HEALTH SPENDING IN EL SALVADOR - euroresources.org

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28 HEALTH SPENDING IN EL SALVADOR RECOMMENDATIONS TO STAKEHOLDERS IN THE EU AND IN EL SALVADOR COUNTRY OWNERSHIP, CIVIL SOCIETY PARTICIPATION AND THE PARLIAMENT ■ ■ ■ ■ There is a need for donors and the government to further take advantage, during their decision-making processes, of CSOs’ expertise with service delivery, specifically with regard to working with communities and reaching the most vulnerable. Continuous quality control of public health services delivery will be necessary – preferably by involving CSOs with the required sector-expertise. In general, the relationship between public and private entities should be pushed towards collaboration and complementarities, rather than competition and rivalry. CSOs should be engaged at every stage of the programme cycle, including the design, implementation and monitoring of national programmes. Continuous efforts need to be made by the government and European donors to support the involvement of a greater diversity of CSOs, including health and women’s organisations, vulnerable groups, as well as CBOs in these processes. To that end, the latter will need to receive specifically targeted support in order for them to be able to attend, understand and value these processes. ■ ■ ■ ■ To the same end, more efforts need to made in order to improve and strengthen the relationship between INGOs, local NGOs, CBOs, local authorities and Members of Parliament in El Salvador in order to ensure that these alliances contribute to true country ownership of development policies. Donors should therefore actively seek to support partnership-building among all actors. Some CSOs in El Salvador recommend undertaking a cost-benefit analysis of programmes implemented in the health sector, by including an impact evaluation of CSOs’ contribution to the sector. In the newly established social participation mechanisms, any favouritism based on party affiliation needs to be strongly condemned by the government, for instance by establishing a code of conduct for government officials, CSOs and donors, in order to jointly tackle what could be considered as one of El Salvador’s biggest obstacles to good governance: The high degree of party polarisation affecting every sphere of society. Mutual accountability and trust between the government, donors and Civil Society could be enhanced through the establishment of a publicly accessible online development database where all actors are asked to indicate and regularly update the programmes they are implementing in El Salvador. For this tool to be truly effective, it needs to be linked to the budget cycle and planning. The IATI initiative could provide guidance in that respect. ■ CSOs in El Salvador would welcome increased funding made available for advocacy-capacity building, but some would like to see an increased focus being put on ensuring that CSOs have the technical capacities and knowledge necessary for undertaking advocacy activities at policy-making level. Increased efforts also need to be made by civil society organisations themselves in order to put advocacy capacity-building on the donors’ agenda, for instance by submitting advocacy project proposals. DSW – German Foundation for World Population www.dsw-brussels.org
HEALTH SPENDING IN EL SALVADOR RECOMMENDATIONS TO STAKEHOLDERS IN THE EU AND IN EL SALVADOR 29 DONOR COORDINATION ■ In the light of the new health sector reform’s financing needs and the upcoming end-of-term review of the EC’s Country Strategy Paper, a strategic change towards health-financing should be considered by the EC. The EU Delegation in El Salvador does not exclude this possibility, but also points to the government’s own responsibility in demanding such a change. The government of El Salvador therefore needs to seize the opportunity and assert its strive for a stronger and more equitable health system, which adequately addresses neglected issues such as SRHR and Gender-based violence, by explicitly asking important donors, such as the EC, for sector budget support. ■ A potential support from European donors to the health sector reform should be provided in a harmonised and aligned manner, in order to collectively contribute to health systems strengthening, gender equality and women’s empowerment. To that end, donors should accept the leadership of the newly reinforced External Cooperation Unit within the Ministry of Health with regard to sector coordination. ■ Adherence to IHP+ in this country could contribute to increasing the technical assistance needed for strengthening the health system. Additionally, IHP+ could also unite donors in their efforts, no matter how large their health aid contributions. In doing so, results attained could be maximised, granting political support to a determined effort to achieve universal access to primary healthcare. Donors should therefore promote El Salvador’s adherence to IHP+. ■ Potential health sector budget support needs to be accompanied by specific capacity-building measures for Ministry of Health officials and integrate gender sensitive policies. While technical assistance to the Ministry shall be continued, as it can be seen as a key condition for sector budget support, donors should increasingly consider employing local (rather than international) consultants to that end. ■ The aid modality used by the EU to cofinance the “Comunidades Solidarias” programme has been positively evaluated in that it combines certain advantages of general budget support (institutional strengthening; use of government public financial systems, etc.) with some favourable characteristics of programme support (the achievement of clearly definable results. If this programme is to be continued under the EC’s new financial framework, a truly integrated approach should be adopted in order to ensure that the water and sanitation component is effectively linked to health systems strengthening, especially by allocating adequate financial resources to this subcomponent. ■ As each donor agency currently still has its individual information management systems, one of the first priorities of the Ministry is to establish a unified online development cooperation database, which could be going in the direction of the IATI initiative. For such a system to be effective the government and donors need to ensure that it is linked to the national budget planning exercise. ■ Vertical health funding mechanisms such as the Global Fund should adopt a more integral approach in order to contribute to health systems strengthening. Recent efforts made by the Global Fund in that direction, through the Health System Strengthening funding window, the Joint Health Systems Funding platform and support for the JANS, can be seen as positive developments in that respect, but their effective impact on health systems strengthening at country level still needs to be assessed. ■ With regard to project support, CSOs interviewed during the fact-finding visit noted a drastic reduction of support channelled directly to CSOs during the last few years. In the light of the new health sector reform, as well as the government’s new policies on social participation in the health sector, it will become all the more crucial for donors to ensure that CSOs are able to participate in the new coordination mechanisms – direct support should therefore increasingly be channelled to partnership-building initiatives between MPs, Civil Society and local authorities, as well as advocacy capacity-building and institutional strengthening for non-state actors. ■ Donors should also consider flexibilising and simplifying funding procedures for local CSOs, in order to allow for increased access by smaller CSOs and CBOs, whose projects are often very effective in terms of reaching the most vulnerable, but which lack the capacities to both absorb higher amounts of funding and to follow the complex procedures established by certain European donors. DSW – German Foundation for World Population www.dsw-brussels.org
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