Report on Joint SWAp Learning Event for the Health Sector in Nicaragua, May
2006
1. Key data
Country: Nicaragua Sector: Health Dates: 2-4th May
No. of participants Government Donors Civil Society
M F M F M F
3-days event – see note 11 10 3 8
Senior level event Not included
Facilitators (names) Nils Boesen, Miguel Orozco, Mario de Franco
Residential /Non-residential Non-Residential (but 30 minutes outside town)
Note: Additionally, around 5 govt officials and 4 donor representatives participated part-
time
2. Evaluation summary
Evaluation Summary Average Average re-
(1:very good – calculated to 4-
5: unsatis- point scale (see
factory note)
1. Achievement of the objectives of the event 1.2 1.2
2. Relevance of the event to my work 1.2 1.1
3. Balance between “theory” and “practice” 1.6 1.4
4. Mix of methods used 1.5 1.4
5. Materials provided 1.2 1.2
6. Quality of group work exercises 1.6 1.5
7. Facilitator’s communication skills 1.2 1.2
8. Logistics and overall organisation 1.3 1.2
Overall average 1.4 1.3
(Note: To make scores comparable with the four-points scale which will be used for other
events, the score has been re-calculated (y = ((x-1)/4*3)+1)
3. Key issues from the evaluation formats:
97% of the scores were very good or good, 3% satisfactory. Lowest average score for a
participant was 1.9 (5-point scale). See the detailed score in the annex.
Strengths and weaknesses mostly focused on the value of having local level staff in the
event, the presence of central ministries, and donors new to the SWAp. The absence of
civil society (one invited representative did not show up) was found to be the main
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weakness. The room for frank and open discussion about key issues was stressed, as well
as the quality of presentations, including by national actors. See details in the annex.
Comments in general focused on follow up needs and composition of participants as
much on the quality of the event as such. There were only few comments mentioning
specific modules, and no negative comments to specific modules, indicating that all
subjects were felt relevant, important and addressed in a suitable manner.
Overall, the key messages from the evaluation formats are:
Importance of having local level and local experiences present
Importance of broad representation (central ministries, civil society, donors at
the margin of the SWAp process)
Importance of follow up of the event
(The organizing group has already circulated a draft report with a number of suggestions
regarding follow up).
4. Status of the SWAp, the Sector Programme and donor support to the sector
programme:
Nicaragua is a pilot country in pursuing the Paris agenda of harmonization and alignment.
The health sector is clearly the sector where SWAp is most advanced, work to advance in
this direction has been ongoing for 3 years. As a result, the core staff of MINSA
(Ministry of Health) as well as most donor staff were well versed in the basic concepts
underlying a SWAp. Both MINSA, the Ministry and Finance and the Ministry of External
Relations had ready-made presentations on sector level SWAp, MTEF and general
harmonization and alignment processes, which all were fully consonant with current
international thinking.
There is a clear government ownership of the SWAp process in health. The Minister, who
made a brief speech at the event, was clearly demonstrating her personal knowledge of
the concepts, and gave clear support to continuing the process.
Below, some few observations to each of the focus areas discussed during the event:
Policy: A policy framework exists, coherent with Nicaragua’s macro level plans, and
expressed in a 2004-2015 health policy, and a 2005-2009 Strategic Plan. Donors in
general support the plan as the joint framework for support to the sector. Key challenges
include prioritizing the 5-year plan fully in accordance with available resources, as well
as detailing some policy areas further and modifying others. Opinions on which these
areas are vary between the actors, and a joint agenda for how to proceed sharpening
policies and addressing outstanding critical issues is not yet prepared.
Funding framework: Nicaragua is working towards a full MTEF from 2008 onwards, and
MINSA/Health is a pilot sector (together with education and transport). At this stage, the
sector MTEF is focusing on MINSA, the plan is to move towards a programme-based and
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more sector-wide MTEF over the next 2 years. There is a clear tension between the
perception of sector needs and the limitations imposed by the macro-fiscal framework,
and as already mentioned the five-year strategic plan is weakened as planning instrument
by not being fully funded. On PFM issues, new legislation has recently been introduced
to streamline procedures and reduce waste, however, the short time for implementation
may some worry that it may lead to serious problems at the local level.
Capacity development: MINSA has a capacity development plan which largely focuses
on internal-functional aspects (information systems, planning procedures etc.). There
appeared to be a need for considering the local level in this context, as well as a broader
look at external and internal incentives to performance in the sector.
Monitoring, accountability: Though basic instruments and capacity exist, it is an ongoing
challenge to link monitoring and decision-making closer together, and to ensure that
deconcentrated levels have a say when performance targets are defined. In relation to
accountability, there seems to be more work to do to rethink how the sector can
strengthen links to citizens and civil society.
Harmonisation, alignment and support mechanisms: Development partners fall broadly
in 4 groups:1) Those funding (project) activities at the margin of the sector plan, mostly
through NGOs, 2) those within the plan, but without participation in the sector work
group; 3) those who have signed the Code of Conduct and who participates in the sector
work group, an finally 4) a smaller group supporting FONSALUD, a combined budget
support/own procedures group.
There appear three key challenges to move ahead in this area: i) Organise dialogue more
effectively and businesslike, ii) ensure that the dialogue be informed by evidence and
high quality analytical inputs; and iii) ensure that the tensions between different
viewpoints and approaches among partners are converted into positive energy
In summary, there have been clear advances in the SWAp in health in Nicaragua, and the
key challenges for all involved is to ground the process so that focus is also kept on the
realities on the local level, and to add quality content to the formal framework established.
5. The event – preparation and logistics
A joint working group headed by MINSA and involving the Netherlands, Sweden and
UNFPA held several preparatory meetings and thoroughly discussed objectives,
participation, and materials. They identified and added a comprehensive set of national
materials to the binders and CDs distributed to participants. During the preparation
process, they kept close contact with the facilitators, who advised on relevant aspects (e.g.
participation).
Peers from the health sector in Guatemala were invited to the event, but did in the end not
arrive.
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The Embassy of the Netherlands organized all logistics regarding materials production,
venue etc. very efficiently. The venue was appropriate, located at some distance without
being fully residential. However, some participants had to attend other business during
part of the time. On the other hand, it is unlikely that e.g. the Ministry of Finance and the
Ministry of External Relations would have participated full time or at all, had the course
been at a much greater distance.
6. The event – content/substance
All modules were covered and took up the envisaged time. As already mentioned, there
were Nicaraguan presentations in addition to the facilitators’ – this had a highly praised
effect of tailoring the event to the current situation in the sector.
The Next Steps group (5 persons) was formed the first day at lunch, and gained speed
essentially in the last half of the event. They ably managed the last session and made a
comprehensive presentation of messages and issues, and they forwarded a number of
recommendations on local follow up work. There was, form the beginning, a strong sense
that the event was to be carried on, and the idea of a next step group was therefore readily
accepted.
7. The event – process/methods
Because of strong local inputs, we ended up skipping all exercises, but we had, in
virtually all modules, a group session allowing for discussion. These sessions were
mostly based on the pre-prepared questions, which in some cases may need review for
relevance.
As we were 3 facilitators, of whom two were local and thus new to the specific content of
the package, we had decided that one facilitator (Miguel Orozco) would concentrate on
facilitating the group sessions (which he did very ably). The other Nicaraguan – Mario de
Franco – covered macro-policies in relation to sector-policies, as well as the PFM module,
this also worked very well.
Participation was fairly evenly distributed, though some development partners were
rather vocal. Notably, the representatives from the local health system level were given
and took the chance to express themselves. All in all, the balance between presentations,
plenary and group work appeared to be rather adequate.
8. Recommendations
In so far as the SWAp process is concerned, the following is recommended for
consideration by the various partners (most of which is what the group already has put on
the table):
i) Keep the SILAIS-level involved. Regular involvement of SILAIS
representatives (and as pertinent the municipal/local level) can strengthen the
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essential feedback between the policy level dialogue and the implementation
level.
ii) Develop a more “executive” sector wide approach: To get more partners on
board, and to ensure continued efficiency of the SWAp, the partners should
develop content and procedures so as to become more business-like: cutting
meetings down to size and agendas; ensure technically well prepared
encounters; as well as systematical follow-up on themes and joint decisions;
etc.
iii) Load more evidence and technical content into the work. Sharing an agenda
for analytical work allowing addressing bottlenecks and special “hard”
problems and constraints in the sector could both be a step in the
harmonization process and allow the required deepening of the substantive
quality of the policy and implementation dialogue.
iv) Follow-up on the joint learning event: While more general events may be
useful at a certain point in time or for introducing other audiences to the
Health Sector SWAp, it seems more urgent – and more constructive with a
view of getting more development partners on board the process – to aim for
joint events focusing on particular health policy areas or other substantive
themes of joint concern (e.g. health sector financing models; or challenges in
monitoring; or capacity development at the local level, etc.). Such events
should count on the participation of recognized expertise as well as relevant
peers from the region, and as necessary build on shorter papers or more
thorough analytical work.
v) Consider joint training in conflict resolution/negotiation: Short, highly
professional basic training in conflict management and negotiation for a joint
group of government and development partners in the sector could be a
helpful way of enhancing the collective capability of the group to move
forward in a constructive manner.
In so far as future Joint Learning Events in other countries are concerned, the following is
recommended:
i) Ensure involvement of government staff close to front line service delivery
ii) Consider always to insist on local presentations
iii) Consider regularly to involve a local facilitator who may be able to assist the
sector partners in carrying the process forward after the event.
9. Innovation
SILAIS staff from remote areas of Nicaragua were asked to take participants on a virtual
visit to health outpost, and vividly described the capacity, services and constraints under
which the health sector has to function there. This might be developed to a more
systematic way of ensuring a way of making central level SWAp processes “meet” reality.
May 8th, 2006
Nils Boesen
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Annex 1: Evaluation comments and score
Summary of comments:
What was the best/ most useful?
The room for frank and open discussions between the key partners & govt. staff,
praising the presence of donors and vice versa.
Participation of different actors, particularly from local levels of the health system.
Shared language and joint understanding between all partners
Presenter’s knowledge about the subject, empathy and conduct /management of
the event; mixture of international and local facilitators
Presence of Min of Finance and Min. of ext. relations
Sector approach at the local level
Being outside Managua, at some distance from the offices
What can be improved
Include more local participation (municipalities, NGOs, private sector)
Some discussions could not be finalised. Should be deepened in joint technical
meetings.
The link between the conceptual framework and the national legislation and
practice.
Combine academic activities with cultural/social events.
Although of high quality, the “technicality” of some presentations may have made
them difficult to follow for those who had not previously been exposed to the
concepts..
A more thorough discussion of one of the themes. A monitoring exercise would
have been good.
More continuity in this kind of work processes, the follow up and establishment of
a network of working groups
More emphasis on strength/weaknesses of SWAp experiences in other countries
Be even further away from offices
Other comments
The concepts should be spread among SILAIS directors and in the territory.
A similar event should be held for central govt. agencies (Finance, Presidency,
External relations)
Short “SWAp literacy” events for central level
Such a joint event should be held annually to monitor progress in the sector
programme
All other themes expressed were important, including presentations by Min of
Finance and External Relations.
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Nicaragua Health Sector May 2006 - evaluation summary
Overall Govenrment Donors
Average 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7
1 Objectives 1.2 1 2 1 1 1 1 1 1 2 1 1.2 1 2 1 1 1 2 1 1.3
2 Relevance 1.2 1 2 1 2 1 1 1 1 1 1 1.2 1 2 1 1 1 1 1 1.1
3 Theory/practice 1.6 1 3 1 3 1 2 2 2 2 1 1.8 1 2 1 1 1 2 1 1.3
4 Mix of methods 1.5 2 3 1 2 1 1 2 2 2 1 1.7 1 2 1 1 1 2 1 1.3
5 Mateirals 1.2 1 1 1 2 1 1 1 2 1 1 1.2 1 2 1 1 1 2 1 1.3
6 Group work 1.6 2 2 2 3 1 1 2 2 1 1 1.7 2 2 1 2 1 1 1.5
7 Facilitators 1.2 2 1 1 1 1 1 1 2 2 1 1.3 1 1.5 1 1 1 1 1 1.1
8 Logistics 1.3 1 1 1 1 1 1 2 2 2 1 1.3 1 2 1 1 1 2 1 1.3
average 1.4 1.4 1.9 1.1 1.9 1.0 1.1 1.5 1.8 1.6 1.0 1.4 1.1 1.9 1.0 1.1 1.0 1.7 1.0 1.3
about right 14
too short 2
too long 1
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