206471 Vertical funding and “common fund” approaches to health sector support in Mozambique: Best practices for donors

Monday, November 9, 2009: 8:30 AM

James Pfeiffer, PhD, MPH , School of Public Health, Department of Health Services, Univertsity of Washington, Seattle, WA
Kenneth Gimbel-Sherr, MPH, PhC , Health Alliance International, University of Washington, Seattle, WA
Stephen Gloyd, MD, MPH , Health Alliance International, University of Washington, Seattle, WA
Wendy Johnson, MD, MPH , Health Alliance International, Seattle, WA
Pablo Montoya, MD, MPH , Beira office, Health Alliance International, Chimoio, Mozambique

Health sector aid to Mozambique has increased markedly since 2003, driven by funding for AIDS, TB and malaria through PEPFAR, the Global Fund, and others. With this heightened attention has come a growing awareness that health system strengthening is essential to tackling Africa's health challenges. However, much of the new health support is channeled through “vertical” funding for short term NGO projects rather than the Ministry of Health, thus undermining system strengthening efforts.


In 2003, Mozambique established a “common fund” mechanism in which donors provide financial support to the MOH and jointly participate in planning. The Global Fund and most bilaterals provide the majority of their health sector support to the fund. However, the greatest growth in aid has come from through PEPFAR, which channels nearly all its support directly to vertical NGO projects.

Outcomes and Challenges:

By 2008, 62% of all external health aid flowed to vertical projects, which accounted for $243 million out of $512 million, or 48% of total health sector spending. PEPFAR provided 67% of this vertical funding while 33% came from an array of bilaterals and UN agencies. With nearly half of all health spending channeled to NGOs, parallel NGO systems were created, MOH ownership has been compromised, and major opportunities missed for MOH capacity strengthening.

Key recommendations:

Donors should redirect their health sector support toward “common fund” mechanisms or direct budget support to ensure that aid resources succeed in strengthening the existing health system in Mozambique, and elsewhere in Africa.

Learning Objectives:
- Define the difference between vertical funding and common fund approaches to health sector support from donors. - Identify three apects of vertical funding that are detrimental to health system strengthening. - Describe three apsects of common fund mechanisms that enhance health system strengthening.

Keywords: Health Service, HIV/AIDS

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have mnay years of experience working with healt Alliance International supporting the Mozambique Ministry of Health and am engaged in a large number of health system strenegthening activities. My public health research and publications focus on health system strengthen issues and managing donor relations. I am trained in medical anthropology and public health.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.