I found Ethiopia’s 11th Annual Review Meeting extremely useful and informative. I need to look more closely at the data presented during the meeting, but I don’t think that it provides all of the data that IHP+Results needs to conduct our independent assessment of the IHP+, and we are likely to require additional information from Development Partners.
Progress and challenges
Speaking to a large gathering of development partners and regional health officials, Minister Tedros discussed the challenges of transforming Ethiopia’s health system. He emphasised the importance of putting new systems into place and strengthening those that are already there, whilst praising successes: the Health Extension Program (HEP) is now in place in almost all villages.
Improvements in health system strengthening at a local level
The HEP has put great efforts into training and facility construction, with over 30,000 health extension workers trained and deployed, and is now ready to focus attention on the delivery and quality of services. It was stated that, if current trends persist, Ethiopia can meet its MDGs. Delivery and quality of services will be supported by the new Health Management Information System (HMIS), which records all necessary data and groups complete family health information in one folder, making it easy to trace family health history. Over 18 million folders have been distributed to health posts across the country. At hospital level an electronic system of recording client information is being introduced with Tulane University as technical lead. Planning is in place in all 800 woredas and reported data is checked against regional-level information; all attempts are being made to plan on the basis of this reported data. As part of the HEP steps are also being taken to strengthen the pharmaceutical logistics system - but donor funding commitments in this area and others have not yet been fully met.
Innovations in social insurance and human resources for health
The review also heard about more innovations in the Social and Community Insurance Schemes. Although social insurance remains to be approved and the community insurance will require a lot of capacity building, trials of the latter are under way in 12 woredas and will be scaled up if successful. Finally, the strategic plan for human resources is complete and the retention mechanism is successful, with material incentives and effective communication meaning 95% of graduates now go to their assigned workplaces.
But what about aid effectiveness?
The IHP+ was quoted as a key element in improved of harmonization and alignment, including of funding and technical assistance, (TA) as well as strengthening monitoring and evaluation. There is increased tendency towards alignment and harmonization of resources coming from Development Partners. The Federal Ministry of Health (FMOH) seems to have realized that alignment and harmonization is going to be a long and arduous process. For this purpose a guideline for technical assistance was discussed in the review and endorsed by partners. The guidance refers to (i) total pooling (ii) mixed pooling (iii) loose pooling. In all the three, FMOH exercise ownership and leadership, activities are aligned to the HSDP, and coordinated and reported to FMOH. Pooling of TA ranges from providing full control of resources and strategic management by FMOH to loose arrangement where the Development Partner manages the personnel management with FMOH controlling use and management of TA. During the review, Development Partners accepted (with modifications) the government system for pooling resources. A joint agreement was signed by seven Development Partners, and four of them have transferred funds. The review recognised that this process is slow but encouraging. The review also noted that monitoring and evaluation has also been strengthened through the development of standardised indicators, in consultation with stakeholders.
These processes are the effect of the IHP+ movement. With regards to effectiveness in the use of funds, some donors think that the government program of speed, volume and quality in health is political. They think that there is the need to be focused instead of trying to reach all. However, the government is determined to reach all, but would work with development partners that they think need to focus in certain areas, say for example where HIV prevalence is high. The ministry wants to work with all irrespective of differences in thinking on delivering health services. This is implied in the guideline for technical assistance.
Useful but not enough – neither for aid effectiveness nor for accountability
The Annual Review provided IHP+Results with a key opportunity to gather data on the indicators we are tracking to measure the implementation of the IHP+. We were encouraged by partners to draw on the data presented as a first step in our data collection efforts, but while it was useful and interesting to attend, there was little explicit discussion about the implementation of the IHP+ Compact or of the commitments. (although this may have been considered in July at an earlier joint review). The review did provide me with a useful opportunity to develop relationships with key partners, and in these discussions I got the sense that the annual review has the potential to become an effective accountability mechanism, but requires work to make it strongeer and more effective for mutual accountability. From IHP+Results perspective, the review needs to routinely consider aid effectiveness measures, and to hold partners to account for the implementation of their commitments. But this is not routinely done in many countries, and Ethiopia is on the right road. I look forward to working with partners during 2010 to help IHP+Results support the development of this important forum as a key accountability mechanism and tool to accelerate progress on health outcomes.
It would be interesting to hear your views on this: can the improvements outlined above be in any way linked to or attributed to the principles endorsed by the IHP+? Sign up to leave a comment and let us know what you think.
Hailom Banteyergu is the IHP+Results Country Researcher for Ethiopia
