HEALTH SPENDING IN EL SALVADOR - euroresources.org

More documents

Recommendations

Info

6 HEALTH SPENDING IN EL SALVADOR INTRODUCTION AND METHODOLOGY from an illness or accident receive medical assistance; there is inappropriate allocation of resources among public health institutions; health spending is low and fragmented; the quality of care provided to citizens is poor”. According to the WHO, a research study conducted in 2005-2007 showed that 41.7% of the population of El Salvador were still excluded from the health system 7 . However, the country is in the process of implementing a major health reform, which is seen by AfGH as being a crucial moment and opportunity for all stakeholders, specifically European donors, to contribute to improving the country’s health sector situation. SUMMARY OF KEY FINDINGS AND RECOMMENDATIONS COUNTRY OWNERSHIP, CIVIL SOCIETY PARTICIPATION AND THE PARLIAMENT ■ With regard to the newly established health sector social participation mechanisms, a code of conduct for civil society participation procedures should be established in order to jointly tackle what could still be considered as one of El Salvador’s major obstacles to good governance: The high degree of party polarisation affecting every sphere of society. ■ Increased efforts of coordination need to be made by civil society organizations in order to strengthen their advocacy work. To that end, they need to generate spaces where everyone is welcome and listened to, independently of their relations with one or other political party. ■ In the light of the government’s intention to significantly expand public health services coverage, it would be recommendable to involve a representative diversity of CSOs with the required sector-expertise in continuous quality control of public health services. In general, the relationship between public and private entities should be pushed towards collaboration and complementarities – existing competition and rivalries need to be overcome. ■ To the same end, more efforts need to be made in order to improve and strengthen the relationship between International Nongovernmental Organizations (INGOs), local NGOs, Community-based Organisations (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. ■ Increased efforts need to be made by CSOs themselves in order to put advocacy capacity-building on the donors’ agenda, for instance by submitting advocacy project proposals. DONOR COORDINATION ■ In the light of the new health sector reform’s financing needs and the upcoming end-of-term review of the European Commission’s Country Strategy Paper, a strategic change towards healthfinancing should be considered by the EU. The government of El Salvador needs to seize this opportunity and assert its strive for a stronger and more equitable health system by explicitly asking important European donors, such as the European Commission, whose multi-annual country strategies are about to undergo their end-ofterm revision, for sector budget support. ■ Potential health sector budget support needs to be accompanied by specific capacity-building measures for MoH officials. 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 WHO/PAHO should support National Sanitary Authorities to continue the development of their leadership and sectorsteering role. ■ 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. To that end, donors should accept the leadership of the newly reinforced External Cooperation Unit within the MoH with regard to sector coordination. For the Department, on the other hand, there is still a need to fully assume its role as an autonomous coordination entity by effectively uniting donors under its leadership, instead of continuing bilateral negotiations with each of them. 7 This data is based on the information given during the interview with the WHO in El Salvador. DSW – German Foundation for World Population www.dsw-brussels.org
HEALTH SPENDING IN EL SALVADOR INTRODUCTION AND METHODOLOGY 7 ■ Adherence to IHP+ would unite donors in their sector harmonisation efforts, no matter how large their health aid contributions, and contribute to increasing the technical assistance needed to implement the sector reform. Donors should therefore promote El Salvador’s adherence to IHP+. ■ European budget support for the “Comunidades Solidarias” programme should be reformed and capacity-building provided in order to effectively link its water and sanitation component to health systems strengthening, especially by allocating adequate financial resources to this integrated approach. ■ 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, involvement in the Joint Health Systems Funding platform as well as in the JANS 8 , can be seen as positive developments in that respect, but their effective impact on health systems strengthening at country level still needs to become more apparent. ■ In the light of El Salvador’s scarce external funding for health, there is a particular need for European donor agencies to seek a strong collaboration with their non- European counterparts in order to canalize funding and jointly improve aid effectiveness in the health sector. In the context of increased funding needs related to the health sector Reform, European donors will need to step up their support to health in order to prevent the deepening of the current funding gap affecting the sector. ■ As each donor agency currently still has its individual information management systems, one of the first priorities of the newly created Vice-Ministry for Development Cooperation is to establish a unified online development cooperation database, which could be going in the direction of the IATI 9 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. MANAGING FOR RESULTS: THE ROLE OF AID FOR PROGRESS TOWARDS THE HEALTH MDGs AND UNIVERSAL ACCESS TO PRIMARY HEALTHCARE ■ In order to monitor whether health services reach the most vulnerable in El Salvador, donors should support the country’s first steps made towards social auditing at community level. ■ International cooperation needs to become more needs-based, specifically in the health sector, where European and other donors are still concentrating a disproportionately high amount of financial resources towards the fight against specific diseases and health infrastructure financing. Programmes should also be based on data and indicators that are adequately disaggregated according to vulnerable groups. ■ The government of El Salvador will need to overcome inequities in terms of per capita distribution of financial resources to health by reforming the health sector’s currently fragmented structure. Donors could support the government in this aim, for instance by providing technical assistance and advice. ■ With regard to CSOs’ own responsibility for results-based management, external evaluations of development programmes in El Salvador show that it is worth working with CSOs and CBOs in order to achieve tangible results at local level. ■ New aid modalities and initiatives, such as results-based financing and the “Iniciativa Mesoamericana”, need to be reassessed with regard to their impact on health equity and their degree of alignment with existing national policies and priorities in the health sector. This assessment should be undertaken by the governments of the beneficiary countries, by involving CSOs, CBOs, women’s organisations and the most marginalised communities. 8 Joint Assessment of National Strategies: www.internationalhealthpartnership.net 9 International Aid Transparency initiative (IATI): www.aidtransparency.net DSW – German Foundation for World Population www.dsw-brussels.org
Page 1 and 2: EU HEALTH ODA AND AID EFFECTIVENESS
Page 3 and 4: HEALTH SPENDING IN EL SALVADOR CONT
Page 5: HEALTH SPENDING IN EL SALVADOR INTR
Page 9 and 10: HEALTH SPENDING IN EL SALVADOR OWNE
Page 17 and 18: HEALTH SPENDING IN EL SALVADOR THE
Page 25 and 26: HEALTH SPENDING IN EL SALVADOR 25 M
Page 27 and 28: HEALTH SPENDING IN EL SALVADOR MANA
Page 29 and 30: HEALTH SPENDING IN EL SALVADOR RECO
Page 31 and 32: HEALTH SPENDING IN EL SALVADOR 31 B

HEALTH SPENDING IN EL SALVADOR - euroresources.org

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?