In Ethiopia, recent health planning implements country ownership and accountability and managing for results, based on the Paris principles reflected in the IHP+. 

Shared planning system aligns objectives

Woreda (district level) planning combines both top-down and bottom-up processes. Using the Health Sector Development Plan HSDP and MDGs, the FMoH and development partners select the key indicators and targets for the development of Woreda plans.  The FMoH discusses these with the regions, who add indicators appropriate to their regional contexts, and then the zones and Woredas adapt the indicators and targets to their conditions by adding and rearranging targets and priorities.  A comprehensive Woreda plan is thus developed, with activities under each indicator, targets and costs and resource gaps indicated. The idea is that the Woredas will eventually align their respective plans with the MDGs and HSDP targets by using common indicators, although additional indicators may be used.

Another benefit of Woreda-based planning is that it clearly articulates the duties and responsibilities of all stakeholders: the FMoH, regions, Woredas and development partners. Resources are mapped and gaps are identified for resource mobilisation, both internally and from development partners.  Woreda planning aims to make the principles of harmonisation and alignment a reality, providing the basis for one plan, one budget and one report.

Developing more responsive planning

Woreda planning started three years ago and is now operative in all 800 Woredas.  The FMoH has signed an agreement with the regions that represented their respective Woredas in the annual review meeting held in October 2009 at Dire Dawa.  Woreda planning has been further improved this year in two ways. First, by introducing the Marginal Budget for Bottleneck (MBB) software, which makes use of tracer intervention. Tracers are selected and grouped and six determiners are selected for each key tracer.  For example, for antenatal care: (i) human resources, (ii) institution, (iii) geographical access, (iv) material supply and (v) initial utilisation, (vi) continuous utilisation as determinants. 

The first four are supply determinants and the last two are demand determinants. If the tracer intervention says antenatal care shows improvement, it is assumed that the other determinants are also improving. This software simplifies and reduces the number of indicators to be considered when looking at performance.  The second intervention is the identification of necessary resources, funding gaps and activities and roles to be performed by FMoH, regions, zones, Woredas and various development partners in order to implement the activities identified.

Woreda planning puts IHP+ principles into practice

Implementation of Woreda plans is monitored and evaluated regularly using routine HMIS and administrative information/data. Every Woreda has a monthly assessment, and Woredas, zones, regions and the FMoH conduct quarterly and annual reviews and evaluations of performances. Decisions are made based on findings and problem areas are identified and actions recommended.

Reflecting the IHP+ core principles of country ownership, accountability, managing for results, and monitoring and evaluation of outcomes and processes, Woreda planning and implementation is also increasingly harmonized and aligned.  It will gradually develop into evidence-based institution (facility-based) planning, ensuring that concrete action is taken in response to the realities in each service-receiving community.

Future challenges for unified reporting

The strategy in place reflects the aspirations and key principles of the IHP+, but the major challenge is to build the planning, monitoring and reporting capacity of the Woredas. Currently, they have been given training by the FMoH. Experts from the centre, including development partners, worked with Woreda experts to develop the Woreda plan. The hope is that Woredas will soon develop the necessary capacity in planning, monitoring and evaluation and reporting in order to provide accurate monitoring and reporting of their activities. It is important that they receive the necessary support of development partners to enable this to happen - see other blogs on this topic.

Hailom Banteyergu is the IHP+Results Country Representative for Ethiopia.