Aid In Mozambique
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The document discusses health care systems and funding in Mozambique. It outlines the various sectors involved in health including public, private, NGOs, and traditional/alternative care. It also describes the types of funding for health care including vertical, horizontal, and diagonal funding. Vertical funding for specific diseases has increased from organizations like PEPFAR, Global Fund, and foundations. While this funding has increased dramatically, questions remain about whether NGOs effectively strengthen health systems or divert resources and can fragment services.
Aid In Mozambique
- 1. James Pfeiffer PhD, MPH
- 4. Health Sector Public sector services Private sector services NGOs Traditional/alternative care Civil Society Black market Other sectors related to health (agric, education, water)
- 5. Health Care System Public sector health care - Human resources - Infrastructure (bricks & mortar) - Training institutions - Pharmacy - Laboratories - Logistics - M&E, SI, data systems - Research
- 6. Health Sector Funding: Vertical, Horizontal, Diagonal Vertical - Disease specific/ project specific - Channeled into MOH, external projects, NGOs Horizontal - Strengthens cross-cutting systems - Strengthens admin and basic institutions Diagonal - Uses vertical funds to strengthen system
- 7. Foreign Aid to the Health Sector Bilateral Multilateral Foundations
- 8. Recent Increase in Vertical Funding PEPFAR Global Fund World Bank (TAP) Bilaterals Gates Foundation Clinton Foundation
- 9. DAH from 1990 to 2007 by channel of assistance Source: IHME DAH Database Channels of assistance: New actors
- 10. Dramatic growth in DAH from 1990-2007 Source: IHME DAH Database DAH from 1990 to 2007 by source of funding
- 11. Mozambique Ministry of Health State budget Common Fund - Technical assistance and provincial support - Drugs - General Vertical Funds SWAp process
- 12. Donors to the Mozambique Health Sector “ Like-minded ” - Western European donors - Multilaterals Single-minded - United States Foundations
- 13. Mozambique: Relative Weight of Vertical Funding
- 14. 2007: Total funding by Agency ($ 157 mln.)
- 15. Vertical Funding to the MOH ($ 29 mn.)
- 16. Who gets the rest of the vertical funds? ICAP EGPAF HAI Vanderbilt Save Care World Vision PCI PSI And on and on……
- 17. Do NGOs Strengthen Health Systems? Our critique: Divert aid funds from public sector health care system Fragment the provision of services/difficult to coordinate Foment disruptive turf wars Push pet projects of questionable value Contribute to brain drain Not sustainable
- 18. Distribution of Health Workers in Selected Countries
- 19. What is to be done? Will an “NGO Code of Conduct for Health System Strengthening” help?
Editor's Notes
- #4: This shows the presence of the various funding partners across the various provinces. As you can see the howl coutnry is covered with their flags and logo´s. Technical agencies such as WHO and UNICEF are practically present in all provinces. Other mainly bilteral are only present in one (Denmark, EC, Finland, Flanders France) or two provinces (Catalunya, Ireland, Italy, Spain, Swiss, UK). Within each province an agency often covers only one or a few districts.
- #15: Source: Info from questionnaire This graph gives an overview of the amount that all individual partners vertically fund. To which extent this gives the full picture is difficutl to say, but thanks the good response from our health partners, it may be rather complete. By far the singel biggest source of vertical funding is PEPEFAR, which contributes roughly. 57 $Mln. UNfortunately it did not provide us with a breakdown by province or at central level. We know anyway that certain funding, coming from international organisations is not always included. An example is the contribution of ILEP partners in this country, that generate funds globally. Also the contributions of various international NGO´s, such as MSF, that may generate own funds or get support from other sources is not included. Also are missing a couple of other global initiatives such as GAVI, Bill and Melinda Gates etc.. Are there contributions from the group of possible other sources not yet mentioned?
- #16: Both in this and in the following slide the contribution of PEPFAR funding is not included. With the information we came to a total of 29 $Mln. of vertical funding at central level ministry. Most of the funding is earmarked for the two ND that provide medical services or run health programmes (Direccao de Promocao de Saude e Doencas endemicas). Earmerkaed support to the DPC is also considerable Far less is eearmarked to the DN´s that are responsible for the supportive systems such as DRH and DAF. Next year the HR department may receive much more input from i.e. PEPFAR