Disclaimer This document contains the independent opinion of the two consultants and as such does not necessarily represent the views of either dfat, the mhms, Mott MacDonald or any other party. Similarly



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Independent Completion Evaluation of Australia’s Contribution to the Solomon Islands Health Sector Support Program

Final

Pete Thompson and Anthony Drexler



13 November 2015

Disclaimer
This document contains the independent opinion of the two consultants and as such does not necessarily represent the views of either DFAT, the MHMS, Mott MacDonald or any other party. Similarly, the recommendations made are those of the consultants alone.

An overview of the findings and the recommendations were presented, both as a written aide memoire and at a presentation before leaving the Solomon Islands and this report expands on the aide memoire.



Acknowledgments
Thanks to all those involved in this evaluation for the support and willing assistance provided during the evaluation period. In particular, thank-you to the DFAT health staff of Honiara Post who provided both technical and logistical support to the evaluation.

Thank-you goes to all national, provincial and local government representatives in Solomon Islands for participating in interviews and for providing thoughtful feedback.

Also, thanks go to the various development partner staff members who also gave of their time and assistance and for their participation, input and commitment to the process.

Thanks also to the Mott MacDonald staff for their helpful comments and support throughout the process, and to the members of the Reference Group who also provided helpful comments and support.


Acronyms

AOP(s) Annual Operational Plan(s)

AUD Australian Dollars

AusAID Australian Agency for International Development

ARI Acute Respiratory Infection

CEWG Core Economic Working Group

DFAT Department of Foreign Affairs and Trade

DFID Department for International Development

DHIS District Health Information System

DHS Demographic and Health Survey (2006-2007)

DP Development Partner

DPCG Development Partners Coordination Group

DSID Design Summary and Implementation Documents

EU European Union

GDP Gross Domestic Product

GESI Gender Equity and Social Inclusion

GoA Government of Australia

GNI Gross National Income

H4D DFAT Health for Development Strategy 2015-2020

HDI Human Development Index

HISP Health Improvement Strengthening Project

HIV Human Immunodeficiency Virus

HPV Human Papilloma Virus

HISP Health Institutional Strengthening Project

HRF Health Resource Facility for Australia’s Aid Program

HSSP Health Sector Support Program

HSSP2 Health Sector Support Program – Second Phase

HSSP3 Health Sector Support Program – Recommended Third Phase

HSTA Health Sector Trust Account

IMF International Monetary Fund

IPA Independent Performance Assessment

IPR Independent Performance Review

JICA Japan International Cooperation Agency

JPA Joint Performance Assessment

MDG Millennium Development Goal

MHMS Ministry of Health and Medical Services

M&E Monitoring and Evaluation

MFT Ministry of Finance and Treasury

MRG Malaria Reference Group (of the Australian funded malaria support to Vanuatu and Solomon Islands)

MTEF Medium Term Expenditure Framework

MTEP Medium Term Expenditure Plan

NCD Non-Communicable Diseases

NDS National Development Strategy

NHSP National Health Strategic Plan

NRH National Referral Hospital

NVBDCP National Vector Bourne Disease Control Programme

ODE Office of Development Effectiveness

PacMI Pacific Malaria Initiative (AusAID)

PacMISC PacMI Support Centre

PACTAM Pacific Technical Assistance Mechanism

PFM Public Financial Management

PHA Provincial Health Authorities

PPP Purchasing Power Parity

RAMSI Regional Assistance Mission to Solomon Islands

RDP Role Delineation Policy

RWASH Rural water supply, sanitation and hygiene

SIG Solomon Islands Government

SLMS Second Level Medical Store

SPC Secretariat of the Pacific Community

SWAp Sector-wide approach

TA Technical Assistance

TB Tuberculosis

The Tensions The 1998‐2003 national civil unrest

ToR Terms of Reference

UHC Universal Health Care

UN United Nations

UNFPA United Nations Population Fund

UNICEF United Nations Children’s Fund

US$ United States Dollar

WASH Water, Sanitation and Hygiene

WHO World Health Organization

Glossary

Budget An estimate, often itemised, of expected income and expense for a given period in the future. A plan of operations based on such an estimate. An itemised allotment of funds, time, etcetera for a given period.

On-budget Included in the regular government budget; activities funded through government disbursement rules

Off-budget not included in the regular government budget; funded through separate agencies using those agencies disbursement rules

On-plan Included in the regular government operational plan, no matter how managed or funded.

Off-plan Not included in the regular government operational plan.


Content

Aid Activity Summary 6

Executive Summary 7

Performance and role of Australia’s investments 12

1.Introduction 24

1.Background and changing health context 25

2.Australian support to health 33

3.The purpose of the evaluation 38

4.Findings and Analysis – performance and role of Australia’s investment 41

5.Modality of investment and management of the health portfolio 69

6.National and international commitments. 70

7.Opportunities for strategic engagement in the sector and capacity to maximise achievement of results aligned to SIG development outcomes and Australia’s aid framework. 70

8.The impact of the projected SIG health budget over next five years on capacity to deliver services. 70

9.Implications of withdrawal from sector budget support on SIG financial planning. 70

10.The most appropriate form of aid to build national capacity for long-term sector stewardship. 70

11.Strength of national systems and identified weaknesses. 70

12.Findings of the “Solomon Islands Health SWAp Progress Review. 70

13.Findings and recommendations from the Assessment of National Systems (2011). 70

14.Findings and recommendations from the Procurement Audit and Review (2011).65 70

15.Appropriate controls to protect AusAID investment, if working in Government systems. 70

16.Alternative approaches, such as targeted programs using earmarked funds and/or managing contractors. 70

17.Risk Management 89

18.Conclusions 93

19.Focus for the next phase 96

20.Summary of recommendations 101

Annex 1 – Terms of Reference 105

Annex 2 – Program of in-country visits 117

Annex 3 – Decadal trends – health status changes 124

Annex 4 – Application of the Australian Aid Policy tests to health 125

Annex 5 – People met 129

Annex 6 – Documents Consulted 133



Annex 7 – Evaluation Plan 139


Tables and figures




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