Briefing Paper

April 2012

2012 Member Survey on Civil Society Engagement in the Global Health Initiative
The Integrating Health in Relief and Development (IHRD) Working Group is co-chaired by Aaron Emmel, PATH and Mary Pack, International Medical Corps.

The U.S. Presidents Global Health Initiative (GHI) is designed to increase the impact and sustainability of U.S. government global health efforts. InterActions Integrating Health in Relief and Development (IHRD) Working Group, a coalition of U.S.-based health and development implementing organizations, surveyed its members and their partners in Spring 2012 to determine how the GHI is being rolled out on the ground. IHRD was particularly interested in how well the U.S. government is engaging civil society in the planning and implementation process. Encouraging countryi led plans is a core principle of the GHI, and IHRD wanted to determine whether and how U.S. officials were reaching out to in-country stakeholders beyond the national government and the capital city. Our first survey, conducted in 2011, asked staff of local and international organizations in first-round GHI Plus Countries (countries which are receiving additional management and technical support for their health strategies) how active they had been in the U.S.-led consultations to develop country GHI strategies. The 2012 survey is meant to gauge the organizations level of perceived involvement in the implementation of those plans. About the Global Health Initiative The GHI is a cross-agency approach to helping partner countries improve their health outcomes by strengthening their health systems. The GHI was initially ii announced in 2009 as a commitment of $63 billion over six years (although a specific dollar is no longer being promoted), linked to a set of concrete health iii targets. The GHI has been implemented in 80 countries around the world with eight countries (Bangladesh, Ethiopia, Guatemala, Kenya, Malawi, Mali, Nepal and Rwanda) selected as GHI Plus countries. An additional 43 countries have completed or are in the process of completing GHI country strategies. The members of IHRD work to advance the core principles of the GHI within global health programming. The group also considers the broader context of how the GHI strengthens its commitment to more effective integrated health programming in the relief and development arenas. Recognizing that the engagement of civil society in the GHI is vital to its success, IHRD is committed to increasing the awareness of and involvement of local actors in the GHI and their individual country health strategies. The responses from both surveys should serve as indicators of what is working and where there is room for improvement.
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For more information, please contact: Danielle Heiberg Senior Program Associate InterAction dheiberg@interaction.org

www.InterAction.org 1400 16th Street, NW Suite 210 Washington, DC 20036 202.667.8227

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Methods and Responses IHRD conducted a non-scientific survey of perceptions of non-governmental organizations (NGOs) engagement in the GHI planning and implementation process. Twenty-three responses were received from the staff of local and international NGOs in fourteen countries; 18 of these responses were from ten countries in which GHI Plus or country strategies are already in place (Armenia, Bolivia, the Dominican Republic, Ethiopia, Guatemala, Kenya, Malawi, Nigeria, Tanzania, and Vietnam). Responses also came from Africa, Egypt, Thailand and the United States. Sixteen of the respondents indicated that they work at an organization which receives U.S. government funding. The results should not be viewed as representative, but they do contain what we believe to be some valuable insights. The questions were developed by InterAction staff and IHRD working group members, and also took into account input from GHI officials from the U.S. Agency for International Development, the Department of State, and the Centers for Disease Control and Prevention, although they did not see the final survey before it went live. Results Knowledge of the Global Health Initiative In both last years and this years survey, we found that over three-quarters of the respondents had some knowledge of the GHI. In this years survey, 22 percent were very familiar with the GHI, while 57 percent are somewhat familiar. One respondent explained that he or she was most familiar with how the GHI applied to his or her own country, and more generally with how the principles were being implemented globally. There were also responses like one from a local Nigerian organization, which stated it has never encountered the GHI. Local NGOs rely on INGOs for information We also asked two new questions: how familiar respondents were with specific GHI principles (75 percent were very or somewhat familiar), and whether their knowledge of the GHI had improved since last year. Half said yes. A consistent theme throughout the responses was that local organizations received much of their information from international NGOs, and some credited INGOs with informing them about the GHI or introducing them to GHI officials. A local NGO in Tanzania stated that the U.S. government might find it easier to work with them when it engages U.S.-based NGOs. Consultations for Strategy Development The vast majority of respondents (about 80 percent) said that they did not feel their organizations had been involved in the GHI strategy development in their countries, a finding consistent with the 2011 results. One respondents organization first saw what was in the country strategy when it was printed. Nevertheless, 29 percent of respondents claimed to be very familiar with their country strategy and 48 percent were somewhat familiar with it. Lack of adequate civil society engagement in country consultations This confirms the findings reported from last years survey that the U.S. government needed to devote more attention to engaging civil society in first-round GHI Plus country consultations. Implementation of Country Strategies The survey highlights some positive developments that have emerged since the initial in-country consultations.

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U.S. government practices changing When respondents were asked whether they have observed a change in how the U.S. government works, either with the national government or with their own organizations, half said yes. This indicates that the U.S. government has been successful in changing its culture across agencies in multiple countries. Respondents identified two primary ways that the U.S. governments approach has changed: first, through improved coordination across government offices and accounts. In Guatemala the example was coordination between GHI, Title II, and Feed the Future, which means that the new approach is not specific to the GHI. From Kenya, we heard that there is increased involvement in health implementation by local organizations, and that the national government is taking more ownership of health and development activities. Some organizations seem to feel they are benefitting from the more coordinated U.S. government approach, including the combined timeframes and a common set of metrics. Implementing organizations shifting their approaches Implementing organizations seem to be responding by adapting their approaches as well. We asked, Has your organization modified its approach to program implementation based on the GHI process? Many, although less than half (43%), said they have. From Tanzania we learned that an INGO is now planning and implementing its projects to align with GHI principles, and from Kenya and Malawi we heard that local organizations are responding to the GHI by pursuing more integrated approaches across health areas and broadening their scopes of work to include GHI target areas including maternal, newborn and child health and reproductive health. A local organization in Tanzania is making more of an effort to work with other partners, specifically including U.S.-government funded partners. One local organization felt encouraged by the new U.S. government approach to advocate for greater country ownership of health plans rather than the concept we had before of donor dependence. Conclusions Several key points emerge from the results: 1. Organizations are observing changes in the way the U.S. government operates in their countries. 2. In a few of the countries surveyed, these new approaches are encouraging local organizations to operate differently as well, including by supporting the principles the U.S. government is promoting. 3. INGOs have played an important role in engaging local NGOs in this process and helping them to connect to and understand what the U.S. government is doing. 4. Last years results were confirmed, in that greater effort needs to be made to include civil society from the beginning: as one respondent commented, We would like to be invited to GHI planning meetings more often so that we can make input.

i Guidance for Global Health Initiative Country Strategies: http://www.ghi.gov/resources/guidance/164904.htm ii Official Statement by the President on Global Health Initiative: http://www.whitehouse.gov/the_press_office/Statement-by-thePresident-on-Global-Health-Initiative iii See list of GHI countries here: http://www.ghi.gov/country/index.htm iv The Global Health Initiative: At-A-Glance: http://www.ghi.gov/about/index.htm