A number of key themes stand out from the data we have collected in Zambia. Most obviously, the corruption issue that unfolded during 2009 has meant that some donors have withheld funding and not signed the MoU Addendum. It has also weakened the position of the MoH and their ability to exert influence around Paris Declaration issues such as donor harmonisation and alignment. Harmonisation and alignment are also compromised by the fact that two of the major donors, USAID and JICA, do not contribute to basket funding and are not able to commit to signing any national level IHP+ Compact that may be developed in the future (or the current MoU Addendum) - something that the majority of development partners and civil society organisations are committed to doing.
For their part, donors report that strategies tend to be overly ambitious. This appears partly due to a reluctance of the government to be anything short of comprehensive in their scope, but ironically is also the result of multi-donor priorities (and attached funding) being included when plans are drawn up. Oxfam state that as a result of this partners can do anything they want as activities will always fall within the broad set of national priorities Donors have also criticised the MoH for being too mechanistic in their planning and priority setting, calling for more decisions to be based on evidence, trends and results.
On the whole donor funding is increasing and becoming more long-term and predictable, although again this has been affected by this year’s corruption scandal. DFID are leading the way with a 10-year funding arrangement from 2007 as direct Poverty Reduction Budget Support (PRBS). However, it’s interesting to note the contrast with UNDP, who are decreasing funding, and the Dutch, who are strategically pulling out of health sector support from 2010.
Country systems for procurement are being used bv some donors such as DFID, the Dutch and UNDP, but not others such as UNFPA and UNICEF who consider country procurement systems inadequate for their needs. Donors report using common reporting procedures such as the National AIDS and Health Strategic M&E Frameworks, and Health Sector Reviews are well attended and participated in by development partners. DFID uses the Performance Assessment Framework to monitor their budget support
Although partners report to meet and share information regularly through various groups. there are reports that criticism (of each other) does not occur in a meaningful manner. For example, the SWAp mechanism is not legally binding and therefore partners cannot forcibly hold each other to account. In response to this perceived lack, there have been calls to make the MoU Addendum legally binding so that partners can hold each other to account. An IHP+ Compact would also enable this to happen, but the Government must lead on this, and given their weakened position following the corruption scandal this is not likely to happen soon. Civil society organisations do not appear to feature in these mechanisms in a meaningful manner, although this has improved recently with the appointment of a CSO liaison officer at the MoH stimulating increased engagement. Despite this, Oxfam report that government are only really accountable to donors – due to the funding they provide. – and far less so to civil society and the population at large.
Do these themes echo your experiences and knowledge of the health sector in Zambia? Do you think something is missing or do you have something to add? If so, sign up, leave a comment, and let us know what you think. For more early findings please see our blogs on Cambodia and Mozambique.
This overview does not reflect the perspective of the Zambian Government, nor is it intended as a comprehensive review of all the data collected. A full progress report will be available in early 2010.
