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1|Page Republic of Kenya Ministry of Health Reversing the Trends The Second National Health Sector Strategic Plan ROADMAP FOR ACCELERATION OF IMPLEMENTATION OF INTERVENTIONS TO ACHIEVE OBJECTIVES OF THE NHSSP II Ministry of Health Afya House, Nairobi, Kenya P.O. Box 30016-General Post Office Nairobi 00100, Kenya Email: email@example.com Website: www.hsrs.health.go.ke February 2008 2|Page Any part of this document may be freely reviewed, quoted, reproduced or translated in full or in part, provided the source is acknowledged. It may not be sold or used in conjunction with commercial purposes or for profit. Reversing the Trends: The Second National Health Sector Strategic Plan of Kenya – ROADMAP FOR ACCELERATION OF IMPLEMENTATION OF INTERVENTIONS TO ACHIEVE OBJECTIVES OF THE NHSSP II Published by: Ministry of Health Sector Planning and Monitoring Department Afya House PO Box 3469 - City Square Nairobi 00200, Kenya Email: firstname.lastname@example.org http://www.hsrs.health.go.ke 3|Page Table of Contents Acronyms ....................................................................................................................... 4 Chapter 1: Introduction and Background................................................................. 6 Chapter 2: Synopsis of Key Documents ..................................................................... 7 Chapter 3: Achievements and Challenges at Mid Term ........................................ 10 NHSSP II Objectve 1: Increase equitable access to health services .................. 10 NHSSP II Objective 2: Improve the quality and responsiveness of services.... 11 NHSSP II Objective 3: Foster partnerships in improving health and delivering services .................................................................................................................... 12 NHSSP II Objective 4: Improve the efficiency and effectiveness of service delivery .................................................................................................................... 12 NHSSP II Objective 5: Improve financing of the health sector......................... 13 Management and Leadership ............................................................................... 14 Chapter 4: Priority Recommendations .................................................................... 15 Implementation Mechanisms ................................................................................ 15 NHSSP II Objective 1: Increase equitable access to health services ................. 15 NHSSP II Objective 2: Improve the quality and responsiveness of services.... 16 NHSSP II Objective 3: Foster partnerships in improving health and delivery services .................................................................................................................... 16 NHSSP II Objective 4: Improve efficiency and effectiveness ............................ 17 NHSSP II Objective 5: Improve financing of the health sector......................... 19 Chapter 5: Monitoring and Evaluation ................................................................... 21 Chapter 6: Implementation Matrix .......................................................................... 22 4|Page Acronyms AIDS Acquired Immunodeficiency Syndrome AOPs Annual Operational Plan (s) BEOC Basic Essential Obstetric Care CDF Community Development Fund CEOC Comprehensive Essential Obstetric Care CE Chief Economist CFO Chief Finance Officer CHEW Community Health Extension Worker CHW Community Health Worker CoC Code of Conduct CU Community Unit DANIDA Danish Development Agency DHMT District Health management Team DHRM Department of Human Resource Management DHS Demographic Health Survey DMS Director of Medical Services DfID Department for International Development DP Development Partners DRH Division of Reproductive Health EMS Essential Medical Supplies EDL Essential Drug list GDC German Development Cooperation GDP Gross Domestic Product GoK Government of Kenya H/C&RS Head, Curative and Rehabilitative Services HENNET Health Non-governmental organisation Network HIV Human Immunodeficiency Virus HMIS Health Management Information System H/PPHS Head, Preventive and Promotive Health Services HR Human Resource HRH Human Resource for Health HRM Human Resource Management H/SPMD Head, Sector Planning and Monitoring Department HSSF Health Sector Services Fund ICC Inter-agency Coordinating Committee ICT Information Communication Technology IDSR Integrated Disease Surveillance and Response IFMIS Integrated financial Management Information System IP Implementing Partner ISO International Standard Organisation IMR Infant Mortality Rate IPT Intermittent Presumptive Treatment ITN Insecticide Treated Net JFA Joint Financing Agreement JICA Japanese International Cooperation Agency JPWF Joint Programme of Work and Funding KSh Kenya Shilling KDHS Kenya Demographic and Health Survey KEMSA Kenya Medical Supplies Agency KEPH Kenya Essential Package for Health KHPF Kenya Health Policy Framework KHSWAp Kenya Health Sector Wide Approach KNBS Kenya National Bureau of Statistics KSPA Kenya Service Provision Assessment MDGs Millennium Development Goals MEDS Mission Essential Drugs and Supplies MMU Ministerial Management Unit MoH Ministry of Health M&E Monitoring and Evaluation MTEF Mid Term Expenditure Framework 5|Page MTC MTR Mid term Review NCDs Non Communicable Diseases NGO Non Governmental Organisation NHA National Health Accounts NHISF National Health Insurance Fund NHSSP National Health Sector Strategic Plan NSHIF National Social Health Insurance Fund PAC Principal Accounting Controller PERs Public Expenditure Reviews PETS Public Expenditure Tracking Survey PHMT Provincial Health Management Team PFM Public Financial management PME Performance-based Monitoring and Evaluation PMIS Procurement Management Information system RBM Results Based Management RH Reproductive Health SWAp Sector Wide Approach SC Service Charter SOP Standard Operation Procedure TB Tuberculosis TCR Treatment Completion Rate TWG Technical Working Group UNFPA United Nations Population Fund USD United States Dollar USG United States Government WHO World Health Organization WB World Bank 6|Page Chapter 1: Introduction and Background Recently the Government of Kenya initiated a mid-term review (MTR) of the implementation of the second National Health Sector Strategic Plan (NHSSP II). MTR report documents progress made in the implementation of NHSSP II, the outstanding challenges, constraints and recommendations for action. An independent external review team validated the MTR findings and provided a succinct set of recommendations on what needs to be done to address the current challenges in the health sector. To take forward the MTR recommendations, the Ministry of Health and its stakeholders undertook a policy dialogue retreat in Mombasa in November 2007. The aim of the retreat was to identify and elaborate actions to accelerate the implementation of the NHSSP II strategies based on the MTR recommendations. The Roadmap for Acceleration of implementation of interventions to achieve the Objectives of the NHSSP II summarises the MTR report and outlines the decisions agreed at the health sector policy dialogue. In addition it outlines the implementation matrix and the framework for monitoring the implementation of the recommended actions. The purpose of this document is to: - provide an overview of the health sector performance and priority actions to be undertaken to remove the bottlenecks for attaining the NHSSP II objectives and the Millenium Development Goals related to health. - serve as the basis for allocation of resources in the second half of the NHSSP II implementation period - provide a monitoring framework for the implementation of the MTR recommendations. It should be emphasised that this document does not define the entire package of all interventions that the health sector will be implementing and as such does not define the full investment for the health sector. The overall investment in the health sector will still be guided by existing sector plans (see Chapter 2 below). It is also important to note that the MTR recommendations stress on processes as well as actions for accelerating implementation. The agreed implementation mechanisms focus on inclusiveness, coordination and accountability to address the challenges identified. This comes at a time of renewed international interest and commitment for better coordination, harmonisation and alignment of inputs into the health sector to accelerate achievement of outcomes. Together with the Code of Conduct, this document also serves as Kenya‟s plan for the International Health Partnership. 7|Page Chapter 2: Synopsis of Key Documents The KHPF1 provides the overarching Health Policy imperatives for the country covering the period 1994-2010. These are: 1 Ensure equitable allocation of Government of Kenya resources to reduce disparities in health status; i. Increase cost-effectiveness and efficiency of resource allocation and use; ii. Manage population growth; iii. Enhance the regulatory role of the government in health care provision; iv. Create an enabling environment for increased private sector and community involvement in service provision and financing; and v. Increase and diversify per capita financial flows to the health sector. To date two NHSSPs, which outline the medium term strategic objectives of the sector, have been developed to support the implementation of the KHPF. By the end of 2004 it became clear that the implementation of NHSSP had not led to improvements in most targets and indicators of health and socioeconomic development as expected. Health outcomes stagnated or worsened and utilization declined in an environment of decreasing per capita GOK allocation (from USD 12/pp in 1990 to USD 6/pp in 2002). Poverty levels went up from 47% in 1999 to 56% in 2002. Box 1: The Community Strategy The National health Sector Strategic Plan II Objective: The community strategy intends to improve the (NHSSP II) covering the period 2005 - 2010 health status of Kenyan communities through the initiation and aimed to reverse the downward trend in implementation of life-cycle focused health actions at level 1 by: health indicators by applying lessons learned Providing level 1 services for all cohorts and socioeconomic groups, including the “differently-abled” and searching for innovative solutions. It is taking into account their needs and priorities designed to re-invigorate the implementation Building the capacity of the community health extension of the Kenyan Health Policy Framework workers (CHWs) and community-based resource persons (KHPF) through: to provide care at level 1. Strengthening health facility–community linkages through (i) increasing equitable access to effective decentralization and partnership for the health services; implementation of LEVEL ONE SERVICES. (ii) improving service quality and Strengthening the community to progressively realize their rights for accessible and quality care and to seek responsiveness; accountability from facility based health services. (iii) improving efficiency and Main innovations: effectiveness; Established norms for level one services : One level one unit will serve 5000 Kenyans and be manned by 50 CHWs (iv) fostering partnership; and and 2 Health extension workers: 1 CHW for 20-50 (v) improving financing of the health Households CHWs will work on voluntary basis with stipends paid to sector them CHEWs will be on government pay roll Payment and control for both cadres will be through the Implementation of the NHSSP II has involved health facility and village committees the introduction of following three key a comprehensive message and commodity kits will be strategies: developed and used by CHWs Provision of the commodity kit to manage minor illnesses. 1. Kenya Essential Package of Health (KEPH), with a human capital based definition of essential packages. The KEPH constitutes a paradigm shift from the conventional „managing illness‟ approach to promoting healthy life styles. It defines the various services that need to be delivered for six different age cohorts2 (from birth to old age) 1 GOK, MOH, 1994, Kenya Policy Framework Paper, 1994-2010. The policy framework paper is still valid and functional, but a new policy paper will be in pace in 2010 together with NHSSP III. 2 The six cohorts that are defined in KEPH has been pregnancy and new born, early childhood (below five years), late child hood (7-12 years), adolescent health (13-24 years); adults (25-69 years) and elderly (60+). The six levels of health service delivery are defined to include community, 8|Page and at each of the six levels of service delivery (Level 1: community, up to Level 6: Tertiary hospital). It brought together the two apparently conflicting concepts of continuum of care together – life cycles and levels. 2. Community Health Strategy recognising the community level as part of the formal health service delivery system. The MOH has developed a Community Strategy3 to strengthen the interface between facility and community based health services and offer services at the community level (see box 1). 3. Kenya Health Sector Wide Approach (KHSWAp), defined as „a sustained partnership with the goal of achieving improvements in peoples’ health’. The emphasis in the KHSWAp is less about funding modalities and more about joint planning, monitoring and reporting. It places emphasis on joint regular review of performance against jointly defined milestones and targets as defined in the Joint Programme on Work and Funding (JPWF) and operationalised in Annual Operational Plans (AOPs). The JPWF outlines the joint priority health interventions to be implemented over the period 2006-2010, their resource implications and financing situation and therefore drives the partnership of all actors in the health sector. In order to reduce transaction costs and improve effectiveness of external support, the Government and its partners designed a framework agreement for coordination, harmonisation and alignments of activities in the health sector, which is also used to track the Paris Declaration on Aid Effectiveness in Kenya. This partnership framework, known as the Code of Conduct (COC), has now been signed by all the key partners in the sector. Figure 2.1 below outlines the linkages between the programme areas of the Joint Programme of Work and Funding for the Kenya Health Sector to the development goals and objectives of the NHSSP II dispensary/clinic, health centre/maternity /nursing homes, primary hospitals, secondary hospitals and finally tertiary hospitals 3 MOH, 2006, Taking the Kenya Essential package for health to the community, strategy for the delivery of Level One Service. Four implementation tools have been developed and are in use since then. 9|Page Fig. 2.1 Linkage between JPWF and development objectives and goals Kenya Health Policy Framework strategic theme: Investing in health NHSSP II goal: Reduce health inequalities and reverse the downward trend in health-related outcome and impact indicators Policy Objectives Increase Improve the quality and Foster partnerships in Improve the efficiency Improve equitable responsiveness of improving health and and effectiveness of financing of the access to services in the sector delivering services service delivery health sector health services Joint Program of Work and Funding Sector priorities 1. Address equity, and 2. Enhance health gains 3. Enhance efficiency and 4. Strengthen sector expand access to budget effectiveness stewardship and partnership basic services with all stakeholders vi. Scale up of a 1. Strengthen and scale up 1. Operational and 1. Joint planning, comprehensive the delivery of cost- effective procurement implementation and community effective interventions system monitoring mechanisms approach to (especially at levels 2-4), in line with a Sector Wide delivery of the 2. Operational and Approach Kenya Essential 2. Strengthen availability and effective public financial Package for Health management of human management (PFM) 2. Coordinated financing resources for health (HRH) system modalities for defined priorities in line with the 3. Strengthen availability and 3. Operational need for harmonization of management of performance-based support infrastructure, equipment, monitoring and communication and ICT evaluation system (PME) and results 4. Strengthen availability and based management management of (RBM) procedures. commodities and supplies 10 | P a g e Chapter 3: Achievements and Challenges at Mid Term As shown in Table 1 below, overall progress towards achievement of key health outcomes appears to be improving. The first half of the implementation of the NHSSP II saw key improvements, particularly in child health, and disease control. Some weaknesses are still evident, particularly in relation to maternal health. Table 1: Kenya’s status with respect to the Millennium Development Goals (selected indicators) MDG Target Baseline Baseline Output Current Target Goal MDG NHSSP I NHSSP I estimate MDG No 1990 1999/2000 2003 s 2007 2015 Kenyan Population 21.4 28.7 NS MDG Development Outcomes / Outputs Prevalence underweight children < 5 yrs 32.5 33.1 28 11 16.2 4. Child Health 4 Reduce IMR/1000 by 2/3 between 1990 and 2015 67.7 73.7 78 79 25 5 Reduce UFMR /1000 by 2/3 between 1990 and 98.9 111.5 114 120 33 2015 Proportion 1 year old immunised against Measles 48 76 74 80 90 % Proportion of Orphans due to AIDS 27.000 890.000 1.2 M 1.2M Reduce MMR /100.000 by ¾ between 1990 and 590 590 414 147 2015 Proportion births attended by skilled health staff % 51 NA 42 37 90 Reproductive 5. Maternal, Coverage of Basic Emergency Obstetric Care 24 100 Sexual – (BEOC) Health % WRA receiving FP commodities -- -- 10 43 70 6 HIV prevalence among 15-24 yr old pregnant 5.1 13.4 10.6 6.1 NS women Malaria Prevalence of persons five yrs and above NA 30% NA 7 Malaria In-patient Case Fatality Rate NA 26% NA 8 Pregnant women / children <5 sleeping under ITN NA 4/5 36.5 / 69 65 / 65 6 Disease % Control TB Case Detection Rate NA 47% 50 60 Treatment Completion Rate (TCR, Smear +ve 75% 80% 90% cases) 9 7 Access to safe water (National) (%) 48 55 48 62 74 10 7 Access to good sanitation (%) 84 81 50 42 NS 8 % Population with access to essential drugs NA 35% NA Adapted from the National health Sector Strategic Plan II (NHSSP II), 2005 – 2010, and mid term Review of the NHSSP II, 2007. Achievements and Challenges for each NHSSP II objectives are summarised below. For more detail, please refer to the NHSSP II Mid Term Review Report. NHSSP II Objectve 1: Increase equitable access to health services A three-pronged strategy to a) improve geographical access; b) improve financial access; and c) address social and cultural barriers to services. Summary: 4 UNICEF: State of the World’s children report, 2008 5 UNICEF: State of the World’s children report, 2008 6 Figure for ALL pregnant women 7 This includes all fever cases treated as malaria. Malaria sentinel surveillance report of 2002 estimated it at less than 5%. 8 Malaria indicator survey, 2007 9 WHO/UNICEF joint monitoring report, 2007 10 WHO/UNICEF joint monitoring report, 2007 11 | P a g e Many achievements have been made in expanding the coverage of facilities, institutionalising the needs of clients, and improving pro-poor financing. Challenges remain in relation to following through on policy implementation, and scaling up services. Achievements Challenges/Constraints 1,600 health facilities built using Constituency Coordinating the investment to ensure Development Funds (CDF). CDF-MOH facilities are built according to priorities and planning mechanism now established. commensurate with available operational resources. Inputs to strengthen referral such as mobile Accelerating the drafting process to guide phones, equipment, ambulances provided. investments in other health systems. Drafting of referral strategy has begun. 3,649 health workers recruited and working in Inequitable distribution of health workers under served areas remains significant. National Social Insurance Scheme designed Insufficient consultations during development and debated. of the NSHIF resulted in legislation not being passed. Reduction in user fees (20/10 policy) Dissemination of KEPH incomplete and consolidated. Free deliveries at levels 2 and implications not fully institutionalised (DP 3. support not fully aligned; implementation guides not completed; staff not oriented/trained; some services not yet scaled up) Pro-poor resource allocation defined and in Geographical dimension of poverty not use sufficiently incorporated into allocation criteria. Surveys suggest client satisfaction is rising. Waiting times reduced. Annual client satisfaction review findings have informed AOPs. Service Charter developed, which defines rights and obligations. Even though there have been noticeable achievements in improving equitable access to health services, the current political crisis has provided extra challenges to the sector. There has been challenges to ensure that the health sector provide emergency health sector response to the affected communities and to ensure that that there is short and long term plans for the health sector response to the crisis and any other emergencies. NHSSP II Objective 2: Improve the quality and responsiveness of services Comprises a) improving health worker performance; and b) improving responsiveness to client needs. Summary: Government-wide roll-out of results based management has underpinned the performance appraisal. A recent pay rise for health workers has also provided a conducive environment for reform. However, key systems and inputs such as supply chain management and transportation remain key challenges. A number of activities in Strategy 1 contribute to Strategy 2. Achievements Challenges/Constraints Introduction of target based performance Reaching targets through efficiency gains appraisal system. without increased resources is proving a challenge Supervisory checklists developed and used. Transport is constraining regular supervision. 12 | P a g e Achievements Challenges/Constraints Growing use of clinical audits, including for maternal mortality (no. of MM audits year on year? Availability of drugs substantially improved Supply chain management has improved, but (extent of improvement? periodic stock outs continue. NHSSP II Objective 3: Foster partnerships in improving health and delivering services This involves parternships with civil society, not for profit organisations, and development partners, and improving inter sectoral collaboration. GOK recognises effective partnership requires a results orientation, accountability, participation and transparency. Summary: Commendable planning frameworks have been developed, and the health sector is rapidly decentralising its planning process. Commitment has been shown on all sides to substantially strengthen partnership arrangements, but full and timely discussion and disclosure of financial decisions are yet to be realised. Achievements Challenges/Constraints JPWF, MTEF and AOPs are established Planning and budgeting processes at framework documents and processes. national level are disjointed. Significant Decentralised planning implemented; activity not aligned to existing plans. participation steadily improved. Code of Conduct signed and inclusive of Capacity of IPs to fully engage in sector is implementing partners (NGOs). limited. Joint Financing Arrangement being Significant external funding still not captured developed. in government budget. Transparency of resource allocation decisions and predictability of funding remain a challenge. Quarterly reviews of progress initiated Quarterly reviews not yet instituitonalised at every level. MOH still not fully adapted to carry out SWAp stewardship, with structure and functions based on vertical programme approach. Mechanisms for IP and DP accountability not yet in place. NHSSP II Objective 4: Improve the efficiency and effectiveness of service delivery Strategy focused on cost efficiency and cost effectiveness, planning, management and administration. Summary: Progress is being made to enable funds to flow directly to lower level service delivery. The Health Sector Services Funds (HSSF) pilot shows that this is likely to accelerate service delivery outputs. Plans have been developed to strengthen certain health systems. However, implementation has been lacking, and plans are needed where they have not yet been developed. Achievements Challenges/Constraints A mechanism to direct funds to health Finalisation of the JFA is experiencing delays facilities (HSSF) was successfully piloted; due to GOK capacity constraints and DP national arrangements are being Gazetted; harmonisation challenges. roll-out is being planned. A shadow/functional budget exercise has Capacity at implementation level for planning been initiated to establish operational and monitoring remains weak. Not all DPs 13 | P a g e Achievements Challenges/Constraints linkages between the government budget follow the planning calendar. format and sector planning format. Harmonisation of HMIS indicators was Data collection and use remains inefficient initiated. and sporadic. Findings from operational research not fully incorporated into decision making. Plans to strengthen financial management, Internal controls remain weak, and fiduciary human resources and supply chain risk is perceived to be high. management (including procurement) have been developed. Annual procurement planning process has been introduced. Transport assessments were conducted in A strategic approach to the management of two provinces. infrastructure, communication and ICT is lacking. A national communication strategy has been drafted. Government-wide ICT policy is being implemented by the MOH. NHSSP II Objective 5: Improve financing of the health sector Focus on increased funding, improving pro-poor resource allocation, achieving an appropriate balance between access and quality. Summary: Resources have increased, and allocative efficiency has improved with more funds channelled to cost effective basic health services. Resolving bottlenecks in spending GOK funds remains a priority. Achievements Challenges/Constraints Increase in allocation and per capita spend Percentage of budget spent has decreased on health (see Table 2 below) from 87% to 69% 2004/05-2006/07. Increased DP funding, especially for scale up Difficult to make strategic resource allocation of priority public health interventions such as decisions with only partial knowledge of for malaria and HIV. resource flows to the sector. Donor conditionality further fragments information systems. National Hospital Insurance Fund increased benefits package to include vulnerable populations. Resource allocation has been reduced at higher levels and increased at lower levels of the system (15.6% 0f the MOH budget allocated to tertiary level) Expenditure reviews and expenditure tracking surveys conducted to rectify expenditure bottlenecks. Table 2: Trend in public expenditures on health 2004/05 2005/06 2006/07 Approved budget (KShs million) 21,977 27,832 33,526 US$ per capita 8.7 10.8 14.5 Share of total government expenditure (% ) 7.24 7.27 7.27 Share of GDP (%) 1.71 1.78 1.91 Actual expenditure (KSh million) 19,158.40 20,636.00 23,178.00 US $ per capita 7.6 8.0 10.0 Share of total government expenditure (%) 6.31 5.39 5.02 Share of GDP (%) 1.49 1.32 1.32 $/KSh exchange rate 77.3 77.3 68 Population projections (in millions) 32.8 33.4 34 14 | P a g e Management and Leadership Whilst management and leadership are subsumed within the strategies above, it is important to identify shortcomings in this area to avoid business as usual and ensure that bottlenecks really are addressed. The MTR has shown that some of the improvement plans in JPWF have not been implemented as planned. Key managerial bottlenecks around the implementation of the sector strategic approaches are: Lack of willing and committed champions to lead and inspire the implementation of the reform program; whenever there is willingness, the capacity for managing and leading the reform process is found quite weak. When such champions exist in some of areas, there is lack of adequate support in terms of resources to implement the reforms agendas; Some of the reforms agendas are core functions of other Ministries, where Ministry of Health cannot implement reform programs on its own. These include financial management, procurement, and human resources. Some of the actions therefore require sanction and agreement from these Ministries. Adequate effort was not made to make the various heads accountable for results. Though monitoring reports were produced and review meetings were held, these have not improved performance where it is needed most. Adequate partnership to support follow up of implementation was not fully achieved. A Health Sector Coordinating Committee was set up as part of the process of operationalising the sector‟s governance structure. However, Technical Committee‟s to coordinate partnership in specified areas of focus were not yet functional. Linkages to existing technical partnership structures such as the ICC‟s that were set up for Global Fund, and other specific programmes were not created. 15 | P a g e Chapter 4: Priority Recommendations For a full list of MTR recommendations, please refer to Annex 1. Here we focus on the recommendations related to: Priority actions to remove bottlenecks; Priority strategies that have experienced no/slow implementation (primarily health system strengthening); and Priority public health interventions that have received less support to date, but are critical to achieving NHSSP II targets (and MDGs). Most of the recommendations are concerned with reforming the health sector, strengthening health systems, and facilitating alignment and harmonisation. The priority recommendations are summarised below. For a full description, please refer to Annex 2. Implementation mechanisms are described, to address management and accountability issues, followed by categorisation by NHSSP II objectives. Implementation Mechanisms In order to address the bottlenecks identified at the end of the last chapter, the following arrangements will be initiated: A Team Leader for each core area of activity will be assigned from the MOH as a champion. This Team Leader is responsible and accountable for delivering the results that are outlined in this plan. S/he will form a team comprising key stakeholders to fast track the implementation process. A mechanism for rewarding and sanctioning Team Leaders based on their performance of the plan will be designed and implemented. Linkages will be made to existing performance contracts and the performance appraisal system. The improvement plans are funded from development partners and government to ensure that appropriate technical and financial support is provided. Development and implementing partners have also nominated respective leads on each area to support the Team Leader. The financial and technical support needs have been identified so that the financier is accountable to all stakeholders alongside the Team Leader. To complete the SWAp governance structure, Technical Working Groups will be established for core areas to facilitate consultation, problem solving and coordination. NHSSP II Objective 1: Increase equitable access to health services Ten actions are identified as necessary to enable achievement of this objective.. They relate to ensuring comprehensive implementation of the KEPH by level and cohort in an equitable manner. Actions to strengthen implementation of KEPH across all cohorts (i) Support to ensure universal access to Maternal and neonatal health services for cohort 1, involving demand creation and supply side interventions such as free delivery, skilled attendants, effect referral and other emergency obstetric care components; (ii) Comprehensive implementation of guides and frameworks for cohorts 4 and 6. (iii) Development of a policy, strategic approach and an implementation framework for NCDs to address healthy lifestyles and provision of direct medical care for individuals in a clinical setting (all cohorts) (iv) Reduce morbidity and mortality from malaria by accelerating implementation the National Malaria Strategy that has been revised in line with NHSSP II, particularly targeting cohorts 2, 3 and 5 16 | P a g e (v) Strengthen implementation of existing service delivery efforts for Child health for cohorts 2 and 3, with a particular focus on coordination (vi) Accelerate implementation of TB control initiatives (cohort 5) (vii) Accelerate Community Strategy implementation (level 1), through operationalising community health worker structure, providing behaviour change communication, scaling up outreach services, etc. (viii) Accelerate Kenya Essential Package for Health (KEPH) dissemination throughout the sector (ix) Develop a strategy to influence the implementation of KEPH outside the health sector (x) Strengthen public-private partnerships in delivery of services, particularly in underserved areas, through improving formal frameworks and facilitating access to the HSSF The sector needs to develop immediate, short and long term health sector response to the post-election events. These plans should include strategies for ensuring that systems as well as services return back to normalcy without reversing the gains that have been achieved in the first half of the implementation of the NHSSP II. NHSSP II Objective 2: Improve the quality and responsiveness of services The actions for acceleration of implementation for this objective are: (i) Roll out of service charter, to be displayed publicly containing information on services, standards, complaints, and the mechanisms to redress (ii) Development and implementation of country specific hospital reforms to support and complement services at the primary care level (iii) Re-categorisation and accreditation of health facilities in line with KEPH to guide the identification of inputs required within the context of existing KEPH Norms and Standards. (iv) Update and implementation service delivery clinical & management guidelines. (v) Creating facility based incentives to improve quality of services such as institutionalising processes for recognition and reward (vi) Put in place national strategy for Integrated Supportive Supervision, involving clear definitions and implementation arrangements, and linkages to annual plans and performance appraisal, and incorporating new service delivery guidelines (vii) Fast track Leadership and management capacity strengthening initiatives in accordance with the decentralisation of management in the sector, including in-service training and patient centred accountability. NHSSP II Objective 3: Foster partnerships in improving health and delivery services The formation of Technical Working Groups, Team Leaders and DP and IP leads is described above. Other actions to strengthen partnerships include: i. Strengthen sector coordination and participation structures at all levels a. Implement sector Governance structures at all levels b. Link Governance structures to vision 2030 strategies 17 | P a g e c. Establish governance TWG d. Develop and implement Public Private Partnership policy ii. Monitor adherence to COC principles and obligations, including the development of aid effectiveness indicators and targets and integrate their measurement in sector annual reviews iii. Joint support and responsibility to strengthen common management arrangements, to ensure use of country systems for support iv. Ensure partners are providing coordinated and demand driven technical assistance and cooperation v. Support implementation of common monitoring tools and systems including utilization of the Joint Review Missions for review and planning of sector interventions. vi. Develop mechanisms for generation, sharing, and use of information with implementing partners vii. Build the capacity of coordinating secretariats for partnership (HENNET and Private sector) viii. DPs increasingly channelling funds through Joint financing arrangements and using in-country systems ix. Establish and implement coordination mechanism for partner missions to the country x. Coordination and pooling of capacity development support particularly for systems strengthening NHSSP II Objective 4: Improve efficiency and effectiveness Key actions for acceleration to improve efficiency and effectiveness are: (i) Fast tracking implementation of HRH initiatives Develop recruitment and deployment policy o Filling 601 existing established posts o Mapping of HR to guide where staff will be posted o Revision of staff establishment for new posts Finalisation and implementation of HRH strategic plan, with a focus on new employment on underserved areas. Strengthen workforce planning and information management Consolidate HRH management and development functions at national level Ensure coordinated management of functions of development, determining of requirements o Employ sms technology to speed up resolution of staff problems o Design of appropriate incentive mechanisms for sustaining equity in distribution of HR o Develop policies on retention of staff in hard to reach areas o Design mechanisms for HRH support and management for non public actors Decentralise HR function (ii) Strengthening the management and availability of commodities and supplies Delineate clearly roles and responsibilities for procurement in Health Sector o Roles and responsibilities of MOH & KEMSA o Clarification of roles and responsibilities of KEMSA for non public actors 18 | P a g e o Transfer of all health commodity procurement to KEMSA o Role of MEDS, and other private procurement entities Review health commodity procurement SOPs and align with new procurement regulations Ensure KEMSA has sufficient funding to support the supply chain management Accelerated implementation of procurement improvement plan Implement the agreed 5% distribution cost of 5% of all commodities distributed through KEMSA Review health commodity procurement SOPs and Build capacity at all levels Finalize revision of National Drug Policy Develop, implement Pharmaceutical Sector Strategic Plan Revision of EDL Develop & implement EMS Scale up of demand driven supply system/pull system Decentralize KEMSA distribution system Operationalisation of MTC at National level and 50% of all hospitals Integration of Parallel commodities into the essential commodity system Strengthening of Pharmacovigilance function activities Introduction of quality assurance (including regular audit) for commodities and supplies Tracking Commodity Supply Chain (iii) Alignment of infrastructure, communication & ICT strategies to ensure they effectively support service delivery Strengthen strategic framework to guide investment in infrastructure, communication, transport and ICT o Development of policies and strategic guidelines (including financing) in above areas o Annual maintenance as part of procurement plan for sector o Carry out a review/assessment of transport management in the health sector MOH, KEMSA, Provinces Districts) ( procurement, maintenance, HR etc) o Develop transport guidelines o ICT implementation plan to guide investment in ICT in line with overall Government Policy o Develop guidelines for donation of medical equipment o Definition of minimum specs for equipment to guide prioritization of investment o Guidelines on investment at facilities o Capacity building of managing resources at provincial and district levels Strengthened information management for infrastructure, communication, transport and ICT o Guideline and manual for collating information from all stakeholders (especially from private sector) o Digitalization of information management 19 | P a g e o Manuals for planning, management and maintenance in facilities and communities o Train staff in the use of IT equipment and software Development and implementation of approaches for quality assurance and audit for infrastructure, equipment maintenance and use Development and implementation of approaches for quality assurance in transport maintenance and use (iv) Strengthening of the Public Financial Management systems Accelerated implementation of PFM improvement plan ( Some parts require updating) o Fast track capacity strengthening in FM at all levels o Improve data capture on PFM o Introduction of IFMIS at all levels o Annual PETS Operationalisation of HSSF Review of the public health act to take care of financial issues Establishment of a Joint Funding Mechanism pooled funding (v) Strengthen use of Strategies for Bottom up planning and Budgeting Build capacity of planning units at all units at all levels in planning, costing and budgeting Strengthen linkages between sector planning and budgeting Operationalise the strategy to integrate gender and human rights issues in planning in collaboration with other government departments Explore the role and use of medium and longer term planning mechanisms at Sub national levels (vi) Scale up use of Performance Monitoring Mechanism (including HMIS) Acceleration of implementation of Monitoring improvement framework o Coordination of PM&E, HMIS and IDSR information sources o Incorporating information from systems, and other sources of information like KNBS, DHS, KAIS etc o Participation of all stakeholders at different levels Strengthen data management capacity (collection, analysis, computerization and use) at all levels Dissemination of ME findings Follow up implementation of MTR recommendations Link IFMIS to HMIS Institute mechanism for ensuring allocation for M&E of 5% of recurrent budgets for GoK and partner programmes NHSSP II Objective 5: Improve financing of the health sector Key actions for acceleration of implementation are: (i) Establish mechanisms to increase availability of resources (ii) Improve budget management and efficient and equitable resource allocation and utilization, particularly developing costing frameworks, improving pro-poor resource allocation formulae, instituting cost effectiveness analysis to aid 20 | P a g e prioritisation, availing finance/cost information to the public, and incorporating all sources for expenditure tracking (iii) Complete and implement Health Care financing strategy (iv) Implement HSSF, through more comprehensive district budgeting, finalisation of guidelines, training, and ensuring fiduciary risk is low (v) Implement the shadow budget as a means to link planning and budgeting processes for entire sector (vi) Improve predictability of resources by holding partners accountable to provide information on their frameworks and budgets, and quarterly disbursement data. 21 | P a g e Chapter 5: Monitoring and Evaluation The monitoring and evaluation of progress shall be done within the sector‟s ongoing monitoring and evaluation mechanisms. Actions needed to be implemented shall be part of the respective AOPs. Actions implemented in this financial year will be part of the current AOP 3. Each of the main areas of focus will be monitored by its Technical Working Group. This TWG shall be composed of all sector actors; Government, Development Partners and Implementing Partners, that are carrying out activities, or have an interest in supporting the respective strategy. The Team Leader shall coordinate the efforts of the TWG. The lead DP and lead IP shall ensure adequate communication with their respective constituencies to ensure their obligations and expectations are realised. The TWG shall report on a quarterly basis to the SWAp umbrella Health Sector Coordinating Committee (HSCC) on progress against milestones, issues and challenges being met in implementation. It shall also bring any issues for decision at this level. The sector shall review progress annually, as part of the AOP monitoring and review process. The progress made against each of the areas of focus shall be documented in the AOP report for each subsequent year. Final evaluation of the sector‟s performance at the end of the NHSSP II shall also review the contribution that the implemented actions will have made towards overall progress. Monitoring indicators shall be the same as those used to monitor the NHSSP II, and its AOP‟s. As highlighted in the recommendations from the Mid Term Review of the NHSSP II, monitoring of partnership and coordination shall be in line with the Paris Declaration indicators (Annex A). 22 | P a g e Chapter 6: Implementation Matrix The implementation matrix (Table 6.1) outlines how implementation of the above actions for acceleration will be carried out. The matrix elaborates: - Key milestones for achievement within 6 months (AOP 3), proceeding 1 year (AOP 4), and in the final year of the NHSSP II (AOP 5) - Responsible persons from Government (Team Leader), Development Partners (Lead DP), and Implementing Partners (Lead IP) for the key actions - Indicators for progress towards achievement of the actions, and - Resource requirements to adequately implement of the actions. The total financial resources required for the implementation of the proposed planned actions are Ksh4,185.1 million, Ksh12,993.5 million, Ksh13,958.0 million for the second half of AOP 3, AOP 4 and AOP 5 respectively. The budget estimates does not include the additional resources required for the health sector response to the post election crisis. The development of the implementation matrix assumed that the country situation would remain politically stable and partnership and coordination of the sector would continue as spelt out in the country CoC. However, the post election events have affected partnerships in the country, with a number of commitments delayed, or revisited to focus more on humanitarian activities. Predictability of Aid, a key principle in the Paris declaration and in the country‟s own Code of Conduct, has been severely restricted due to political events, which are out of the control of the health sector. Regarding the sector‟s way forward, there are 3 potential scenarios arising from this situation i) A political solution agreeable to all sides in the conflict is quickly arrived at: The reversal of the humanitarian situation would be done quickly. Many displaced persons would be able to return to their homes. Donor commitments would in most situations be honoured, and the sector would shift to a recovery phase. Some donor funds would be channelled to humanitarian activities, but most likely additional funds would be available to the sector for routine activities to address the resultant funding gaps. ii) A political solution is agreed at, but not all sides are in full agreement: The immediate and visible signs of the humanitarian crisis (IDP camps, etc) would largely be addressed. However, simmering tensions would continue, with a high possibility of sporadic outbreaks of violence in the country. Many displaced persons would still not be able to return to their homes. A humanitarian focus would have to be maintained in the country in the medium term. A large number of the pre-election donor commitments would be honoured. However, a large proportion of their funds would also be channelled to humanitarian activities, leaving less funds available for routine sector interventions. iii) No political solution is agreed at: The immediate visible signs of the humanitarian crisis would remain in some areas of the country, as it would prove difficult to assure security in all areas for affected persons. Tensions would continue in the country, with sporadic outbreaks of violence, A strong humanitarian focus would have to be maintained in the country in the medium term. A large number of the pre-election donor commitments would not be honoured. Of the fund available, a large proportion would be channelled to humanitarian activities, leaving minimal funds available for routine sector interventions. 23 | P a g e TABLE 6.1 NHSSPII ACCELERATION IMPLEMENTATION MATRIX NHSSPII Strategies Responsibility Indicator for Targets Budget (Ksh.000,000) Objectives TL L/DP L/IP Progress six months AOP4 AOP5 six AOP4 AOP5 months A. Increase equitable A1.Universal access to Maternal and neonatal health services access to health services A1.1. Exploring GDC HENNET* Increased no. situational Impleme Imple 1.2 TBD TBD issues hindering of women analysis ntation mentat utilization of delivering report ion maternal and with skilled disseminated and neonatal services in attendance and review Kenya, such as designing attitudes of health attitude providers, male change H/PPHS involvement, etc A1.2 UNFPA HENNET* No. of CEOC 5 10 20 5 20 10 Comprehensive facilities Emergency Obstetric Care (CEOC) including care for the newborn at all level 4 through 24 | P a g e functional maternities, nurseries, maternity theatres and laboratory and x-ray services A1.3 Ensure UNFPA HENNET* % of Health 70% of HFs 80% 90% 1200 1300 availability of facilities family planning reporting no commodity at point stock-out of use (commodity security and distribution) A1.4 Basic UNFPA HENNET* No. of Level 3 200 300 500 30 60 120 Emergency offering BEOC Obstetric care (BEOC), including care for the newborn in all level 3 facilities A1.5 Availability of UNFPA HENNET* No. of 120 200 500 1.2 3 4 Skilled attendants at operational births in the community community mid-wives 25 | P a g e A1.6 GDC HENNET* Proportion of Referral Impleme Imple 2 690 690 Implementation of facilities strategy nt 25% ment Referral Strategy implementing disseminated Referral 25% H/C&RS RS Strategy Referr al Strateg y A1.7 Free deliveries DMS GDC HENNET* in Health Facilities TWG A1.8 24 hours a day GDC, HENNET* working hours in WORLD Level 3 nation-wide Bank Agreed comprehensi Imple Proportion of ve Impleme mentat Concept Paper Maternal/Ne ntation ion as 3 TBD TBD Plan wborn as per per implemented requirement plan plan A1.9 Implement GDC HENNET* Concept strategies to ensure Paper financial access to Comprehensive Maternal Health services A2 A nation-wide implementation of community strategy 26 | P a g e A2.1 Establishment H/SPM UNICEF HENNET* No.(CUs) of functional D established community units 150 480 960 600 1,000 1,634 (CUs) A3.Accelerate Kenya Essential Package for Health (KEPH) implementation A3.1.Comprehensiv UNICEF HENNET* % Schools School health 5% 30% 2 32 50 e implementation of implementing strategy guides and comprehensive finalised frameworks for school health cohorts 4 package A3.2 Develop a H/PPHS WHO HENNET* % Strategy Draft Consens 15% 1 10 20 policy, strategy & implementation Policy/Strate us & 5% Strateg comprehensive gy and Strategy y implementation plan implementati impleme imple cohorts 4& 6 on plan ntation mentat ion 27 | P a g e A3.4 Development WHO HENNET* % of health Policy/strateg 10% 30% 1 12 12 of a policy, strategic facilities y and planned planne approach and an implementing implementati d implementation guidelines ons plan framework for NCDs to address healthy lifestyles and provision of direct medical care for individuals in a clinical setting A3.5 Reduce WHO HENNET* % in patients 14% 14% 12% 3000 6000 6000 morbidity and admitted due to mortality from malaria malaria by implementing the National Malaria Strategy that has been revised in line with NHSSP II A3.6 Strengthen UNICEF HENNET* % reduction in Baseline 15 30 400 500 implementation of under-five data, existing service inpatient implementati delivery efforts for mortality on plan & Child health disseminatio n A3.7 Accelerate WHO HENNET* % increase in 20% 20% 20% 50 3000 3000 implementation of case TB control activities notification 28 | P a g e A3.8 Modification Head DfID HENNET* Proportion of Curricul 50% 2.2 3 of pre-service curative institutions a revised faciliti curricula in line with participating in es Service Delivery modified using expectations training revise d curricu la SUB-TOTAL BUDGET FOR NKSSP II OBJECTIVE A 3696.8 12,429.2 13,343. B. Improve B1. Improvement of facility-based services service quality and responsivenes s B1.1 Development GDC HENNET* Proportion of 5% 10% 10 10 and implementation facilities of country specific implementing hospital reforms reforms B1.2 Re- Head GDC HENNET* % facilities Draft 50% 100% 2 5 5 categorisation of curative categorised guideline Categori Catego health facilities in sation of risatio line with KEPH facilities n of faciliti es 29 | P a g e B1.3 Roll out of WB HENNET* Proportion of 13 Intern 25% of 50% 1.8 3.6 3.9 service charter (SC) facilities training L4 of L4 implementing facilities impleme imple SC implementin nting SC mentin g SC g SC B1.4 Update and WHO HENNET* Proportion of Guidelines 50% 50% 10 5 5 implement service facilities disseminated level 1-4 level delivery clinical adhering to facilities 1-4 guidelines. guidelines adhering faciliti to es guidelin adheri es ng to guideli nes B1.5 Creating WB HENNET* Proportion of Agreed 10% 4 4 facility based facilities Concept faciliti incentives to implementing Paper es improve quality of agreed imple services concepts mentin g B2. Improving service responsiveness B2.2 Develop & Head Proportion of Headquarter L5 L4 Implement ISO- MMU facilities ISO ISO 9000 facilities faciliti 9000 Quality certified certified ISO es ISO 5 20.5 22.5 Management System certified certifie 30 | P a g e d B2.1 .Put in place USG HENNET* Agreed A 50% 1 2 3 national strategy for supervision district district Integrated tool per s per Supportive province provin Supervision adhering ce H/C&RS to adheri integrate ng to d tool integra ted tool SUB-TOTAL BUDGET FOR NHSSP II OBJECTIVE B 19.8 50.1 53.4 C. Strategies for Scale up C1 Human Resource for Health Improvement in Efficiency and 31 | P a g e effectiveness C.1.1 DHRM DfID HENNET Proportion of Draft Approve Imple 2 1 4 of Services Rationalisation of additional deployment d mentati establishment and posts filled policy & revised on of deployment of staff revised establish approv establishment ment & ed in place deloyme revised nt policy establis & hment impleme ntation plan C.1.2. Finalisation DfID HENNET Proportion of HRH Plan 10 % 20 % 8 34 119 and implementation HRH Plan launched Plan Plan of HRH strategic implemented impleme imple plan nted mented C2. Commodity Supply Management Improvement C.2.1 Institutionalise Proportion of Comprehensi Train Train 5 15 20 the Public Proc Act facilities with ve Proc Proc & regulations functional Guidelines/M Committ Comm Committees & anuals and ees in ittees H/Proc KEMSA Established 50% of in increased Proc L4 additio responsibility Committees 100% nal in 50% of L4 L5 50% 100% L5 of L4 32 | P a g e and 50% L2&3 C.2.2.Establishemen WB/USG ?HENNET Proportion of PMIS PMIS PMIS 3 10 10 t Procurement facilities with designed establish establi Management functional ed in shed Information PMIS 50% of in System(PMIS) L4 & additio 100% nal L5 50% of L4 C3. Infrastructure, communication & ICT effectively support service delivery C.3.1 Strengthen H/C&RS JICA ? Proportion of Draft 5% 10% 5 15 40 strategic framework HENNET facilities integrated districts district to guide investment implementing policy impleme s in infrastructure, integrated nting imple communication, policy integrate mentin transport and ICT d policy g integra 33 | P a g e ted policy C4 Public Financial Management (PFM) C.4.1.increasing CFO WB HENNET % increase in 10% 15% 2 5 3 absorption capacity development absorpti absorp including 5% funds on tion KEMSA distribution absorption increase increas funds e C.4.1Introduction of PAC WB HENNET Proportion of Integrated 50% 50% 20 40 40 IFMIS at all levels compliant IFMIS district district districts (national, reportin reporti provincial & g on-line ng on- district) line C.4.1 Capacity PAC DANIDA HENNET Proportion of Fiduciary 50% 50% 100 75 50 building for HSSF facilities training of facilities faciliti submitting Committees, participa es accurate facilities, ting in partici financial report district & HSSF pating provincial in managers HSSF 34 | P a g e C.4.1 Review of the CE DANIDA HENNET Revised Public consultant -Draft -Draft 2 2 public health act to Health Act contracted amendm amend take care of financial ents and ments issues cabinet submit memo ted to Parlia ment C5 Information Management C5.1. Incorporating CE DANIDA Annual health 2007 health 2008 2009 1.5 1.5 1.5 information from facts and facts and health health systems, and other figures figures facts and facts sources of figures and information like figures KNBS, DHS, KAIS etc C5.2 Strengthen data H/SPM DANIDA HENNET Proportion of 10% of 25% of 25% 35 43 55 management D districts districts in districts of capacity (collection, reporting on- Central and nationall district analysis, line timely Eastern y s computerization and Provinces nation use) at all levels ally SUB-TOTAL BUDGET FOR NHSSP II OBJECTIVE C 181.5 272.7 207.1 35 | P a g e D Fostering D1.1 Joint Sector Planning strengthened. Partnership D.1.1.1 H/SPM DANIDA HENNET Launched AOP AOP4 AOP5 AOP1 42 44 46 Strengthening joint D by June annual planning linked with budget & KEPH dissemination D.1.1.2 Facilitate DANIDA HENNET Launched Draft Draft NSSPI 45 40 10 sector medium and Policy Policy KHPF II long term planning Framework & Framework adopted & launch NHSSPIII draft ed NHSSPIII D1.2 Scale up use of Performance Monitoring Mechanism D1.2.1 Joint H/SPM ? HENNET Timely Quarterly Quarte 24.2 26.6 quarterly and annual D adopted & AOP3 rly & reviews performance Performan AOP4 reports ce report Perfor mance report D1.2.2 Institute an CE DANIDA HENNET % allocation in 2% 3% Nil Nil Nil agreed mechanism annual budgets for ensuring allocation for M&E of 5% of recurrent budgets for GoK and 36 | P a g e partner programmes D.2 Partnership & financing D2.1. Annual CE WB PERs and 2007 PETS 2008 2009 21.5 21.5 21.5 expenditure tracking PETs Report and 2008 PETS and PETS mechanisms for PER 2009 PER and funds from GoK, DP 2010 and IPs, using PETS PER and PER D2.2 Entrench CE WB HENNET Shadow 2008/9 2009/10 2010/1 1 1 shadow budget budgets shadow shadow 1 tracking – DPs, budgets budgets shado NGOs, & HH w costing budget s D2.3 Complete and CE GDC HENNET Health care NHA Health Health 5 5 implement Health financing report, care care Care financing strategy costing financing financi strategy including report strategy, ng Act equity health care financing Bill 37 | P a g e D2.4 Creation of CE GDC HENNET Mapping report pilot phase Mapping 2.5 25 sector investment completed Report plan including CDF – all levels D2.5 Scale up Proportion of Harmonisati 20% of 50% 1 2 2 strategies for partners on and Partners of harmonisation & adhering to alignment adhering Partne alignment to sector CoC tool rs priorities & Govt designed adheri systems ng D2.6 Strengthen H/SPM DP Chair HENNET 25% district 60% 80% 90% 170 110 100 leadership & D managers Facility facility facility governance trained in Committees Committe Comm structures at all leadership and es, 480 ittees, levels 70% facility CUs 960 Committees functional CUs established functio nal SUB-TOTAL BUDGET FOR NHSSP II OBJECTIVE D 287.0 272.7 207.1 GRAND- TOTAL BUDGET FOR THE ROADMAP 4,185.1 12,993.5 13,948 38 | P a g e Annex A: Indicators for monitoring progress in strengthening of partnerships Indicat Paris declaration Description Paris Declaration Target Country target or OWNERSHIP 1 Partners have operational development At least 75% of partner countries -- (Already achieved) strategies — Number of countries with have operational development national development strategies strategies. (including PRSs) that have clear strategic priorities linked to a medium- term expenditure framework and reflected in annual budgets. ALIGNMENT 2 Reliable country systems — Number of (a) Public financial management – partner countries that have procurement Half of partner countries move up at and public financial management least one measure (i.e., 0.5 points) on systems that either (a) adhere to the PFM/ CPIA (Country Policy and broadly accepted good practices or (b) Institutional Assessment) scale of have a reform programme in place to performance. achieve these. (b) Procurement – One-third of partner countries move up at least one measure (i.e., from D to C, C to B or B to A) on the four-point scale used to assess performance for this indicator. 3 Aid flows are aligned on national Halve the gap — halve the proportion priorities — Percent of aid flows to the of aid flows to government sector not government sector that is reported on reported on government’s budget(s) partners’ national budgets. (with at least 85% reported on budget). 4 Strengthen capacity by co-ordinated 50% of technical co-operation flows support — Percent of donor capacity- are implemented through co-ordinated development support provided through programmes consistent with national coordinated programmes consistent development strategies. with partners’ national development strategies. 5a Use of country public financial 5+ All donors use partner management systems — Percent of countries’ PFM systems. donors and of aid flows that use public 3.5 – 90% of donors use partner financial management systems in 4.5 countries’ PFM systems. partner countries, which either (a) 5+ A two-thirds reduction in adhere to broadly accepted good the % of aid to the public practices or (b) have a reform sector not using partner programme in place to achieve these. countries’ PFM systems. 3.5 – A one-third reduction in the 4.5 % of aid to the public sector not using partner countries’ PFM systems. 5b Use of country procurement systems — 5+ All donors use partner Percent of donors and of aid flows that countries’ Procurement use partner country procurement systems. systems which either (a) adhere to 3.5 – 90% of donors use partner broadly accepted good practices or (b) 4.5 countries’ Procurement have a reform programme in place to systems. achieve these. 5+ A two-thirds reduction in the % of aid to the public 39 | P a g e Indicat Paris declaration Description Paris Declaration Target Country target or sector not using partner countries’ Procurement systems 3.5 – A one-third reduction in the 4.5 % of aid to the public sector not using partner countries’ Procurement systems. 6 Strengthen capacity by avoiding parallel Reduce by two-thirds the stock of implementation structures — Number of parallel project implementation units parallel project implementation units (PIUs). (PIUs) per country. 7 Aid is more predictable — Percent of Halve the gap — halve the proportion aid disbursements released according of aid not disbursed within the fiscal to agreed schedules in annual or year for which it was scheduled. multiyear frameworks. 8 Aid is untied — Percent of bilateral aid Continued progress over time. that is untied. HARMONIZATION 9 Use of common arrangements or 66% of aid flows are provided in the procedures — Percent of aid provided context of programmebased as programme-based approaches. approaches. 10 Encourage shared analysis — Percent (a) 40% of donor missions to the of (a) field missions and/or (b) country field are joint. analytic work, including diagnostic (b) 66% of country analytic work is reviews that are joint. joint. MANAGING FOR RESULTS 11 Results-oriented frameworks — Reduce the gap by one-third — Number of countries with transparent Reduce the proportion of countries and monitorable performance without transparent and monitorable assessment frameworks to assess performance assessment frameworks progress against (a) the national by one-third. development strategies and (b) sector programmes. MUTUAL ACCOUNTABILITY 12 Mutual accountability — Number of All partner countries have mutual partner countries that undertake mutual assessment reviews in place. assessments of progress in implementing agreed commitments on aid effectiveness including those in this Declaration.
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