HSSP2 should be regarded as a flagship program for Australia and for DFAT. Developed from HSSP in a situation of resolving post-conflict economic disorder, the HSSP support has been a critical and successful component of Australia’s support to Solomon Islands and to the Pacific region. It seems likely that HSSP and HSSP2 have been a significant element of the success of the RAMSI mission.95 Despite being designed in a fragile political environment, the program has focused on working with and through government and has been instrumental in allowing Australia to move towards its stated policy objectives. Given the unusually predominant position as a donor that Australia occupies in the Solomon Island health sector, it would have been very easy for Australia to slip back into project mode despite its higher-level policy objectives and international commitments, but this temptation has been resisted and this alone should be seen as a positive achievement of HSSP2. The DFAT management team should be congratulated for this success.
The design of HSSP2 allowed for process style flexibility and ‘tweaking’ in discussion with partners. This has allowed HSSP2 to move towards less earmarked and an arguably more pure form of sectoral budget support. This has supported the winding-down of Australia’s regional programs. It also allowed rapid response to natural disasters.
The health status of the Solomon Islanders is good when one considers the expenditure per capita and when compared with comparable Pacific Island nations. In health, during HSSP2, the expenditure made appears to result in good cost efficiency.
There is minimal private health care available in the Solomon Islands, except to those people rich enough to travel offshore for treatment. Furthermore, available evidence is that out of pocket expenditures are comparatively very small.96Faith Based Organisations manage three out of the twelve hospitals and some other health facilities such as nurse aide posts, but these receive significant financial and other support from government. This leaves the public, government managed sector as by far the most significant provider of health care in the Solomon Islands. As the Australian Government over the life of HSSP2 has provided up to 40 per cent97 of the government budget, it can be confidently assumed that the good health results achieved in the Solomon Islands during HSSP2 are in large part attributable to the Australian investment.
Put another way – without the Australian investment of HSSP2 the government health services health services of the Solomon Islands would have been severely compromised – and the health status of all Solomon Islanders, and in particular the health status of the poorest, would have been significantly worse.
Australia (and the SIG) must recognise that the present situation is not sustainable if assessed in a conventional manner. Conversely, as stated above, without the Australian support, health services in the Solomon Islands would be severely compromised.
It is the view of the evaluation team that the situation in Solomon Islands is unique, and that the GoA might consider its support to the health sector in the light of the greater bilateral support from Australia to Solomon Islands (of which the Australian support to RAMSI is a significant part). GoA should perhaps recognise that in the longer term the good-will and nation building generated by its investment in health is of intrinsic value to both Governments and peoples, even if not sustainable in a conventional manner.
The approach whereby funds are placed as sector budget support possibly offers the purest version of support of the aid effectiveness agenda in Australia’s investment portfolio. The large majority of funds are both on-plan on-budget and on-system. However, several minor elements of Australian support to the Solomon Islands health sector remain not fully on plan or fully transparently on budget. Where funds are managed through a second party (for example the UN agencies) the totality of the funding as allocated for SIG support is not immediately apparent. The other element is the funding allocated for TA, which is directly procured by Australia on behalf of HSSP. While this is reflected in the non-appropriated development budget, the TA costs are not allocated to the individual AOPs.
HSSP2 financial mechanisms have been refined both from the disbursement mechanisms (with the introduction of payments in arears) and in the financial management procedures – particularly following the introduction of the PFM Directive.
Overall, the consistency and dependability of the funding over the past some eight years of HSSP, building on the previous support, has been of significant value to the SIG in planning the management of the health sector. This dependability has been a significant positive aspect in enabling the MHMS to plan efficiently and effectively and has increased the value of the Australian investment. The only failing in this regard has been in the previous year where there was a reduction in Australian funding along with a fundamental review of the Australian aid budget which introduced significant uncertainty (and some apprehension) to SIG officers.
Emerging and additional priorities have been recognised by the MHMS and partners throughout the progress of HSSP2 and are prioritised and addressed in the new NHSP now in draft. Furthermore, in the interim AOPs have been revised to address the issues, and major new investments are planned – for example the EU funded RWASH support. At the same time, the MHMS UHC Policy / Role Delineation / De-concentration Policy is focusing activities. However, the increasing burden of disease attributable to NCDs is increasing, and while the new investments focused on water and sanitation and food fortification will assist to address the stunting problems, family planning rates remain unacceptably low. Additional support may need to be focused on family planning and NCDs in the next plan period (the last year of HSSP2) until the new NHSP is fully developed. SWAp management must be also be aware of the manner in which that EU support is channelled (that is through the general budget rather than the sector budget), and the time required for EU support to come on line.
Decreasing the degree of earmarking and the removal of regional and other fragmented funding streams, including those managed from Canberra, has increased the efficiency of the Australian investment and ensured significantly greater Government ownership and increased efficiency in Australia’s investment and management.
It should not be assumed that management of a SWAp is less management intense than traditional project management for DFAT. In fact, as the latter may often be contracted to a management company this often makes projects less management intense for DFAT.98 The present DFAT team are to be complemented for keeping the program on track, and particularly for managing the fiduciary risk elements around the major fraud without significant effect on service provision to the population. Canberra must be prepared to provide appropriate senior high level sectoral focused support as required.
