How Nepal Implements Global Health Initiative

By Mina Fabulous    

Senior GH Advisor Mark Austin today discussed how the "Plus Country" Nepal is implementing Global Health Initiative.

"Among the opportunities to see USG-supported programs in action in rural and urban communities, we also had multiple opportunities throughout our stay to speak with Ministry of Health and Population (MOHP) officials and other donor representatives. At each of these meetings one thing became quite clear: the collaborative environment between the Government of Nepal (GON), the U.S. Government (USG) and other donors is remarkable...and certainly worth highlighting." -Mr. Austin

Costumed Hindu-girls in Nepal. The two small children represent the god Krishna and his consort Radha. Sitting behind are the god Vishnu and his consort Lakshmi. Wikimedia Commons

He stated that one issue that he has raised in country after country where he have worked or visited is the issue of the "basket" or of "pooled donors and non-pooled donors". He said in many countries, including Nepal, there are health development partnerships that use the term, Sector-wide Approach (SWAp). The SWAp usually refers only to donors that contribute resources to a "pool" or "basket" without strings, which is managed by the host government.

"But in Nepal, all health donors whether they pool their resources or not, or even if they provide earmarked funding to the GON or not, are considered part of the SWAp." -Mr. Austin

He cited that the SWAp partners worked with the GON to produce the Nepal Health Sector Implementation Plan, Phase II, (NHSP-II) 2010-2015, and some partners committed to pooling their resources, some partners like the USG committed to earmarking but directly funding GON activities through their funding channels, and others providing technical assistance outside the GON funding channels.

He noted that the USG commits most of its funds to technical assistance outside the GON channels, but supporting the NHSP-II, and a certain amount directly into the GON channels, but earmarked, tracked and audited separately and on a reimbursable basis.

"When it came time to prepare the Joint Financing Arrangement (JFA) to manage the pooled funds under NHSP-II, several donors including USAID, asked: we also provide funds directly to the GON, why don't we also try to harmonize and align these resources and streamline the GON reporting requirements to multiple donors on the use of these funds through the JFA as well?" -Mr. Austin

He stressed that the reasons for the non-pooling approach are many, but the most commonly used explanation refers to the need to ensure that American tax Dollars aren't disappearing into a pot where the funds can't be traced and the results per Dollar spent can't be measured.

"In Nepal, improving aid effectiveness is an important goal within the donor community, resulting in a unique solution that is proving effective to the USG, to the donor community writ large, and to the MOHP and its beneficiaries." -Mr. Austin

He noted that it was recognized among individual donor representatives in Nepal that the exclusion of the non-pooling donors (USG, UNICEF, UNFPA, and others) from the JFA with the MOHP, a key strategic and coordination document, was hampering coordination and not capitalizing on the potential for increased synergies and donor leveraging.

"So rather than trying to convince the non-poolers to change their tune and hop in the pool with the rest, some key individuals, including strong encouragement from the World Bank representative and support from USAID/Nepal, convinced the donor community and the MOHP that a different solution was possible." -Mr. Austin

He cited that the result of all this is that they are now seeing more effective and efficient coordination among donors in support of the NHSP-II and a single set of reporting requirements that the MOHP adheres to (rather than separate requirements to serve the specific needs of each donor).

"We need more bold actions like this to put aside old ways of thinking and to innovate creative solutions. That's what GHI is all about." -Mr. Austin

Mina Fabulous follows the news, especially what is going on in the US State Department. Mina turns State Department waffle into plain english. Contact Mina through NewsBlaze.