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7th European Congress on Tropical Medicine & International Health Barcelona, 3-6 October 2011

Comparative analysis of two different

approaches to putting IHP+ into

practice: Mali and Benin

Elisabeth Paul1*, Issa Berthé²* and Salif Samaké²

1 Université de Liège, GRAP-PA Santé, Belgium (E.Paul@ulg.ac.be)* 2 Cellule de Planification et de Statistique du secteur santé, Mali

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1. Introduction

• International Health Partnership and related

initiatives (IHP+) launched in 2007, seeking to

achieve better results in health / MDGs

• At country level: “Country Compact”









commitments // SWAp:

– To support the NHP in a common framework

(coordination, fiduciary, M&E)

– To respect the principles of aid effectiveness

(including financing modalities)

• Determining features:

(3)

2. Methods

• Comparative analysis of IHP+ country Compact

preparation and implementation in Mali and Benin

• Mali: the 3 authors have been supporting +

documenting the SWAp & IHP+ processes for

years + interviews

• Benin: follow-up of the SWAp process since 2004,

(4)

3. Results (1/6)

1. In Mali:

• Functioning SWAp since 1999



 achievements:





– Ownership (national policy documents, steering bodies,

bottom-up planning process, …)

– Donors align on the NHP, participate in steering bodies – MoH capacities strengthened  leadership

– Partial alignment on (improving) national systems – Joint missions, annual audit

– HSS efforts, in a more coherent way

– Trust building, transparency of processes, improved

(5)

3. Results (2/6)

1. In Mali:

• IHP+ builds on strong SWAp grounds:

– Joined in 2007, country Compact signed April 2009 by

MoH + 13 donors (

only

– out of about 50!!)

– Preparation process extremely inclusive (trust), under

MoH leadership

– Common M&E matrix (35 indicators) – Preferred aid modalities

– IHP+ Compact uses SWAp framework / bodies 

implementation and M&E started immediately

– Increased domestic resources allocated to Health – Improvement and acceleration in reporting

(6)

3. Results (3/6)

1. In Mali:

• IHP+ has an added value compared to SWAp…:

– Compact preparation process (1,5 year) accelerated the

preparation of the HRH policy and revision of MTEF

– Rather strong commitments (19 for GoM, 8 for donors),

followed-up during the PRODESS steering bodies  mutual accountability

– Preparation of the new NHP supported by CHPP &

JANS

(7)

3. Results (4/6)

1. In Mali:

• … but there are still important problems:

Donor proliferation (about 50)

Still many targeted projects (geographically or thematically) rather than general support to HSS

Donors keep intervening at procurement stages

Donors maintain individual missions/audits in addition to joint ones

Ex post predictability of external funding still weak

National financial procedures sometimes cumbersome

Donor have not yet kept on their promise to increase aid to health in Mali

(8)

3. Results (5/6)

2. In Benin:

• No real SWAp until recently:

– Governance problems within the MoH

– Donor fragmented / disengaged from health sector

– Donor coordination mechanism exists, but MoH

not very involved

– Embryo of SWAp following the NHP 2009-2018

• IHP+ seen as the impetus for building a SWAp

(9)

3. Results (6/6)

2. In Benin:

• IHP+ seen as the impetus for building a SWAp (c’ed):

– Short preparation process, under the leadership of

UNICEF (lead donor)







 no agreement on the

common framework / “minimalist” commitments:

– Coordination / M&E framework not defined

– Fiduciary framework / preferred aid modalities not defined

– Implementation has been slow to start up

– Positive prospects:

– Donor-led harmonization initiatives expected to make it

happen (joint HSS platform + BTC)  harmonization

(10)

4. Conclusion

• IHP+ grounded on general SWAp

principles, but implementation very

country-specific



 hence results will be such!





• Need to carefully monitor implementation

• Benin starts with less assets than Mali, but

in both countries IHP+ has stimulated a

new dynamic

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