Accra Agenda for Action (AAA), have made four notable efforts towards better coordination, resulting in different frameworks.
Firstly, a National Committee for Aid Coordination (NCAC) was created in 2005 to coordinate all external aid to Burundi. The NCAC supervised 13 sector groups, of which one was for HIV and another for health, illustrating the persistent willingness to separate HIV and health at ministry level. These sectors were put in place according to the PRS paper:
“The National Committee for Aid Coordination was put in place by donors. It is a structure which is highly paid to perform other people‟s job and therefore results in a conflict between civil servants and employees of this structure.”
(ITW22N09, group 4, local)
The two most active groups were the health and the education groups, with efforts in the health group towards improving partnerships between government and technical and financial development partners (DPs). Their achievement was the establishment of a framework for consultation of health development partners (CPSD) in March 2007.
Secondly, this framework was a consultative organ, whose aim was to improve aid effectiveness in the spirit of the Paris Declaration, via increased coordination between financial and technical DPs in the health sector and the Ministry of Health (Harmer 2008). Following the creation of this framework, a partnership framework acting as a Memorandum of Understanding was signed in February 2008 between major bilateral and multilateral partners, some NGOs, some UN agencies and the MoH. Expected intermediate outcomes of this framework were: 1) improved efficiency of international aid and 2) quantitative and qualitative improvement of service delivery. In order to reach these objectives, the financial and technical
partners and the MoH committed themselves, in particular, to ―increased coordination and consultation‖ (Gouvernement du Burundi 2008a). This framework also
introduced the creation of a permanent technical multi-sectoral organ, in charge of piloting and monitoring progress using MDGs indicators. This organ had two tiers: the one was political (political CPSD), meeting quarterly for decisional purposes; and the other, technical, meeting monthly. The technical organ (technical CPSD) proposed solutions to the political organ, on the basis of the preliminary work of four working groups, created according to the four problematic areas within the health sector in Burundi - namely HRH, financing, health information system and drug supply (Gouvernement du Burundi 2008a).
The first meeting of the technical group of the CPSD was held in February 2009. However, the extent to which CPSD meetings were held seemed to depend on other external factors. For instance, between May and December 2009, no meeting was held, since the P4P platform dominated the scene [(―International Health Partnership +‖ 2009) and ITW09N29]. Also, when held, meetings looked more like an information sharing platform, than a coordination platform (non-participative observations of CPSD meetings 2011).
Thirdly, since 2007, Burundi has also been involved in piloting the International
Health Partnership Initiative (IHP+). The aim of IHP+ was to lead to the signature of a ‗compact‘ between government and all DPs in the health sector. This compact was supposed to act as: a national health strategy; a joint monitoring and evaluation (M&E) framework; and as a mid-term expenditure framework to which all DPs contributed (International Health Partnership + 2015). Practical actions in order to better coordinate activities in the health sector, linked to the IHP+, included: an
attempt to harmonise performance-based financing (P4P) initiatives which were officially on-going all around the country; the elaboration of the first national health expenditures estimates for 2007 (finalised in 2009); and the decision to mainstream part of MAP2 funds from the PES-NAC to the MoH and part of HIV prevention activities (PMTCT) from the PES-NAC to the reproductive health department within the MoH.
Disbursement of IHP+ funds was very low (8% of US$800,000 over the first two years) due to the heavy demands of administrative procedures and the lack of
ownership by the government (―International Health Partnership +‖ 2009). According to one IHP+ progress review conducted in 2009, sector dialogue was still very weak, essentially conducted by donors. There was no participation of multilateral donors such as GHIs and WB, although more than a third of external aid to health sector was HIV-related. The US Agency for International Development (USAID) and the Japanese International Cooperation Agency (JICA) were not keen on signing the compact (Garay and Flahaut 2009). The lack of skills and capacity to coordinate was acknowledged both by the donors and government (Garay and Flahaut 2009;
―International Health Partnership +‖ 2009).
The compact was eventually signed in December 2012, for the period 2012-2015. While JICA and USAID were not signatories, as expected, the three major
contributors to health sector – the Belgian Technical Cooperation (BTC), EU and WB - were, as were four UN agencies and three civil society organizations (CSOs), beside the MoH and the MoF.
Among the donors, joint missions of key donors started to be organized annually from 2007, with uneven participation. The (UK) Department for International
Development (DfID), the EU and BTC were the lead donors in this initiative, but were not necessarily followed by others, especially the multilaterals. DfID withdrew from Burundi in 2012.
“Together with bilateral donors, in particular with those who are EU member states – they are not such numerous in the health sector - we try to promote [coordination] precisely …everybody tries to coordinate in order to be able to move forward a joint planning. We are lucky in Burundi this year, to have a
planning window during which everyone needs to plan.” (ITW14N09, group 3, expatriate)
Multiple initiatives from global levels try to promote coordination, without preparing the terrain. While some donors organized themselves into alliances, the government sometimes perceived this as pressure.