FRONTESPIZIO - Cooperazione Italiana allo Sviluppo

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