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30 Augusto Cosulich, Vincenzo RacalbutoBox 3 illustrates funding for a SWAp, with the ‘Pool’, supported by donor(1), operating through a Ministry of Health account, and earmarked for specificactivities only. Donor (2) is providing general budget support whichneed not necessarily be spent on health. Donor (3) is providing non-earmarkedsector level support. Donor (4) is continuing to provide parallelfunding to a project which fits within the Sector Wide Approach. The projectcan be said to fit in the SWAp because it is within the sector plan and itsbudget appears within the government budget, even though it does not usegovernment systems for disbursement.Donor 2Ministry ofFinanceDonor 3Donor 1OthergovernmentexpenditureMoHexpenditure‘Pool’Donor 4Public sector expend.in healthDefined groupof activitiesHealth Sector Plan and BudgetHarmonisation in the health sector in EthiopiaProjectBox 3 Funding for a SWApThe section above describes the current situation with respect to donors.There is a general recognition amongst Government and donors that the currentsituation is too fragmented and that greater harmonisation is required.What might this more harmonized health sector look like?The central idea of harmonisation is that Government is in the “driving seat”.This means that Government provides direction on priorities and ways ofworking – for example “we want development partners to work in timeframesthat match the SDPRPs, with new plans in 2005 and 2010.” This is not somuch about particular activities, but is a way of thinking and a way of working.Government and donors are to start their negotiations and plans withGovernment priorities and procedures at the centre.
3. The ethiopian health sector and the italian contribution to HSDP 31The excellent phrase “one plan, one budget, one report” has been used to describeharmonisation. In the health sector, the “one plan” is the HSDP3. Inpractice this means that donors should respect the contents of the plan, andthat Government should invite frank and unhurried dialogue about it. Thereare inevitably tensions in this relationship – but the idea is that the discussionsfocus on important policy issues, rather than on more minor issues suchas individual donor procedures.Within HSDP3, Government has requested donors to concentrate on theHealth Service Extension Programme (and the related Essential HealthServices Package). The HSEP has variously been described as the “flagship”or the “centre of gravity” of HSDP3. Concentrating on the HSEP provides auseful focus for donors – there must be a continuing and mutually respectfuldialogue about issues within this Programme, such as its projected cost andhow it relates to woreda planning.There are three aspects to the “one budget” part of the description of harmonisation:(1) all inputs to the health sector should be captured in one paper budgetand expenditure report, and this should be actively used as a tool forplanning and co-ordination. This includes all inputs from multilaterals,bilaterals and global initiatives. Funding for NGOs is money for developmentof the overall health sector in Ethiopia and should not be regardedas “second-best” in this exercise.The exact nature of the “one budget” idea in the federal context ofEthiopia needs to be clarified. Budgets (and expenditure returns) comefrom various sources – i.e. woredas, regions and the federal level. Ideallyat some point these should all be consolidated into one health sectorbudget – so that overall spending patterns can be reviewed – but this isundeniably a difficult and slow process.(2) The number of single-donor funding streams should be kept to a minimum- resources should be pooled wherever possible. Pooling can bedone in many ways – for TA, drugs, woreda support etc.(3) Similarly, the number of financial management systems should be keptto a minimum – at the very least, donors should agree on one parallelsystem if the Government system is not acceptable in the short term. Allaccounts should follow the Ethiopian fiscal year and there should beagreement on the chart of accounts to be used.“One report” requires both multi-partner reviews and an agreed short-list ofindicators to be used. The HMIS requires ongoing work – a crucial first step is
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