (R4D), University of Ottawa, the WHO and the World Health Professionals Alliance (WHPA).
GHWA is a platform for joint action to address the health workforce crisis. The stated purpose of the GHWA is “to highlight the crisis and keep it on the global agenda, convene members, partners and countries to work together to find solutions, advocate for their effective implementation and facilitate the sharing of knowledge and best practices on health workforce issues.”
Useful Web Sites
- International Health Partnership and Related Initiatives
- WHO and German Federal Ministry for Economic Cooperation and Development, Report on the Technical Meeting on “Providing for Health”, Bonn, 2007
- Harmonization for Health in Africa: An action framework
- The World Bank: Health Systems and Financing: Results Based Financing
- Deliver Now for Women and Children
- Health Metrics Network
- Global Health Workforce Alliance