A consensus is emerging from the information IHP+Results has collected in Mozambique.  Here are a few general themes:

1)     Many respondents considered the IHP+ Global and Country compacts a way to align all donors with the pre-existing SWAp mechanism, harmonising funding and monitoring and evaluation processes.  While there is some consensus that the SWAp mechanism is strengthened, more effective monitoring and evaluation seems to be more of a hope than a reality.  Respondents, including CSOs, noted that some donors were not participating and that this limited the effectiveness of these alignment processes.  The Ministry of Health (MoH) highlighted the difficulty in moving faster in terms of coordination of actions and planning at the different levels of the system.

2)     Respondents mentioned a perception that the IHP+ process would bring increased funding, especially on-plan funding, but this is not always reflected in the funding promised and disbursed. While the MoH reported that funding was not increasing (due to scarce resources), many donors were committing over the longer term, DFID in particular. The MoH reported unfilled funding gaps and a serious shortage of health personnel, to be mitigated by the implementation of a 5-year strategic plan for human resources. It was noted that the Joint Annual Evaluation often reported weakness in implementing plans.  Others, including CSO respondents, noted that their participation in planning was not as easy and open at district as at central level.  This was because, while M&E was relatively harmonised at national level, at district level different sets of indicators are used, making reporting much more cumbersome.

3)     Funding was a critical area, both for supporting country plans and for using country systems. All of those respondents who signed the 2008 MoU, which specified that funding should be based on results, stated that their activities were consistent with country plans.  However, the focus was more on inputs than on outcomes/results, and on trying to foster improvements rather than penalising results below expectations.. An area of weakness was procurement, considered by many respondents as reasonable for domestic purposes but not meeting international standards.  The MoH recognised this, aimed at more training/recruitment of qualified staff and noted procurement delays had led to them not being able to spend all their allocated funding.

4)     Poor quality of data also reduces the focus on results. Despite improvements in information systems results, as reported, were not of much help to make rational and results based funding.,  The majority of respondents were not satisfied with the quality of data; however they were reluctant to withdraw funding unless results were very bad, leaving decisions based most definitively on the overall objectives of the agency rather than on the reported results in-country. This reflects acknowledgement of both system progress over time and the genuine commitment of some donors to supporting further improvements in country reporting processes and procedures. Monitoring and evaluation were widely considered the weakest aspect of the system performance in Mozambique.

5)     Trust was a key theme. Some respondents reported a lack of trust among donors and between donors and the MoH, as well as a lack of trust in the strength of reporting mechanisms and the quality of the data.  CSO respondents also mentioned that lack of trust also undermined mutual accountability.  Most partners participated in the PAP partner evaluation system, but it was widely described as unenforceable, with no sanctions for poorly-performing partners.  On a more positive note, one or two responses stood out for their emphasis on attempts to build trust and to create a dialogue in order to improve relations as well as the outcomes of the planning and implementation processes.  These differences in approach seem to indicate a change from the consensus in early days of SWAp. It seems that, as with Zambia, partners are confronted with challenges to build increased trust and dialogue that are key to reliable and successful development in the health sector.

These are the key messages appearing across the responses to our Country Representative’s questions in Mozambique: are they reflected in your experiences? Do you have any other themes to add, or contradictory experiences?  Sign up to leave us a comment and let us know what you think.