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

Aid Activity Summary

Investment Name	Solomon Islands Health Sector Support - Phase 2
Investment Number	INK561
Commencement date	1 July 2012	Completion date	30 June 2016
Total Australian $	80 million
Total other $	N/A
Delivery organisation(s)	The primary delivery organisation is the Solomon Islands Government acting through the Ministry of Health and Medical Services through a sector wide approach. The Government is supported by Australia with other Development Partner staff.
Country/Region	Solomon Islands
Primary Sector	Health

Executive Summary

Introduction

The aim of this evaluation is to assess the effectiveness and efficiency of Australia’s support through the Health Sector Support Program – Phase 2 (HSSP2) with a view to identifying opportunities for improvement for a third phase of support from 2016 to 2020. HSSP2 began in July 2012, is due to end in June 2016 and is an investment of an indicative amount of AUD80 million. Whilst HSSP and HSSP2 are often seen as synonymous with the Solomon Islands health sector-wide approach (SWAp), this evaluation only considers the single Australian Aid investment as detailed in the Aid Activity Summary above.

Context

Performance of the Solomon Islands health sector has been strong when compared to neighbouring and wealthier countries. HSSP2 has been successful in ensuring that a cost effective publicly funded health service has continued to provide equitable services throughout Solomon Islands. Whilst the private sector is a minimal player in health care in Solomon Islands, opportunities have been taken to bring private sector agencies on-board in micronutrient fortification of foodstuffs. Government has sustained a significant percentage of its Gross Domestic Product (GDP) to the sector. The sector is not yet able to go it alone and without the Australian support would be severely compromised. A third phase of support is recommended with various adjustments to address the changing burden of disease.

Changes in service delivery – the AOPs and the Provinces

Under HSSP2, a series of costed Annual Operational Plans (AOPs) have been put in place for the major cost-centres, including the Provinces. Australian support has facilitated funding directed to the Provinces. The Ministry of Health and Medical Services (MHMS) has also met targets in budgeting and in the use of AOPs and budgets at the provincial level. This is a significant step in decentralisation and local management. This opens up opportunities for greater efficiencies, including integrated outreach programs. In 2013 HSSP2 introduced provincial performance related payments, with additional payments to Provinces, which are assessed at the annual Joint Performance Assessment meetings.¹

Gender Equity and Social Inclusion

Gender Equity and Social(ly) Inclusive (GESI) development are integral to the national development strategy, and generally, there is a good enabling policy environment for GESI in Solomon Islands contained in the Solomon Islands National Development Strategy.² Gender has been included in the AOPs and monitored since 2013, with annual reports capturing disaggregated data and highlighting gender equity issues. However, stronger integration of GESI into the SWAp design and monitoring processes will require negotiation and agreement between government and development partners, and agreement on specific GESI indicators.

Performance and role of Australia’s investments

Relevance

Policy alignment. HSSP2 is fully consistent with both Solomon Islands Government (SIG) and Australian policies and fully supports the Paris Declaration on Aid Effectiveness, the Pacific Island Principles on Aid Effectiveness and the 2008 Accra Agenda for Action on Aid Effectiveness, declarations to which both Governments are signatories. HSSP2 is consistent with the Australian Aid Policy tests (see Annex 4).

Continuity and dependability of funding. The consistency and dependability of the funding has been a significant positive aspect in enabling the MHMS to plan efficiently and effectively and has increased the value of the Australian investment.

Changing burden of disease. HSSP2 closely supports the MHMS National Health Strategic Plan (NHSP). With hindsight, it is possible to conclude that there was lack of emphasis on some health areas in the NHSP and consequently HSSP2 – that is in nutrition (particularly the problems relating to stunting)³, family planning, and the emergence of non-communicable diseases. The 2015 AOPs have been revised to address the issues, and the new draft NHSP addresses these.

Attribution

Attribution in SWAps is problematic, and internationally considered less important than in project support. The Solomon Islands health SWAp is easier to conceptualise than are some SWAps, in that it has (effectively) only one funding Development Partner (DP), and Australia has contributed a significant amount of total budget – 25 – 40% of the SWAp life cycle under review.. Therefore, without the HSSP funding, a significant proportion of all health activities would not have been possible. Attribution is further complicated as over HSSP2 earmarking for specific ‘programs’ (which are easier to measure, for example malaria) has decreased, while earmarking for systems changes to improve overall efficiency has increased – for example the dedication of a percentage of funding to the provinces. Whilst making attribution more difficult this is overall a positive move.