UGANDA’S EXPERIENCE WITH MONITORING AID EFFECTIVENESS COMMITMENTS IN THE HEALTH SECTOR Dr. Sarah Byakika Ministry of Health 5th October 2012 HOW IS IT BEING DONE, AND WHAT IS BEING MONITORED? Compact between GOU and Partners for Implementation of the Health Sector Strategic and Investment (HSSIP) 2010/11 – 2014/15 Guiding Principles: Ownership and leadership by government Alignment of all partner programmes, activities and funding to one national plan (HSSIP) and harmonized annual plan Use of common management arrangements Value for money, and One monitoring framework to promote accountability HOW IS IT BEING DONE, & WHAT IS MONITORED? Health Policy and Advisory Committee (HPAC) serves as the main oversight and steering body for monitoring implementation of the Compact. Specifically responsible for; Quarterly review of whether signatories are on track with their commitments . Attendance of the quarterly sector performance review meetings Participating in Annual reviews to monitor whether “Government” has met its commitments with respect to the implementation of HSSIP HOW IS IT BEING DONE, & WHAT IS MONITORED? How it should be done? What is monitored? What is being done? Quarterly review during HPAC Whether signatories are on track with their commitments Not done. No monitoring tool. Quarterly and Annual sector performance reviews Whether government has met its commitments Quarterly and annual sector performance reviews conducted based on the key outputs in the workplan and HSSIP core indicators WHAT IS BEING MONITORED? INPUT & PROCESS OUTPUT Health financing Service access and Information, readiness Governance GGA on health TB case 1 as % of total 5 detection rate gov’t budget Per capita OPD Workforce 6 utilization rate Annual reduction % of HFs w/o of 2 in absenteeism 7 any of 6 tracer rate medicines % of posts filled % functional 3 8 by trained HWs HCs IV Service quality and Infrastructure safety % of villages/ % clients 4 wards with a 9 expressing functional VHT satisfaction 10 11 12 OUTCOME IMPACT Coverage of interventions Health status % pregnant women attending 4 ANC sessions % of deliveries in public and PNFP % children under one year immunized with 3rd dose pentavalent vaccine Maternal Mortality 22 Ratio Neonatal mortality rate Infant Mortality 24 Rate 23 % one year old children immunized Under 5 mortality 25 rate against measles % pregnant women who have Financial risk 14 completed IPT2 protection % of children exposed to HIV % of HHs 15 accessing HIV testing within 12 months 26 experiencing catastrophic pay % UFs with fever receiving malaria 16 treatment within 24 hrs 17 % eligible persons receiving ART 13 Risk factors and behaviours 18 % of households with a pit latrine 19 20 % U5’s new visits with stunting % U5s with marasmus 21 Contraceptive Prevalence Rate HOW ARE FINDINGS BEING USED, AND BY WHOM? Quarterly/biannual and annual reports compiled, discussed and disseminated Annual performance report findings are discussed at the Joint Review Mission; Involves all stakeholders in health Focuses on performance against the core indicator targets, Jointly identify challenges, priority interventions and targets for the remaining period in the FY and subsequent year. Expected to guide planning & resource allocation by government and partners Used for recognition and reward HOW ARE FINDINGS BEING USED, AND BY WHOM? Used to meet other national and global reporting requirements e.g. Government of Uganda Annual Report, Project Reports, IHP+ report WHAT HAS CHANGED, AS A RESULT? Government taking lead in determining sector priorities (HSSIP) and available resource allocation Using a common M&E framework (Country-led) with harmonized M&E tools. Minimised reporting requirements at implementation level Joint Assessment Framework – jointly agreed targets and monitoring avoiding conflicting reports MAIN LESSONS Continuous dialogue necessary to bring all partners on board (Long consultative process) All key stakeholders need to be involved in development of monitoring tools to cater for data/reporting needs, ensure ownership, use and transparency MAJOR CHALLENGES Not all donors are signatory to the Compact Some partners hesitant to adopt the SWAPs – off budget funding which is difficult to program and monitor and may not be aligned to sector priorities Opting for project support and Parallel Implementing Units with focus on achieving project indicators. (skews resources) Difficult to track donor resources due to lack of transparency. (Some do not share MOU, commitments or amounts disbursed with MoH and this information is not easily accessible from MoFPED) Sometimes disbursements are below commitments. Who is to be held accountable? Development Partner Commitments are not assessed or discussed during the sector performance reviews.