Rolla Khadduri, public health specialist at MannionDaniels, has been contracted by DFID to provide independent quality assurance on the monitoring and evaluation of the E4A programme.  This involves working closely with both DFID as the donor and the consortium implementing the programme to ensure the high quality and adequate use of data collected for monitoring, and adequate design and implementation of the complex evaluation.

A pastoralist community’s camel herds

The strategy focuses on support to the dry lands of the region and particularly pastoralist communities in Somalia and  Somaliland, the Somali Region of Ethiopia and North Eastern Kenya.   The health team has visited various locations including Jijiga, Isiola, Hargeisa, Berbera and Burao across the region.  The focus of the assessment is to look at ways that the new cooperation can transition from humanitarian support to more health development approaches.  In this drought-prone and conflict affected environment there are many challenges, not least the long distances and dispersed communities, that need to be considered if health services and public health messages are to be more accessible and better utilised by pastoralist communities.  The work is on-going and the team will report back to SDC in late June.

MannionDaniels Africa’s new premises in Karen, Nairobi.

In January 2013, just prior to the national elections in Kenya, Mannion Daniels Africa Limited was registered as a new company.  This new company will lead MannionDaniels’  short term consultancy work in health and social care in the East and Horn of Africa Region. The new office opened this week and recruitment is underway for new positions based in Nairobi.   Our work in the region currently includes supporting the development of the health component of a newly released Swiss Government “Horn of Africa Cooperation Strategy (2013-2016)”.  The focus of the cooperation will be on arid/dry lands and pastoralist communities.  We are also starting an annual review of the DFID funded Health Consortium Somalia programme that includes reviewing the work of five implementing agencies across the three zones of Somalia.  We see the East and Horn of Africa region as a key focus area for our company over the coming years in view of the health and development challenges facing governments and communities across the region and the need to transition from humanitarian assistance to building sustainable health and social care systems appropriate to the different socio-political situations that exist.

Catherine holds an MSc in International Relations from Loughborough University which focused on the impact of migration on development.  For the past 5 years she has been working in the international development sector mostly within West and Central Africa.   Catherine started as an intern within the United Nations in New York before working with the World Food Programme as a youth outreach consultant.  Her interest and experience lie within programme management, aid effectiveness and monitoring and evaluation.  Previous to her position as Programme Manager for MannionDaniels Catherine worked for International Medical Corps for two and a half years.   Her last assignment was in the Central African Republic managing a portfolio of emergency primary health care interventions.

Motorbike traffic in Kathmandu

MannionDaniels have been contracted by HEART (Health and Education Advice and Resource Team – funded by DfID and managed by Oxford Policy Management) to participate in a Mid-Term Review of Nepal’s second Health Sector Programme (NHSP II).  This is a 5 year programme whose wide-reaching aims include:

• Improved sector management
• Improved service delivery
• Improved health governance and financial management
• Reduced cultural and economic barriers to accessing health care services
• Strengthened human resources for health
• Increased health knowledge and awareness
• Improved M&E and health information systems
• Improved physical assets and logistics management
• Improved sustainable health financing

This project has involved a team of 9 consultants, working alongside the Nepalese Ministry of Health and Population.  During their trips to Kathmandu and Biratnagar, the team have visited health facilities, talked to district health workers, and looked at private sector facilities and pharmacies to measure the progress made in implementing strategies.

Dr Narmeen Hamid, a member of the team evaluating the improvement of health service provision, finds:

“Despite the challenges of political instability, a long conflict and resource constraints, Nepal has managed to make great strides in the health sector. Bringing in the experience from another developing South Asian country, Pakistan, it was interesting to see the completely different way health is prioritized in Nepal with a much higher budget allocation, emphasis on primary rather than tertiary care and constitutional commitments to free basic health, and yet how both countries also face similar pitfalls of aid management, over-centralization and inequities that pose serious challenges to the delivery of effective health care to the people”.

Another aspect of the health sector being evaluated by the review is gender equity and social inclusion (GESI).  Dr Poonam Thapa, a member of the team evaluating GESI, explains its current position and importance:

“GESI institutional mainstreaming is still far from being well integrated with service delivery and quality of care.  The lack of full implementation of Human Resources for Health (which is actually GESI sensitive) remains the weakest link in the system. There is hope, in that some critical training programmes are being adapted, pro-poor targeted programmes are slowly but surely being expanded and GESI operational guidelines introduced. If planning and management are even more serious about GESI, Nepal could be much closer to achieving most of the MDG targets by 2015 even in the face of current cut backs in public health investment. GESI cannot remain an option on the side for health because the full achievement of it is a necessity for the people of Nepal.”

 The team, led by David Daniels, presented its findings to the Nepalese government and development partners in late January 2013.

Date: July 2012 – January 2013

MannionDaniels have been contracted by HEART (Health and Education Advice and Resource Team, funded by DfID and managed by Oxford Policy Management) to conduct a Mid-Term Review of Nepal’s second Health Sector Programme (NHSP II).  The Government of Nepal launched NHSP II, which is a 5-year programme in July 2010. The agreement to finance and support the programme of work in NHSP II was formalised in a Joint Financing Arrangement using a Sector Wide Approach. A Mid-Term Review of NHSPII is required in line with these commitments made by the Government of Nepal, external development partners and civil society.

Nepal’s health system faces post-conflict challenges after emerging from a ten-year civil war in 2006 which halved potential economic growth. It must navigate a complex set of interrelated factors including: gender; caste; ethnicity; age; religion; disability; language; geography; corruption and poor infrastructure, all of which impact on the provision and accessibility of health services.  Despite these challenges, Nepal has experienced two decades of steady improvement in health outcomes. Progress accelerated and was accompanied by significant improvements in equality of access during the first NHSP (2004-10) and Nepal is now on track to meet the child and maternal mortality MDGs and it is estimated that NHSP1 saved 96,000 deaths and nearly 3.2 million disability-adjusted life years (DALYs).

NHSP II represents a continuation and refinement of earlier policies and plans based on implementation of cost-effective, evidence-based health interventions, some free of charge.  NHSP II’s vision is to improve the health and nutritional status of all Nepali people, especially the poor and excluded. Three main objectives in the NHSP II results framework are:

1. Increase access to and utilisation of a package of quality essential health care services;
2. Reduce cultural and economic barriers to accessing health care services and harmful cultural practices in partnership with non-state actors.  Fundamental to this objective is the implementation of the Gender Equality and Social Inclusion Strategy;
3. Improve the health system to achieve universal coverage of essential health services. Fundamental to this objective is the implementation of the Governance and Accountability Action Plan.

David Daniels is leading a team of consultants contracted by Oxford Policy Management to assess progress on delivering NHSPII’s objectives. The team are undertaking a series of in-depth consultations with a broad range of health sector stakeholders to inform quantitative and qualitative measurement of progress across the following nine output areas:

• Improved service delivery
• Improved sector management
• Improved health governance and financial management
• Reduced cultural and economic barriers to accessing health care services
• Strengthened human resources for health
• Increased health knowledge and awareness
• Improved M&E and health information systems
• Improved physical assets and logistics management
• Improved sustainable health financing

Broad based consultations with all stakeholders in the sector will be emphasised, as will collecting opinions from different client groups including those from more vulnerable or disadvantaged situations.

Findings from the MTR were presented at the Joint Annual Review in January 2013.

Date: November 2011 – February 2013

Effective governance, leadership and management (G,L &M) is a prerequisite to an effective and equitable health system.  In 2011, MannionDaniels was contracted by WHO Somalia to lead a participatory process to develop a programme to strengthen governance, leadership and management in the Health Authorities of Puntland, Somaliland and South Central Somalia. The programme design had five phases:

• An on-site needs assessment of the capacity of the Health Authorities’ leaders to carry out the core functions of a ministry of health was conducted using participative workshops. The assessment revealed common goals for G,L&M skills that were applicable to all three Health Authorities.
• Initial training workshops in leadership and management for senior officials from the three Health Authorities were held in Hargeisa, Garowe and Nairobi.  The seminar-style of this training focused on governance, levers of change, strategic planning, team working and aid coordination.
• A draft G,L&M Programme design by senior officials from South Central Somalia, Somaliland and Puntland emerged as a result of a collaborative planning workshop held in Nairobi in February 2012.
•  WHO Somalia supported the refining of the design of the G,L&M Programme and the costing of its implementation.  This was completed in late 2012/early 2013 with joint MannionDaniels – Health Authority work in all three zones.
•  The capacity-building elements of the G,L&M Programme were incorporated into the Health Sector Strategic Plans as a foundational input to the G,L&M Strategy for developing the Somali public health sector.  Costs for the training programme were amalgamated with other support needed to build the capacity of the three Health Authorities in governance, leadership and management.

By agreeing to a common G,L&M Programme, the zonal Health Authorities wish to improve the efficiency and effectiveness of support provided to them by development partners.  Alignment by different partners of their funding for capacity improvement with this G,L&M Programme will improve transparency, reduce duplication of effort, and lead to greater value for money in development spending in the Somali health sector.

Date: December 2012 – February 2013

The three Zonal Health Authorities of Puntland, Somaliland and the Federal Government of Somalia operate within severely limited annual budgets, a situation which has necessitated a reliance on development partners to top up salaries and incentivise staff to work on donor projects.  In turn this has created an unregulated system of rewards being offered by different agencies to health workers among and even within the three Zones.  There are also widespread discrepancies between role and remuneration in evidence.

MannionDaniels was commissioned by UNICEF on behalf of the partners in the Somali health sector to study and make recommendations for a standard compensation, salaries and benefits structure for the employees of the three zonal Health Authorities.  MannionDaniels teamed up with Charlie Goldsmith Associates and the NIA Group for this work.  A team visited Nairobi, Hargeisa, Garowe and Mogadishu and interviewed representatives of government, implementing partners and funders about their remuneration practices.  In parallel, a detailed questionnaire was circulated to partners, seeking information on the staff they paid or funded, remuneration levels, and pay and human resource management processes.  The many different job titles and their various remuneration packages were mapped and grouped into job “families”.  Taking into account the cost of living, projected inflation, the projected increases to locally-generated funds and available external support, recommendations for three levels of remuneration per job family were made.

In addition, the study found that the three Health Authorities now have at least incipient accountability systems for staff salaries: payroll systems; HR filing systems and attendance monitoring have been instigated, which are allowing funders to transfer some funds to government for the Authorities to manage payments to staff.  The success of this approach is that it is cost-effective, reduces security and operational risks, and reinforces the legitimacy, oversight and responsibility of government.  The remuneration levels recommended were incorporated into the cost projections of the Health Authorities’ 4-year Health Sector Strategic Plans, a consultancy being conducted by MannionDaniels during the same period.

]]> http://www.manniondaniels.com/2013/02/28/review-of-compensation-salaries-incentives-and-benefits-for-health-personnel-in-somalia/feed/ 0 http://www.manniondaniels.com/2013/02/19/gavi-aid-effectiveness/ http://www.manniondaniels.com/2013/02/19/gavi-aid-effectiveness/#comments Tue, 19 Feb 2013 13:01:28 +0000 MaNn10n_D4aNi3Ls_U53R http://www.manniondaniels.com/?p=1379 GAVI’s mission is “saving children’s lives and protecting people’s health by increasing access to immunisation in poor countries” – it mobilises and disburses billions of dollars to support increased immunisation.  GAVI is a signatory to all the key aid effectiveness agreements: the Paris Declaration, the Accra Agenda for Action, the International Health Partnership+ and the Busan Partnership for Effective Development Cooperation.  GAVI asked MannionDaniels to provide assistance and advice on GAVI’s approach to meeting its aid effectiveness commitments.  Martin Taylor provided advice in the lead up to the 2011 Busan High Level Forum on Aid Effectiveness including advising on how GAVI could accelerate progress on implementing its aid effectiveness commitments.

MannionDaniels’ consultants have also finalised the design of a long-term “Governance, Leadership and Management” capacity development programme with the Somali Health Authorities.  Begun in 2011 with a needs assessment, the Programme has been incorporated into the Health Sector Strategic Plans and carefully costed by a team of international and Somali finance experts.  An international training institution will be sought to implement the Programme, working with a consortium of Somali institutions.

Finally, with annual budgets in recent years of as little as $500,000, the Somali Health Authorities have had to rely on development partners to pay their staff a living wage.  This has resulted in an unregulated system of “salary top ups” or “incentives” being offered by different agencies to health workers.  MannionDaniels, working with Charlie Goldsmith Associates, has just completed a study of health workers’ remuneration packages in order to recommend a series of more rational options, and the resultant report has been submitted to UNICEF Somalia.