The Ministry of Health in Mozambique began developing an HIV and AIDS Strategic Plan in 2003, bolstered by substantial donor support for increased ownership. The Minister took a strong stance in providing guidance and designing the framework for all partners wishing to work in the area of HIV and AIDS, with the Strategic Plan as the guiding document. Decision-making around HIV and AIDS is increasingly integrated into the broader health system – not only in terms of planning and budgeting but also in terms of service delivery, with the aim of achieving greater equity in access to services in general and reducing the stigma associated with ‘exceptionalised’ services for HIV and AIDS.
A Code of Conduct has been signed by donors, technical agencies and non governmental organisations, adhering to jointly agreed principles for engagement in the sector and all partners, regardless of their financing modalities, are expected to fully align their support to the national strategic framework.
The Irish Aid-Clinton Foundation partnership provided the Minister with an opportunity to demonstrate that significant Global Initiatives with a specific disease focus could work in a way that contributed to the attainment of broader health sector goals, while harmonising and aligning completely with government systems. This bolstered the ownership of the Ministry – not only in financial terms with funding being channelled through a common funding mechanism, but in negotiation with other Global Initiatives who subsequently followed suit. The approach taken by the Irish Aid-Clinton Foundation partnership was instrumental in catalysing this strong stance taken by the Minister of Health.
As well as providing a unique opportunity for systems-strengthening, this approach has contributed to the capacity of the sector to demonstrate mutual accountability and to manage for results. A performance framework for the health sector in Mozambique, monitored on an annual basis, includes an indicator for tracking development partners’ responsibilities and behaviour and provides the general basis for joint monitoring and reporting by all partners with a focus on service delivery and improved health outcomes. A yearly joint evaluation by the Ministry and partners is now firmly established as the ‘one’ evaluation and continues to evolve in terms of quality and inclusiveness.
This example highlights the strong leadership and ownership of the Ministry of Health in Mozambique and demonstrates the difference a critical mass of likeminded donors can make to promote adherence to the “three ones” – one agreed HIV/AIDS action framework, one national AIDS co-ordinating authority and one agreed country level monitoring and evaluation system – and to influence global initiatives to use and support existing structures.
Strong leadership by a committed Minister of Health with a consistent focus on building systems and a long-term vision for the sector helps, but broad participation of all stakeholders is essential and transparency and openness of communication are needed. Institutional differences should be respected and common ground sought.
A critical mass of likeminded donors committed to harmonisation and alignment is essential to align to and harmonise with government-led approaches, and involves clearly demonstrating the comparative advantages of individual approaches, creating active debate around them, and reaching consensus.
It is important to have an established Sector Wide Approach (SWAp) which sets the context.
The consistency and congruency of Irish Aid’s objectives in channelling the Clinton Foundation’s funding to the health sector contributed to the partnership’s success.
The client (the people) must always be the ultimate beneficiary. A sustainable and country-owned approach to guaranteeing this is through a strong systems approach led by the relevant ministry. The partners’ role is to unite around this approach.
This original version of this case study was included in the report “Key messages and case studies for the HLF-3 roundtables from the workshop on “Strengthening the development results and impacts of the Paris Declaration on aid effectiveness through work on gender equality, social exclusion and human rights”, London, 12-13 March 2008”.
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