Summary Report of the

4th Sector Network Meeting

Health & Social Protection

Africa & MENA & LAC

Windhoek, Namibia

September 8 – 12, 2008

Table of Content

1. The Sector Network Meeting at a glance

2. Monday 8th of September

2.1 Opening Session

2.2 Follow-Up Sector Network Meeting Rwanda 2007

2.3Profile and Perspectives of the Sections Health and Social Protection

2.3.1Health Section (Kompetenzfeld Gesundheit)

2.3.2 Social Protection Section (Kompetenzfeld Soziale Sicherung)

2.4Future Perspectives of the Sectors Health and Social Protection in Africa

2.4.1 Public-Benefit area

2.4.2 GTZ International Service

2.4.3 PublicPrivate Partnership

3. Tuesday 9th of September

3.1 Opening Session

3.2 Challenges for Health System and Health Financing Development in Africa

3.3 Examples of effective health sector coordination

4. Wednesday 10th of September

4.1 BMZpolicy papers and guidelines

4.1.1BMZ Health Sector Strategy (Draft)

4.1.2BMZ Sector Concept on Social Protection

4.1.3 Policy Framework Paper on Social and Ecological Market Economy

4.1.4 BMZ Topic Concentration

4.2 The Providing For Health Initiative (P4H)

4.3. Round Table on Social Protection Strategies for Africa

4.4 Technical exchange fora with Namibian experts and NGOs

4.4.1 Social Health Protection

4.4.2 Social Cash transfer

5. Thursday 11th of September

5.1 Learning from Evaluation

5.2 “Analysis of the SWAP process in the health sector and the contribution of GTZ in five partner countries of German DC in Africa”

5.3Poverty and Social Impact Analysis – PSIA

5.4 SQI –Systemic Quality Improvement

5.5What makes networks work?

5.6New organisational structure of the Sector Network Health and Social Protection Africa

5.6.1 Decisions on the organisational structure of the Sector Network

5.6.2 Working Group and Task Teams

6. Friday 12th of September – Thematic Day – HIV/AIDS

6.1 Working group results for BACKUP Initiative & Gender

6.1.1 Summary of discussion

6.2 Working group results for ESTHER

6.3 Thematic session on The Global Fund

6.3.1 Conclusions for GTZ:

6.4 ANNEX: Purpose of the Global Fund thematic session

1. The Sector Network Meeting at a glance

The 4th joined Anglophone and Francophone Sector Meeting Health and Social Protection took place in WindhoekNamibia, Safari Court Conference Centre from 8 to 12 September 2008. 61participants (46 GTZ staff members from 15 countries, 2 counterparts, 7 CIM staff, 2 DED staff, and 3 consultants) discussed various health and social protection topics.

Bernd Appelt (Priority Area CoordinatorHealth and Social Protection GTZ Eschborn) together withKathrin Lauckner (Principal Technical Advisor of the Integrated HIV/AIDS Control Programme GTZ Namibia) organised the meeting. Michael Hagedorn (consultant) facilitated the meeting, and Anna Rau (Assistantto the Head of Department Health Education and Social Protection, GTZ Eschborn) was responsiblefor the summary report.

The meeting elaborated on the future perspectives of GTZ’s work in the sectors health and social protection in Africa. In this context, successful projects and cooperation concepts in all four business areas (Public-Benefit – Ministry of Economic Cooperation and Development (BMZ), International Services, other German Public-Benefit Commissions (DöAG), Public Private Partnerships) were presented and discussed. Working Groups elaborated future options for health and social protection in the different business areas.

Key challenges for health system and health financing development were discussed with delegates from the Namibian Ministry of Health, WHO Tanzania, theCoordinator of the African Health Economics and Policy Association and the economist of GTZ’s Africa Department. Five examples from GTZ field experience provided deep insights into challenges and problems of SWAps, TA-Pooling and donor harmonisation.

The meeting discusseddifferent aspects and experiences of social protection and the further development of the priority area which this year was granted for the first time its own thematic target by BMZ.

In the course of the meeting participants were updated on several new BMZ policy and strategy papers.

In the “Open Space” slot the results of a comparative SWAP study, the method product SQI (Systemic Quality Improvement) and the tool PSIA (Poverty and Social Impact Analysis) were presented.

On the last day of the meeting, the Sector Network (SN) decided on a new organisational structure. A SN speaker and a steering committee were elected and 8 preliminary working groups constituted.

The Sector Project HIV/AIDS in German DC organised the last day of the network meeting to discuss responses to the changing pattern of the HIV/Aids epidemic.

2. Monday 8th of September

2.1 Opening Session

Hans Momber (GTZ Country Director Namibia)opened the 4th Sector Network Meeting Health and Social Protection with a warm welcome toall participants.

Dr. Hedwig Petry, Director of the Division Health, Education and Social Protection, GTZ Eschborn, accentuated the future perspectives of GTZ’s work in the sectors health and social protection in Africa. The rising commitments by national governments and multilateral institutions to development cooperation and the emergence of global financemechanisms and institutions as important partners and actors have increased the opportunitiesforGTZ to expand its portfolio and client base. GTZ-IS and the recently established new strategic unit 09DöAG (Other German Public Client) are well positionedto offer GTZ expertise and services and provide an entry point for clients other than BMZ.The fact thatGTZ-IS has chosen health as one out of its six priority clusters improves our business opportunities.Likewise, social protection is gaining more relevance and importancedocumented amongst other things by the fact that the BMZ has given social protection a separate thematic target and that it lobbies constantly for this theme at national and international level.

2.2 Follow-Up Sector Network Meeting Rwanda 2007

Bernd Appelt(Priority Area Coordinator Health and Social Protection, GTZ Eschborn) gave an overview of theaccomplishments of the tasks and agreements fromthe last SN Meeting in Rwanda 2007.

Completed issues:

  • Comparative survey on SWAps in five African countries (see respective presentation on Thursday 09.11.2008)
  • A one week training course on health economics in 2008 conducted
  • Learning from evaluations: A desk Study on the evaluation of 20 years of support to the Health System in Madagascar was conducted and discussed
  • The themes Reproductive Health and HIV/AIDS have improved their standing through effective public relation work
  • The GTZ products for Reproductive and Sexual Health and Rights (149) and HIV Workplace Programs (062) were updated

Pending issues:

  • Coordinated and targeted SN work in between the SN plenary meetingsthroughproductiveworking groups
  • Public relation work beyond the above mentioned areas to improve the reputation and potential for commissions for our topics
  • Quality check of the health products and anoverhaulof the fact sheets and the BackUpproduct

2.3 Profile and Perspectives of the Sections Health and Social Protection

Andreas Stadler (Health Section, GTZ Bonn)and Matthias Rompel (Social Protection Section, GTZ Eschborn) presented work, profiles and perspectives of the sections Health and Social Protection.

2.3.1 Health Section (Kompetenzfeld Gesundheit)

Future perspectives for the health sector were seen in the light of continuously high international commitment to healthand social development and global health initiatives.

New themes identified in the health sector:

  • Global architecture, ‘global SWAp’
  • Human resources and health
  • Climate change and migration

Pilot area for work for other ministries:

  • Epidemiological transition and urbanisation
  • Health in fragile states

Pilot area for support to GTZ IS:

  • Drug provision
  • Hospital management, e-Health

Discussion:

Participants discussed the comparative advantage of the German DC in the health sector. It was stated that Germany has a broadexpertise in the health sector, as 15% of the jobs in Germany are related to health, but GTZ makes barely use of the existing German networks and know-how. To meet the demands of clients, it was concluded to further elaborate on the new themes within theSector Network as well as athead office level.

2.3.2 Social Protection Section (Kompetenzfeld Soziale Sicherung)

Social Protectionhas a high relevancefor developmentregarding its impacts on poverty alleviation. GTZ leads the policy debate inthis field, and consequently the Social Protection Section in GTZ headquarters is growing. Recently,anew focal area on old age protection was added to the section.

Discussion:

It was stressed that the work of the section does not aim to export the German system, but tailors country-specific solutions for social protection. To cope with the continuously growing demand, experts have beendeployed and the section makes use of German expertise by e.g. linking world wide known brands like Allianz and Münchner Rück with German Development Cooperation.

2.4 Future Perspectives of the Sectors Health and Social Protection in Africa

Future perspectives of the sectors health and social protection in the four GTZ business areas were presented and then further elaborated in working groups.

2.4.1 Public-Benefit Business (GnB)

  • Georg Schäfer (Economistof the GTZ Arica Department, Eschborn) gave an overview of the current health and social protection portfolioin Africa. He referred to the public-benefit clients only. Core Messages:
  • Health remains an important focal area in the bilateral DC.
  • The best way to promote the sector is to promote specific topics.
  • Bernd Appelt (Priority Area Coordinator Health and Social Protection, GTZ Eschborn) highlighted the business potential of cooperation between priority areas as a potential to increase the share of health and social protection within GTZ public-benefit business (GNB).

Proposals of Working Group on GTZ GnB:

  • Explore and prioritize innovative topics likely to attract funding through the Africa NA portfolio, taking into account expected benefits and investment
  • Develop text modules for proposals to be able to respond at short notice
  • Approach those sectors which are currently priorities of the German DC (especially governance, water, sustainable economic development) and explore opportunities to link health activities withtheir programmes to improve their effectiveness
  • Other sectors measure their successes by typical health indicators (e.g. WatSan); this provides an opportunity for the establishment and support of surveillance/health information systems
  • Best practices and examples of successful cooperation inbetween priority areas from countries will be communicated to the LSPs for the design of future projects
  • LSP to establish contacts with other divisions within the GTZ department 4
  • Increase cooperation between programmes within countries
  • Increase visibility of health programmes within the country; opportunities to present the programme within the Ministry of Health or otherrelevant ministries like finance and planning should be explored
  • Increase visibility of innovative health topics within the GTZthrough Newsletters and lectures (Fachgespräche)

2.4.2GTZ International Service

Alan Walsh (Regional Director GTZ IS, Ethiopia) and Anselm Schneider(GTZ Health Program, DR Congo) reported on their success to assemble the biggest GTZ health programme if GTZ-IS and GTZ-GnBcommissions are added up in the Democratic Republic of Congo. Savings and efficiency gains could be made by sharing resources and information. Factors for success are:

  • High visibility of the GTZ-GnB projects and field credibility of GTZ-IS projects
  • Staff of both business areas act as one team

Proposals of Working Group on GTZ IS:

  • Increase incentives for GnB staff to supportIS
  • To improve cooperation; IS needs to feedback their experience to the GnB sector more systematically
  • More information on IS and their special requirementsin the AMA preparation is required

2.4.3 Public Private Partnership

Meinolf Kuper (GTZ Health Program, Tanzania)presented two integrated Public Private Partnerships in the German- Tanzanian Health Program. Both PPPs contributed successfully to reach the goals of the German-Tanzanian Health Programs. Core message:

  • PPPs are an opportunity and not a burden.

Proposals of Working Group on PPP:

  • PPP needs strategic planning at country level, across different sectors; GTZ offices should think about designating a PPP coordinator at country level
  • GTZ head office could offer awareness raising programmson PPP for GTZ staff at country level
  • the sector network healthsocial protection should establish a working group on PPP to facilitate an exchange of existing experiences, linking up to similar groups in other sectors and to the relevant persons in HO, such a working group would also facilitate the access to relevant knowledge and contact persons for colleagues interested to set up a PPP
  • there is a need for support and guidance on PPP, e.g. standard models (types of PPPs and operational procedures), tools facilitating the set up of PPPs, including trust building processes; the working group on PPP could further refine these demands and come up with a proposal how these could be met.

2.4.4 Public-benefit clients other than BMZ (DöAG)

Anja Dahl (DöAG, GTZ Berlin) analyzed the potential of German public-sector clients other than BMZ. In the course of the Heiligendamm Process, the demand for GTZ knowledge has increased. The GTZ sectionfor other public benefit clients (DöAG) is about to be upgraded to thestrategic unit 09 (Stabsstelle 09) and will be directed from 1st January 2009 by our present deputy director of the department 4 Mr Bernd Hoffmann.

Proposals of Working Group on DöAG:

  • Opportunities at the country level were identified;
  • A core measure that needs to be taken is the establishment of a formalised and regular dialogue between all involved parties:
  • DÖAG  P&E RG/countries: communicate e.g. BMG’s priorities
  • RG/countries  P&E  DÖAG: communicate thematic opportunities/needs from country level with the aim of stimulating e.g. BMG’s portfolio
  • DÖAG (underway): mapping of e.g. BMG commitments

3. Tuesday 9th of September

3.1 Opening Session

The Sector Network Meeting was officially opened by the HonourablePetrina Haingura, Deputy Minister of Health and Social Services in Namibia, and Matthias Hansen, Chargé de Affaires German Embassy in Namibia. Petrina Haingurastressed the important role of development partners in providing strategies to address the challenges of the Aids epidemic. Both speakers appreciated the meeting as an important opportunity to develop innovative strategies to improve the health situation in Africa.

3.2 Challenges for Health System and Health Financing Development in Africa

  • Norbert Foster (Deputy Permanent Secretary Health, Namibia) presented a detailed assessment of the Namibian Health System. The human resource crisis in the public health sector and the health service coverage in remote areas were pointed out as severe problems.The human resource crisis in the health sector is one of the main challenges for the health system development as well as for health financing systems. In Africa the health workforce density is 0.8 per 1000 capita. However, in order to reach the MDGs, a health workforce density of 2.5 per 1000 capita is required.
  • Max Mapunda(WHO country office,Tanzania) outlined in his presentation the experience of different funding mechanismto improve health systems.
  • Chris Atim (Coordinator of the African Health Economics and Policy Association, London) focused on new emerging paradigms in health financing systems.
  • User fees impede access to health services and are about to be abolished in many countries
  • Performance-based aid and funding regarding government leadership, transparency and efficiency of resource, financial and management flows
  • Emphasis on key priorities like the human resource crisis, maternal and child health
  • Increased attention to the Abuja targets
  • Equity-focused economic growth would provide the basis for sustainable health financing systems
  • Georg Schäfer (GTZ Africa Department, Eschborn)highlighted the brain drain and fragmented aid as major challenges for health in Africa. Proposed solutions:
  • Holistic approaches to support national health systems
  • Strong focus on capacity development
  • Broadening of innovative financial mechanisms
  • Establishment of incentive schemes for people to return to their homelands
  • Increase of training capacity

Issues arising from the discussion:

  • How to face the workforce problem:
  • Professional training requires a sufficient pre-qualification which is often lacking
  • Focus on capacity development in our partnercountries
  • Big HR Crisis in Malawi was improved through three measures:
  • People came back from retirement and from other sectors
  • Increase of salaries of health workers
  • Organising the financial incentives by learningfrom other sectors
  • How to cope with the multitude of global health initiatives:
  • We need additional resources but not new structures
  • Imitate the Education for All Fast Track Initiative (EFA-FTI) for the health sector
  • Indicators to evaluate the performance of health systems and their contribution to poverty alleviationare required

3.3 Examples of effective health sector coordination

Colleagues from five African Countries (Rwanda: Elisabeth Girrbach, Mozambique: Günther Dietz, Malawi: Dieter Köcher, Madagascar: Danny Denolf, Tanzania: Bergis Schmidt-Ehry) reported on their experiences with TA-Pooling, SWAps, Sector Budget Support and health sector coordination. Advantages, success factors and challenges/problems were presented and discussed.

Advantages of sector coordination:

  • Improved mutual accountability
  • More predictable funding
  • More flexible and manageable aid system by TA pools

Factors for successful sector coordination:

  • Ownership of the partner government
  • Mix of different modes of delivery
  • Efficient division of labour within the donor community
  • Positioning TA by delivering capacity development in a multi-level manner
  • The experiences in Malawi has shown that harmonisation within the German DC is highly appreciated by the partner government

Challenges:

  • Strong management and moderation skills for staff working within sector coordination programmes is compulsory
  • Integration of technical assistance in sector budget support and other joint funding mechanisms
  • Fragmented aid landscape, mushrooming initiatives and big donor groups remain in spite of sector coordination an issue
  • Balance between necessary financial discussions and the management of the “real task” policy dialogue

4. Wednesday 10th of September

4.1 BMZ policy papers and guidelines

4.1.1 BMZ Health Sector Strategy – Andreas Stadler (Health Section, GTZBonn)

  • It is the conceptual framework for the German development aid in the health sector
  • A Guideline for cooperation and communication with partner countries and organisations
  • Core Principles: Health is a human right, equity in access to health services and quality of health services
  • The strategy focuses on certain aspects of health but is not exclusive.

Main Topics: