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Harmonization and alignment in development assistance for health: now what?

Cristian Baeza's picture

SDM-NP-101 World Bank

The International Health Partnership (IHP+) has done an exceptional job the last three years in bringing together countries, donors, international financial institutions, civil society, the United Nations, and many other partners to agree on how, concretely, we would implement the principles of the Paris Declaration on Aid Effectiveness. It’s a complex, demanding, and crucial task.

We support countries’ efforts to improve the lives of millions of people—but we often accompany this support by burdening countries with many different reporting, fiduciary, monitoring, evaluation, and other systems. Five years ago, we didn’t have a venue to discuss, or know, what good harmonization and alignment could look like, and we hadn’t agreed to common fiduciary, monitoring, and evaluation systems.

But today, in large part to our shared efforts in the context of IHP+ and country leadership, we’ve agreed on a joint assessment of country health strategies, a common financial management approach, and on some aspects of monitoring and evaluation. And we have outstanding country examples such as Nepal.

Why, then, isn’t this happening at a speed compatible with the urgency of the task? If we have examples and agreements, what’s stopping us?

Our efforts to sustain and scale up our support to countries’ efforts to improve the health conditions of millions are undermined by many examples of lack of harmonization and alignment. It is imperative that we now must walk the walk, since for some time, we’ve talked the talk.

Through our work on the ground, we—the bilateral organizations, World Bank, Global Fund, GAVI, regional development banks, foundations, civil society—will achieve the much-needed harmonization of approaches and systems among partners and alignment with country leadership priorities. It’s through country leadership making us accountable that we will not only walk the walk, but run ahead. It is urgent.


I agree that this urgent - to stop the chaos that donors create in poor low-income countries by funding their own projects instead of putting their resources behind each country's health system. However I am concerned whether donors still care about this and whether any real action will happen. The Health Systems Funding Platform is very unclear now that the Global Fund has cancelled Round 11. Busan was not very inspiring. Will the Bank fasttrack the HSFP into the next stage where multilaterals money is made available to support national health plans as soon as a JANS assessment is carried out? The Bank and WHO really need to champion this process.

Simon, Thank you very much for your comment. We believe now, more than ever, that it’s important that we as donors align behind comprehensive national health sector strategies that articulate the priorities of countries and that we should resist the urge to cherry-pick interventions. We hope that the current events at the Global Fund will not pose an obstacle for them to continue work in IHP+. We are confident that once the immediate urgency to put in place the important set of reforms the Global Fund has undertaken, we will continue working together in both IHP+ and the Platform. At the World Bank, we are fully committed to IHP+ and the Platform. It is a priority for us. In countries that have requested Bank operations, we’ve worked with our partners on JANS and use its results — and harmonized and increasingly aligned agreements on financial management and M&E — as a critical input in the preparation of World Bank programs under the leadership of the country. Very best regards, Cristian

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