Evaluarea Performanţelor în Sănătate Atelier de lucru 5 – 6

ANNUAL REPORT ON OFFICIAL DEVELOPMENT ASSISTANCE
OFFERED TO THE HEALTH SECTOR OF THE REPUBLIC OF MOLDOVA
2014
7TH EDITION
MINISTERUL SĂNĂTĂȚII
REPUBLICA MOLDOVA
1
Report Objectives
1. to picture donors alignment towards the Moldovan health system
strategies
2. to improve quality of information available for sector coordination
and strategic decision-making for strategic planning of financial
resources in health sector
3. to provide evidences to strengthen donor coordination mechanism
towards the on-going reforms in the Moldovan health sector
4. to illustrate donors’ short and medium term commitments to the
Moldovan health sector
5. to inform on future sectorial strategic plans and donors’ strategies to
support the MOH of the RM
2
DEVELOPMENT PARTNERS 2014
MULTILATERAL
BILATERAL
EUROPEAN UNION
UNFPA
GOVERNMENT OF AUSTRIA/ADA
CEB
UNODC
GOVERNMENT OF ROMANIA
COUNCIL OF EUROPE
UNECE
GOVERNMENT OF JAPAN/JICA
GLOBAL FUND
WHO
GOVERNMENT OF ESTONIA
GAVI
WB
GOVERNMENT OF TURKEY/TIKA
UNAIDS
UNDP
GOVERNMENT OF SWITZERLAND/SDC
UNICEF
IAEA
GOVERNMENT OF FRG/GIZ
3
Differences with previous editions
• Tied and untied aid mapping
• Organizational effort track
• MTBF comparison in terms of donor strategic programming
and alignment versus domestic funds
• Progress achieved within the health sector during 2014 in
implementing the Busan commitments
4
KEY RESULTS
MINISTRY OF
HEALTH OF THE
REPUBLIC OF
MOLDOVA
5
Donors interviewed
Agency
Council of Europe
Council of Europe Development Bank (CEB)
European Union (EU)
German Society for International Cooperation (GIZ)
Global Alliance for Vaccines and Immunization (GAVI)
Global Fund to Fight AIDS, Tuberculosis and Malaria (GF)
Government of Austria / Austrian Development Agency (ADA)
Government of China
Government of Estonia
Government of Japan
Government of Romania
International Atomic Energy Agency (IAEA)
Joint United Nations Programme on HIV/AIDS (UNAIDS)
Swiss Agency for Development and Cooperation (SDC)
Turkish International Cooperation and Development Agency (TIKA)
United Nations Development Programme (UNDP)
United Nations Children’s Fund (UNICEF)
United Nations Economic Commission for Europe (UNECE)
United Nations Population Fund (UNFPA)
United Nations Office on Drugs and Crime (UNODC)
World Bank (WB)
World Health Organization (WHO)
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Overall ODA disbursed per donor and
by type of disbursement 2014
Government of Japan
Global Fund
SDC
Government of Austria
World Health Organization
World Bank
Government of Romania
GAVI
UNDP
UNICEF
UNFPA
UNECE
Council of Europe
Government of Estonia
GIZ
UNODC
UNAIDS
IAEA
TICA
Grant
Soft Loan
7
Type of Funding
Tied
26%
Untied
74%
8
Type of funding
Administrative; 8,50%
Investments; 74,20%
Technical assistance; 17,30%
9
Grants and loans
70 000 000
64 023 141
60 000 000
51 855 929
50 000 000
50 506 864
46 392 051
46 355 929
43 168 147
40 000 000
30 000 000
28 886 921
25 441 334
25 065 530
20 854 994
17 505 130
20 000 000
10 000 000
5 500 000
0
Grant
Soft Loan
2011
2012
2013
Total
2014
US$ equivalent, 2011 - 2014
10
Type of mechanism by which ODA is provided
62 931 331
50 325 146
39 289 697
32 909 422
18 946 507
7 102 354
1 091 811
2011
2012
2013
Project aid
181 718
2014
Sector budget support
US$ equivalent, 2011 - 2014
11
Geographic coverage
MINISTERUL SĂNĂTĂȚII
REPUBLICA MOLDOVA
12
Type of funding
90,0%
78,0%
80,0%
74,2%
70,0%
62,2%
58,5%
60,0%
50,0%
40,0%
32,5%
32,7%
30,0%
20,0%
17,3%
17,3%
9,0%
10,0%
5,1%
8,5%
4,6%
0,0%
Technical Assistance
Investments
2011
2012
2013
Administrative
2014
% of funds disbursed, 2011 - 2014
13
Investments
80,0%
71,0%
70,0%
60,0%
50,0%
40,0%
30,0%
39,8%
38,7%
35,3%
33,6%
32,0%
28,7%
18,7% 19,0%
20,0%
13,0%
10,0%
8,9%
8,7%
2,9%
10,1%
14,6%
12,0%
10,9%
0,8% 0,8% 0,5%
0,0%
Construction and refurbishment
Medical Equipment
IT Technology
2011
2012
2013
Medical Supplies
Other
2014
% of funds disbursed for Investments in
2011- 2014
14
Technical assistance
60,0%
56,6%
50,0%
47,4% 47,1% 47,1%
40,0%
30,0%
20,0%
23,2%
19,9%
20,2%
19,3%
15,5%
12,6%
10,0%
11,3%
7,6% 6,9%
4,8%
6,2%
13,4%
8,5% 8,9%
14,3%
9,1%
0,0%
Policy
Capacity Building
Guidelines and Protocols
2011
2012
2013
Legal Framework
Other
2014
% of funds disbursed for Technical
assistance in 2011- 2014
15
ODA distribution to Health System Core Functions
80,0%
74,4%
70,0%
57,1% 56,8%
60,0%
49,6%
50,0%
40,0%
37,4%
33,6%
35,5%
30,0%
21,3%
20,0%
10,7%
10,0%
2,3% 2,8% 1,3% 2,0%
6,5% 6,4%
2,3%
0,0%
Health Services Delivery
Resource generation
2011
Health Financing
2012
2013
Leadership& Governance
2014
% of total funds disbursed in
2011- 2014
16
ODA provided for Health Service Provision
70,0%
63,4%
60,0%
50,0%
55,7%
57,9%
47,1%
40,5%
40,0%
30,0%
21,5% 22,5% 20,3%
20,0%
15,7%
11,8%
10,0%
12,3%
9,5%
6,2%
6,2%
6,1%
3,4%
0,0%
Primary Health Care
Hospitals
2011
Public Health Services
2012
2013
Emergency
2014
% of funds disbursed for Health Service
Provision in 2011 - 2014
17
ODA distribution against Public health priority areas
Not Applicable; 14,9%
Communicable diseases; 22,2%
Adolescent health; 2,9%
Risk Factors; 1,1%
MCH and Reproductive Health;
15,1%
Non-Communicable diseases;
36,1%
Injuries and Violence; 7,7%
% of total funds disbursed in 2014
18
ODA distribution against Public health priority areas
Non-Communicable diseases;
42,4%
Injuries and Violence; 9,0%
MCH and Reproductive Health;
17,7%
Adolescent health; 3,4%
Other; 0,1%
Risk Factors; 1,3%
Communicable diseases; 26,1%
% of total funds disbursed in 2014
19
Alignment of ODA to national health policies
Health policy, strategy or programme
National Health Policy, 2007-2021
Health Systems Development Strategy, 2008-2017
National Anti-Drug Strategy, 2011-2018
State Policy on Pharmaceuticals
National Public Health Strategy, 2014-2020
National Strategy for Reproductive Health, 2005-2015
Agency of Medicines and Medical Devices Road map, 2012-2014
Institutional Development Strategy of the National Health Insurance Company, 2013-2017
National Program for Viral Hepatitis B, C and D Control, 2012-2016
National Program for Health Lifestyle Promotion, 2007-2015
National Program for Mental Health, 2012-2016
National Blood Transfusion Safety Program, 2012-2016
National Immunizations Program, 2011-2015
National HIV/AIDS and STI Prevention Program, 2014-2015
National TB Prevention and Control Program, 2011-2015
National Program for Diabetes Control, 2011- 2015
National Program for Emergency Care Development, 2011-2015
National Program for Tobacco control 2012-2016
National Program for Alcohol control 2012-2016
National Program for Transplant 2012-2016
National Program on Iron and Folic Acid Deficiencies 2012-2017
National Program on Iodine Deficiency Disorders Eradication 2011-2015
National Prevention and Control Program for Cardiovascular Diseases, 2014-2020
National Program in the field of Food and Nutrition, 2014-2020
National Program for Prevention and Reduction of the morbidity and mortality of children
with congenital malformations and hereditary pathologies, 2013-2017
Other (Regionalization of pediatric Emergency and Intensive Care services (MoH Order Nr.
1215 from October 2013)
Development partners (total number)
ADA Austria; BDCE; WB; GIZ; Estonian Government; Japan Government; Romanian Government; WHO;
SDC; TIKA; EU; UNECE; UNFPA; UNICEF; (14)
ADA Austria; IAEA; BDCE; WB; GF; GIZ; Estonian Government; Japan Government; Romanian
Government; WHO; UNDP; SDC; EU; UNICEF; UNODC; (15)
WHO; UNODC; (2)
WHO; (1)
Estonian Government; Japan Government; WHO; SDC; EU; UNECE; UNFPA; (7)
Estonian Government; Romanian Government; WHO; UNDP; SDC; TIKA; UNFPA; (7)
WHO; SDC; (2)
WB; WHO; SDC; (3)
WHO; (1)
IAEA; Estonian Government; WHO; SDC; UNFPA; (5)
WHO; UNDP; SDC; (3)
BDCE; WHO; (2)
GAVI; WHO; UNICEF; (3)
COE; GF; WHO; UNDP; SDC; EU; UNAIDS; UNFPA; UNICEF; (9)
COE; GF; WHO; (3)
WHO; (1)
Japan Government; WHO; SDC; (3)
WHO; SDC; (2)
WHO; SDC; (2)
Japan Government; EU; (2)
SDC; UNICEF; (2)
WHO; (1)
WHO; SDC; UNICEF; (3)
Romanian Government; WHO; SDC; (3)
SDC; (1)
20
ODA implementation using national procedures
Budget execution
Financial reporting
Auditing
All three procedures
Procurement
Recorded in the national
accounting
Total
2011
15 724 739
7 405 866
7 405 866
1 905 866
388 381
15 724 739
51 855 929
2012
24 419 639
30 844 995
24 226 901
19 750 242
1 755 957
31 021 115
46 392 051
2013
26 595 449
41 729 827
26 144 148
19 090 233
11 309 949
42 181 128
64 023 142
2014
9 103 469
12 789 648
9 012 995
9 012 995
5 024 373
31 508 054
50 506 864
US$ equivalent, 2011 - 2014
21
Alignment of ODA to MTBF categories 2014
Development and modernization of the healthcare facilities
National and Special Health Programs
Management of the mandatory health insurance reserve fund
Rational Management of Medicines and Medical Devices
Forensic Medicine
Recovery Medical Care
Mother and Child and Youth Health
High-Performance Medical Services
Hospital Care
Emergency Pre-hospital Medical Care
Community and Home-based Medical Services
Outpatient Specialized Care
Primary Health Care
Public Health
Health System Monitoring, Evaluation and Quality Management
Administration of Mandatory Health Insurance Funds
Policy development and health systems management
Public
ODA
22
Alignment of ODA to MTBF categories 2015 – 2017
Policy development and health systems management
Administration of Mandatory Health Insurance Funds
Health System Monitoring, Evaluation and Quality Management
Public Health
Primary Health Care
Outpatient Specialized Care
Community and Home-based Medical Services
Emergency Pre-hospital Medical Care
Hospital Care
High-Performance Medical Services
Mother and Child and Youth Health
Recovery Medical Care
Forensic Medicine
Rational Management of Medicines and Medical Devices
Management of the mandatory health insurance reserve fund
National and Special Health Programs
Development and modernization of the healthcare facilities
2015
2016
2017
US$ equivalent
23
Aid Predictability
Scheduled and actual ODA disbursements
61 794 921
64 023 141
51 855 929
51 239 537 50 506 864
46 392 051
42 414 562
32 304 632
2011
2012
2013
Scheduled
2014
Disbursed
US$ equivalent, 2011 - 2014
24
Donor coordination and complementarity
Joint missions
70
64
60
50
40
30
20
10
7
6
5
4
4
3
3
4
1
1
2
2
1
0
1
1
0
4
1
3
3
2
1
1
1
0
WB
GF
Council of Europe
GAVI
GIZ
Estonian
Government
Overall donor missions in the sector
Romanian
Government
WHO
UNDP
UNAIDS
UNECE
UNFPA
UNODC
Coordinated missions with other donors
Number of missions, 2014
25
Donor coordination and complementarity
Analytical works
6
6
6
4
3
3
1
1
1
0
WB
GAVI
Estonian Government
Nr. of analytic works
WHO
UNAIDS
Nr. of coordinated analytic works
Number of works, 2014
26
Aid Predictability
Intention to continue support to health sector
mid-term, 2015 - 2017
60 000 000
50 000 000
40 000 000
30 000 000
20 000 000
10 000 000
0
2015
2016
2017
US$ equivalent
27
Number of projects and closing year
30
26
25
Nr. of projects
20
20
15
10
5
5
2
1
0
2014
2015
2016
2017
2018
28
ODA partners presence in the sector
18
17
16
Development partners
14
12
12
10
9
8
6
4
4
2
2
1
0
2015
2016
2017
2018
2019
Uncertain
29
Findings
• In 2014 donors have disbursed an equivalent of US$ 50.5 million, which is a 11%
adding to the overall public health expenditure, estimated at US$ 411.8 million. If
compared to the 2013 assessment, the ODA contribution to the total health sector
public expenditure was less by 6 % points comparing to 2013 (17% ODA to the US$
378 million public spent in 2013)
• The share of ODA in form of soft loans has considerably increased - 50% of the total
funds in 2014 (33% in 2013, 38% in 2012, and only 11% in 2011).
• The technical assistance decreased by half during 2013, 2014 (17%) compared to
2011, 2012 (33%)
• Investment component shows a continuous increase trend starting with 2011 58.5% to 74% in 2014
• Of note is the fact that administrative costs increased by 3.8 % compared to 2013
(4.6%), almost reaching those reported in 2011 (9%).
30
Findings
• Due to the investments in the hospital sector is observed the switch between the resource
generation (decrease by 14.2%) and health service delivery (increase by 17.6%) categories,
thus both categories continued to account for the larger share of the donor assistance
scrutinized until now.
• Of note is that Leadership&Governance category picture a step decreasing trend over the
last 4 years in both terms (real and %)
• ODA to hospital sector as a share of total expenditure slightly increase in 2014 with 2,2%
points comparing to 2013, although in real terms decreased with 3,6 mln USD.
• After a dramatic fall of ODA to primary health care (drop from 47.1% in 2011 to 21.5% in
2012), the trend remains stable around 20% for the last 3 years.
• The disbursements to emergency care doubled in 2014 compared to 2013 and are 4 times
higher compared to 2012.
31
Findings
• Non-Communicable diseases tracks a major increase in 2014 reaching
36.1% comparing to 4.4% in 2013. For the first time the NCD share is the
biggest within the public health category.
• Communicable diseases share decreased with 7.5% over the last 2 years,
although in real terms it almost halved.
• MCH & Reproductive health category almost doubled in real terms over
the last 2 years, and increased with 8.9%
• Injuries and Violence enjoys major attention and encounter a 7%
increase in 2014 comparing to 2013
• Adolescent health category remain stable over the last two years
32
Findings
• In terms of Geographical Coverage, the distribution continues to be uneven as in
previous editions. The main cities of Chisinau and Balti are covered by the highest
number of donors. Looking to regions Transnistria enjoys the highest presence of
partners. Of note is that 18 rayons have no targeted assistance in 2014.
• In health sector, donors aligned well to support priorities in national health policies
and national programs, however some national strategies and programmes receive
less attention as the last years, such as the areas related to Pharmaceuticals,
Hepatitis, Diabetes and Cardiovascular diseases.
• The resource distribution by MTBF categories picture top two categories: hospital
and PHC for the public support during the last two years; followed by Development
and modernization of the healthcare facilities and National and Special Health
Programs categories which are the first choice of partners support (2013,2014).
33
Findings
Checked against the Busan commitments and the Global Partnership Monitoring
Framework
1. If to consider all the national strategic health planning documents as country results
framework: all the development partners are aligned to the health policy priorities
2. 7 out of 21 (33.3%) development partners are active in the sector and disburse
fund thru NGO’s
5. a. The ratio of planned to disbursed fund is the smallest in the last 4 years (1.5% 2014) thus being opposite to the situation in the precedent years (scheduled
greater then disbursed).
b. Out 21 development partners only 8 (38%) provided exact amount of future
disbursement for the next 3 years, out of them 7 (33.4%) stated the areas of
interest
34
Findings
Checked against the Busan commitments and the Global Partnership Monitoring
Framework
6. The proportion of funds recorded in the national accounting is over
60% in the last 3 years – 62% in 2014 compared to the 66% in 2013,
67% in 2012 and 30.3% in 2011
9.b. The use of country PFM and procurement systems was at the level of
17.8% in 2014, it is almost 2 times less than in 2013 (41.8%) and 2014
(41.3%) although is higher than in 2011 (14.9%)
10. A quarter of aid has been reported under tied category (26%).
35
Findings
• The Joint Missions target recorded 34% in 2014 of the total missions,
thus it is less than the recommended at least 40% mentioned in the
Paris Declaration.
• The joint country Analytic Work indicator reached 82% in 2014, against
the 66% target indicated by the Paris Declaration.
36
Thank you for your attention
MINISTERUL SĂNĂTĂŢII AL
REPUBLICII MOLDOVA
37