IHP+: the silent partner(ship) of global health
Global health partnerships are a bit of a mystery, even to people like me who spend too much of their time studying them. Some partnerships – notably the Global Fund to fight AIDS, TB and Malaria – have a high profile. There are various reasons for this: the type of health issue (AIDS is highly politically sensitive), controversy (the fund has been embroiled in recent fraud allegations, but also public consultation (you still have until June to participate in the Fund’s partnership forum). Other partnerships are less well-known. The International Health Partnership plus (+) related initiatives fits squarely in this category. There are various reasons for this too: the type of health issue (various, but improving coordination, behaviour change and mutual accountability are core to the partnership), degree of added value, and buy-in to name but three.
The IHP+ is different from most other partnerships in that its focus is a concept (broadly speaking ‘governance’) rather than a specific disease, and that the output is behaviour change rather than more drugs, nets or (even) more money. This is a difficult concept to market: for example, many stakeholders still wonder why the partnership hasn’t resulted in more money (which is not what it’s about at all).
Take the concept of mutual accountability. This idea is at the heart of the IHP+ and operationalised at the national level via Country Compacts between donors, governments and civil society. Unfortunately, as a newly published Annual Progress Report by IHP+Results states: “Although there are some signs of this happening in a few countries, the IHP+ is still a long way off from achieving mutual accountability at the country-level”.
A big part of the problem is in the terminology itself. IHP+Results’ Annual Report’s Methodology Annex helpfully provides a list of confusing words and concepts, noting that mutual accountability was “particularly subjective” and one of the concepts “most likely to be open to interpretation” by those interviewed during its monitoring exercise.
The added value of IHP+ has also puzzled partners since its birth in 2007. A 2008 short-term evaluation of the IHP+ found that: “many… still question what value…[the IHP+]… adds at the country level, especially in countries where measures to improve aid effectiveness have already been undertaken for some time”. Many commentators wondered at the time what was wrong with the sector-wide approach (SWAp) to donor health assistance and why we needed the IHP+, and some still do. The short IHP+ answer is that there’s nothing wrong with the SWAp but that the IHP+ adds a formal Compact, a new way of jointly assessing national strategies (JANS), and mutual accountability.
But is this enough to ensure stakeholder buy-in? We learn from IHP+Results that Ethiopia, Mali and Mozambique have seen the most improvements in Development Partners actions to meet their IHP+ targets (that’s just three countries) and that Burundi, Djibouti, DRC, Niger and Nigeria have benefitted less. But we also learn that enthusiasm, at least for IHP+’s monitoring exercise, is waning – just 10 country governments and 15 development partners participated, leaving 50 other partners that didn’t. The Advisory Group to IHP+Results make it pretty clear why this is a problem: “The long- term robustness and utility of the accountability exercise rests on participation by a larger proportion of reporting signatories”.
It’s a shame that the IHP+Results monitoring exercise wasn’t something more – an evaluation, for example. We need to know whether the IHP+ is on track, and what it’s on track to achieve. This may be a difficult ask, however. In the case of evaluating mutual accountability, for example, no target dates have been formally agreed by the IHP+’s Mutual Accountability Working Group, and so it may not be possible to make firm statements about whether progress reported in the monitoring exercise is sufficient, on-track, or off-track. But what would progress towards mutual accountability look like? To help us imagine that it might help if Country Compacts could be assessed for quality.
It’s time to start demanding more of the IHP+. If its stakeholders are committed, then they need to start participating in the process. If its leaders – the Executive Team – are genuinely behind the IHP+, then they need to come out from the shadows and start giving the IHP+ a visibility it currently does not have. The danger is that this too silent partner(ship) will slip away; that efforts to monitor the partnership will lose momentum, be delayed, put on hold; that, ultimately, it will give its excuses and leave the party early. That would be a sad day for global health governance.