Public Health Budget Practices and Procedures in Africa: How African Countries Budget for Health Launch presentation – 21 May 2020
About the report
The Public Health Budget Practices and Procedures Report provides an inquiry into the funding practices and processes around public health interventions in Africa Purpose of the survey The survey seeks to provide useful insights into the public health budgeting process to inform policy considerations around financing and expenditure management in the sector and will therefore probe issues relating to the following Allocation and expenditure Institutional arrangements Financing and budgeting for to public health that shape public health Water, Sanitation and interventions financing considerations Hygiene (WASH) and coordination 2019 CABRI Public Health Budget Practices and Procedures Survey 3
The survey was informed by data collated from country respondents from the ministry of health and/or the ministry of finance 01 02 03 04 05 Launch and Communication and Report elaboration Data cleaning and External review and completion of focal points and diffusion analysis validation identification survey Focal points are The nominated focal Country responses are The survey data is A draft report is identified in the point reviewed, and an in- consolidated and circulated to countries Lean Diagnostic Baseline Analysis Develop Plan Follow Up finance and health from the ministry of country validation is cleaned for analysis.. for their consultation ministries. finance was responsible conducted in and feedback, after for delegating and collaboration with which the final report is coordinating the survey country focal points. published in English, completion French and Portuguese. Coaching 2019 CABRI Public Health Budget Practices and Procedures Survey 4
What information about health financing the report highlights What data was collected ? Basic characteristic of Health budget ODA for health Health budget execution Budget monitoring health systems formulation Government awareness of Structure of Health Institutional structure of Mechanisms for Budget process development assistance Financing health purchasers monitoring expenditure and projects Decision making and Provider payments Budget execution and ODA coordination Coverage arrangements coordination mechanisms systems reporting mechanisms General budget allocation Procurement practices for Budget overspending and Use of development Benefits and Entitlements for Health pharmaceuticals underspending assistance Performance agreements Aid management policies Health budget formulation and assessments and systems 2019 CABRI Public Health Budget Practices and Procedures Report 5
The CABRI’s Public Health Budget Procedure and Process Survey was conducted among 15 African countries, heterogeneous in terms of health and socioeconomic conditions Life expectancy Population Average life expectancy in the sample The two island nations, the Seychelles and countries was 60.6 years , which is close to the Mauritius , have small populations of 97,000 average for Africa ( 61.2 years), but and just more than a million people , significantly lower than the global life respectively. At the other end of the scale, expectancy (72.0 years) estimated by World Nigeria is the most populous country in Africa. Chad The Gambia Health Organization (WHO) in 2016. Guinea-Bissau Nigeria Sierra Leone Benin Liberia GDP Per capita Income inequality, Gini Coefficient Cameroon Côte d'Ivoire Uganda Democratic Seychelles South Africa has the most unequal economy Republic of the Congo The global average GDP per capita in 2018 in the world, reflected in a high Gini was US$15 914 , while the average for sub- coefficient of 63 (a lower Gini coefficient Saharan Africa was US$3 536 . The average for Mauritius shows a low level of inequality). Sierra the sample is US$5 855 , about 65% higher Leone has a much more equal economy, with than the average for Sub-Saharan Africa. South Africa Lesotho a Gini coefficient of 34.0 . Benin | Cameroon | Chad | Congo, Dem. Rep. | Cote d’Ivoire | Gambia, The | Guinea -Bissau | Lesotho | Liberia | Mauritius | Nigeria | Seychelles | Sierra Leone | South Africa | Uganda 6 2019 CABRI Public Health Budget Practices and Procedures Survey
How African Countries Budget for Health
Budget formulation
Most of countries have 100% of health expenditures in their central government budget, while only part of the health budget is reflected in countries such as Guinea Bissau, Nigeria, and South Africa Yes, Fully Yes, Partially Not In Chad, the expenditure of all sectoral • 73% of participants ministries and institutions is centralised by countries have the full 7% the Ministry of Finance, and in particular by the health budget in central 20% General Directorate of Budget Services. In budget terms of budget preparation, the General Budget Directorate allocates envelopes to the • Medium-Term Expenditure Framework (MTEF) Are health 67% of countries have a expenditures that each sectoral ministry will adapt in its central budget authority, included in the budget. Subsequently, the Ministry concerned, central usually a ministry of including that of health, allocates these government finance, which set budget ? budgetary envelopes in accordance with its expenditure levels for needs (personnel, goods and services, healthcare transfers, and subsidies and investments (interior and exterior). 73% 2019 CABRI Public Health Budget Practices and Procedures Survey 12
Coordination mechanisms are widely used. Less coordination with civil society. Many countries have bodies to focus on preventative care 47% 80% 67% have a mechanism to reported that they have a have a specific budget co- coordinate activities with specific body that focuses ordination body civil society on prophylactic treatment The Democratic Republic of the Congo is a good example of such a body actually meeting. There are several thematic task forces, [including] six thematic technical commissions bringing together 20 to 30 members from various departments. These groups meet at least once a month. These technical commissions meet in a Technical Coordination Committee, at least once a quarter, under the chairmanship of the Secretary General for Health. A National Steering Committee, bringing together public health actors, from the central level and from the provinces, technical and financial partners, as well as civil society, meets once or twice a year, under the chairmanship of the Minister of Health. 2019 CABRI Public Health Budget Practices and Procedures Survey 13
Medium Term Expenditure Framework (MTEF) is used by nearly all countries. Allocation by healthcare function, specific disease or individual health facility is common 90% of surveyed countries use MTEF for mid term allocation. 2/3 of the respondent countries provide allocations for the prevention of specific diseases, and eight of Chad these countries use these categories as the basis for a The Gambia Nigeria budget appropriation. Sierra Leone Cameroon Liberia “Allocations to specific diseases allow health Benin Democratic Uganda Cote Republic D’ivoire officials to move funds within budgets during Use of of Congo Seychelles the fiscal year, if the funds are still being used MTEF to fight the specific disease. There is no need to across go through a virement process to reallocate Mauritius funding across different types of costs. This surveyed South flexibility can lead to a quicker response to Africa Lesotho countries health crises.” 2019 CABRI Public Health Budget Practices and Procedures Survey 14
Parliament plays an important role in the budget process by setting rules relating to the reallocation of funds from specific line items. However, challenges remain in legislature involvement in the budget process Role of parliament in health budget process in surveyed countries Lack of clear rules distinguishing the Lack of functional functions of the • Parliament plays an important role in the oversight of budget executive and execution reports legislature in the budget process. In terms of implementing budget process health policies, parliaments often indicate national priorities through the use of Insufficient time to mechanisms to prevent certain allocation Lack of specialized review budget staff support budget formulation being reduced . committees Common documents challenges faced by parliaments • These mechanisms were common in in the budget process respondent countries and in some cases could be used by the central budget authority as well. 2019 CABRI Public Health Budget Practices and Procedures Survey 15
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