MINISTERUL SĂNĂTĂȚII

REPUBLICA MOLDOVA

ANNUAL REPORT ON OFFICIAL DEVELOPMENT ASSISTANCE OFFERED TO THE HEALTH SECTOR OF THE REPUBLIC OF MOLDOVA

2014

7TH EDITION

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

3

EUROPEAN UNION

BILATERAL

DEVELOPMENT PARTNERS 2014

MULTILATERAL

CEB

COUNCIL OF EUROPE

GLOBAL FUND

GAVI

UNAIDS

UNICEF

UNFPA

UNODC

UNECE

WHO

WB

GOVERNMENT OF AUSTRIA/ADA

GOVERNMENT OF ROMANIA

GOVERNMENT OF JAPAN/JICA

GOVERNMENT OF ESTONIA

GOVERNMENT OF SWITZERLAND/SDC

GOVERNMENT OF TURKEY/TIKA

UNDP

GOVERNMENT OF FRG/GIZ IAEA

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

5

MINISTRY OF

HEALTH OF THE

REPUBLIC OF

MOLDOVA

Donors interviewed

6

Agency 2011 2012 2013 2014

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) + + + +

Overall ODA disbursed per donor and by type of disbursement 2014

7

TICA

IAEA

UNAIDS

UNODC

GIZ

Government of Estonia

Council of Europe

UNECE

UNFPA

UNICEF

UNDP

GAVI

Government of Romania

World Bank

World Health Organization

Government of Austria

SDC

Global Fund

Government of Japan

Grant Soft Loan

Type of Funding

8

Tied 26%

Untied 74%

Type of funding

9

Technical assistance; 17,30%

Investments; 74,20%

Administrative; 8,50%

Grants and loans

10

US$ equivalent, 2011 - 2014

46 355 929

5 500 000

51 855 929

28 886 921

17 505 130

46 392 051 43 168 147

20 854 994

64 023 141

25 441 334 25 065 530

50 506 864

0

10 000 000

20 000 000

30 000 000

40 000 000

50 000 000

60 000 000

70 000 000

Grant Soft Loan Total

2011 2012 2013 2014

Type of mechanism by which ODA is provided

11

US$ equivalent, 2011 - 2014

32 909 422

39 289 697

62 931 331

50 325 146

18 946 507

7 102 354

1 091 811 181 718

2011 2012 2013 2014

Project aid Sector budget support

12

Geographic coverage

MINISTERUL SĂNĂTĂȚII

REPUBLICA MOLDOVA

Type of funding

13

% of funds disbursed, 2011 - 2014

32,5%

58,5%

9,0%

32,7%

62,2%

5,1%

17,3%

78,0%

4,6%

17,3%

74,2%

8,5%

0,0%

10,0%

20,0%

30,0%

40,0%

50,0%

60,0%

70,0%

80,0%

90,0%

Technical Assistance Investments Administrative

2011 2012 2013 2014

Investments

14

% of funds disbursed for Investments in

2011- 2014

38,7%

13,0%

2,9%

35,3%

10,1%

28,7%

39,8%

0,8%

18,7%

12,0%

32,0% 33,6%

0,8%

19,0%

14,6%

8,7%

71,0%

0,5%

8,9% 10,9%

0,0%

10,0%

20,0%

30,0%

40,0%

50,0%

60,0%

70,0%

80,0%

Construction and refurbishment Medical Equipment IT Technology Medical Supplies Other

2011 2012 2013 2014

Technical assistance

15

% of funds disbursed for Technical

assistance in 2011- 2014

15,5%

56,6%

12,6%

6,2% 9,1%

20,2%

47,4%

7,6%

11,3% 13,4%

23,2%

47,1%

6,9% 8,5%

14,3%

19,9%

47,1%

4,8%

8,9%

19,3%

0,0%

10,0%

20,0%

30,0%

40,0%

50,0%

60,0%

Policy Capacity Building Guidelines and Protocols Legal Framework Other

2011 2012 2013 2014

ODA distribution to Health System Core Functions

16

% of total funds disbursed in

2011- 2014

37,4%

49,6%

2,3%

10,7%

33,6%

57,1%

2,8% 6,5%

35,5%

56,8%

1,3%

6,4%

21,3%

74,4%

2,0% 2,3%

0,0%

10,0%

20,0%

30,0%

40,0%

50,0%

60,0%

70,0%

80,0%

Health Services Delivery Resource generation Health Financing Leadership& Governance

2011 2012 2013 2014

ODA provided for Health Service Provision

17

% of funds disbursed for Health Service

Provision in 2011 - 2014

47,1%

40,5%

6,2% 6,2%

21,5%

63,4%

11,8%

3,4%

22,5%

55,7%

15,7%

6,1%

20,3%

57,9%

9,5% 12,3%

0,0%

10,0%

20,0%

30,0%

40,0%

50,0%

60,0%

70,0%

Primary Health Care Hospitals Public Health Services Emergency

2011 2012 2013 2014

ODA distribution against Public health priority areas

18

% of total funds disbursed in 2014

Communicable diseases; 22,2%

Risk Factors; 1,1%

Non-Communicable diseases; 36,1% Injuries and Violence; 7,7%

MCH and Reproductive Health; 15,1%

Adolescent health; 2,9%

Not Applicable; 14,9%

ODA distribution against Public health priority areas

19

% of total funds disbursed in 2014

Communicable diseases; 26,1% Risk Factors; 1,3%

Non-Communicable diseases; 42,4%

Injuries and Violence; 9,0%

MCH and Reproductive Health; 17,7%

Adolescent health; 3,4%

Other; 0,1%

Alignment of ODA to national health policies

20

Health policy, strategy or programme Development partners (total number)

National Health Policy, 2007-2021 ADA Austria; BDCE; WB; GIZ; Estonian Government; Japan Government; Romanian Government; WHO; SDC; TIKA; EU; UNECE; UNFPA; UNICEF; (14)

Health Systems Development Strategy, 2008-2017 ADA Austria; IAEA; BDCE; WB; GF; GIZ; Estonian Government; Japan Government; Romanian Government; WHO; UNDP; SDC; EU; UNICEF; UNODC; (15)

National Anti-Drug Strategy, 2011-2018 WHO; UNODC; (2)

State Policy on Pharmaceuticals WHO; (1)

National Public Health Strategy, 2014-2020 Estonian Government; Japan Government; WHO; SDC; EU; UNECE; UNFPA; (7)

National Strategy for Reproductive Health, 2005-2015 Estonian Government; Romanian Government; WHO; UNDP; SDC; TIKA; UNFPA; (7)

Agency of Medicines and Medical Devices Road map, 2012-2014 WHO; SDC; (2)

Institutional Development Strategy of the National Health Insurance Company, 2013-2017 WB; WHO; SDC; (3)

National Program for Viral Hepatitis B, C and D Control, 2012-2016 WHO; (1)

National Program for Health Lifestyle Promotion, 2007-2015 IAEA; Estonian Government; WHO; SDC; UNFPA; (5)

National Program for Mental Health, 2012-2016 WHO; UNDP; SDC; (3)

National Blood Transfusion Safety Program, 2012-2016 BDCE; WHO; (2)

National Immunizations Program, 2011-2015 GAVI; WHO; UNICEF; (3)

National HIV/AIDS and STI Prevention Program, 2014-2015 COE; GF; WHO; UNDP; SDC; EU; UNAIDS; UNFPA; UNICEF; (9)

National TB Prevention and Control Program, 2011-2015 COE; GF; WHO; (3)

National Program for Diabetes Control, 2011- 2015 WHO; (1)

National Program for Emergency Care Development, 2011-2015 Japan Government; WHO; SDC; (3)

National Program for Tobacco control 2012-2016 WHO; SDC; (2)

National Program for Alcohol control 2012-2016 WHO; SDC; (2)

National Program for Transplant 2012-2016 Japan Government; EU; (2)

National Program on Iron and Folic Acid Deficiencies 2012-2017 SDC; UNICEF; (2)

National Program on Iodine Deficiency Disorders Eradication 2011-2015

National Prevention and Control Program for Cardiovascular Diseases, 2014-2020 WHO; (1)

National Program in the field of Food and Nutrition, 2014-2020 WHO; SDC; UNICEF; (3)

National Program for Prevention and Reduction of the morbidity and mortality of children with congenital malformations and hereditary pathologies, 2013-2017

Romanian Government; WHO; SDC; (3)

Other (Regionalization of pediatric Emergency and Intensive Care services (MoH Order Nr. 1215 from October 2013)

SDC; (1)

ODA implementation using national procedures

21 US$ equivalent, 2011 - 2014

Budget execution Financial reporting Auditing All three procedures ProcurementRecorded in the national

accountingTotal

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

Alignment of ODA to MTBF categories 2014

22

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

Public ODA

Alignment of ODA to MTBF categories 2015 – 2017

23

US$ equivalent

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

2015 2016 2017

Aid Predictability Scheduled and actual ODA disbursements

24

US$ equivalent, 2011 - 2014

42 414 562

32 304 632

61 794 921

51 239 537 51 855 929

46 392 051

64 023 141

50 506 864

2011 2012 2013 2014

Scheduled Disbursed

Donor coordination and complementarity Joint missions

25

Number of missions, 2014

6 4

3 1 2 1 1

64

1

4 3

2 1

5 4

3 1 2

0 0

7

1

4 3

1 1

0

10

20

30

40

50

60

70

WB GF Council of Europe GAVI GIZ EstonianGovernment

RomanianGovernment

WHO UNDP UNAIDS UNECE UNFPA UNODC

Overall donor missions in the sector Coordinated missions with other donors

Donor coordination and complementarity Analytical works

26

Number of works, 2014

3

1 1

6 6

3

1

0

4

6

WB GAVI Estonian Government WHO UNAIDS

Nr. of analytic works Nr. of coordinated analytic works

Aid Predictability Intention to continue support to health sector

mid-term, 2015 - 2017

27

US$ equivalent

0

10 000 000

20 000 000

30 000 000

40 000 000

50 000 000

60 000 000

2015 2016 2017

Number of projects and closing year

28

20

26

1

5

2

0

5

10

15

20

25

30

2014 2015 2016 2017 2018

Nr.

of

pro

ject

s

ODA partners presence in the sector

29

17

12

9

2

1

4

0

2

4

6

8

10

12

14

16

18

2015 2016 2017 2018 2019 Uncertain

Dev

elo

pm

ent

par

tner

s

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

37

MINISTERUL SĂNĂTĂŢII AL

REPUBLICII MOLDOVA