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HSSP2 is impressive in its achievements with its partners, is highly appreciated by government and is an investment of which Australia should be proud. The health system requires substantial continuing support to maintain its current gains and to move forward. Australia has a strong comparative advantage as the major supporter of SIG and the health sector.
Three issues stand out as needing increased focus in the next phase:
Increased focus on developing the policy dialogue and ensuring that Australia has an effective seat at the policy table, and developing and strengthening effective tools to manage the relationship.
A more formal, wider strategic and systematic focus on health systems strengthening (building on the financial strengthening already done) with a formal systems wide review, including both central and provincial systems.
Once the health systems gaps are identified, there can then be a similar formal, strategic and systematic review of the TA needs of the next phase to support the systems strengthening needs identified.
The SWAp approach using variable degrees of earmarked budget support in support of SIG policies has been appropriate. The investment is aligned – on-plan and on-budget. The approach has allowed the MHMS increasingly to take ownership of the management of the sector (even though there is still work to do here) while allowing efficient and effective use of the Australian investment.
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.
Support has increasingly focused on MHMS activities at the provincial level, with strengthening of financial systems at the provincial level. This offers the potential for efficiency gains to be made with the management of resources placed nearer to the delivery point and the opportunity for MHMS Divisions to combine resources (for example in outreach activities) resulting in cost savings and efficient and effective use of resources.
Emerging and additional disease priorities are recognised, prioritised and addressed in the New NHSP now in draft.
Government leadership of the SWAp partnership, while improving, to now is poorly developed and a weakness appears to be limited to constructive engagement at the policy level. There is a perception of a degree of DP control.
Financial risk management has been a significant aspect of HSSP2, but appears to have been managed well. However, this has had significant financial consequences (for example the recruitment of additional TA and while the team were not able to verify the claim is perceived by some respondents to have slowed implementation of activities. There has also been significant management load on DFAT staff.
While MHMS technical skills are strong, there is reportedly a lack of management capacity. This has resulted in support from a number of TA. There does not appear to be an overall strategic plan for TA and this should be addressed.
Australia should invest in continued support to health when HSSP2 ends in June 2016.
Support should continue to be as budget support to the health sector, with limited earmarking as appropriate. Australia should continue to act as “honest broker” to assist the MHMS to bring other DPs fully into the SWAp partnership. The focus of the next phase of support is likely to be on systems development and strengthening, while maintaining strong financial management support.
Australia must intensify efforts to improve the mechanisms available for, and the quality of, the policy debate between MHMS and DPs, while ensuring the MHMS ownership of the process is strengthened.
The move towards placing increasing investment at the provincial level is a positive move and should continue and accelerate in any follow-on funding.
The performance related provincial grants are at an early stage of implementation. While successful to date, this approach should be considered to ensure that the process remains simple and a positive incentive and not seen as a penalty system for under-performance.
The program should consider encouraging the SIG to allocate a greater share of own revenue to health. An increase to 15 per cent has been proposed.
Significant support for financial risk management will need to be included in the design of HSSP3 and TA resources continued for the foreseeable future. This should include support at the provincial level and to the internal audit team.
There should be a formal wide-ranging health systems review to identify capacity gaps in the MHMS management and propose a strategic plan to address any gaps. The review should propose a plan for TA across the MHMS, including recommendations for recruitment and management. This plan would also identify the role of TA and clarify the approach of each TA – that is the balance between capacity building and line-function – and consider the TA procurement and management approach.
Once a TA plan is agreed, the costs of TA should then be reflected in the AOPs. This will increase ownership and allow line managers to better understand the true costs of managing their AOP.
DFAT staff workload is unlikely to reduce in the next phase of support. Management should plan to ensure effective high-level technical SWAp support for the incoming First Secretary as the highly experienced incumbent moves on.
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The Health Sector Support Program Phase 2 (HSSP2) began in July 2012 and is due to end in June 2016. HSSP2 is Australia’s program of support to the Solomon Islands health sector delivered through earmarked budgetary support using a Sector-wide approach (SWAp) mechanism. It is a follow-on program to HSSP. The program value is an indicative amount of AUD80 million. This report contains an independent evaluation of HSSP2 and makes recommendations for follow-on support. Whilst HSSP and HSSP2 are often seen as synonymous with the Solomon Islands Health SWAp this evaluation does not evaluate the SWAp in its entirety, but only considers the single Australian Aid project as detailed in the Aid Activity Summary at the start of this document.
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