Thinking about the relationship between the Ministry of Health and - PowerPoint PPT Presentation

Public Financing for UHC: Towards Implementation Building partnerships between MOH and MOF: Is it possible? Midori de Habich Montreux, 31st November, 2017

Thinking about the relationship between the Ministry of Health and the Ministry of Finance when reform is on the table. • What do we have in common? • What sets us apart?

What do we have in common? BEST HEALTH OUTCOMES MINISTRY OF MINISTRY OF FINANCE HEALTH

What sets us apart? First generation reforms: Second generation reforms: Macroeconomic reforms Institutional reforms Priorities Inflation; growth. Social conditions; Health and Education. Reform strategies Change of macroeconomic rules. Reform of the provision public services Stakeholders Presidency, MoF, Economic Cabinet, Presidency, sector ministries, MoF, Central Bank, financial groups, Congress, media, public bureaucracy, multilateral financial agencies. public sector workers and unions, political parties, NGOs, etc., etc., etc. Impact of reforms Immediate. Medium and long term. High public visibility. Low public visibility. Technical and Moderate to low. Very high. administrative complexity Institutional Macroeconomic administration by Institutional development highly challenge insulated technocratic elites. dependent on mid level public sector management. Adapted from Naim, M. (1994) Latin America: the second stage of reform, Journal of Democracy, vol. 5, No. 3, Washington D.C., National Endowment for Democracy.

What sets us apart? MINISTRY OF FINANCE MINISTRY OF HEALTH FIRST GENERATION REFORMS SECOND GENERATION REFORMS First generation A B reforms It’s all about designing the policy. Implementation really matters. No invisible hand. Messy! The market takes care.

What I learned (provisional) So, where do we go from there? • Stakeholders • Time frame of impact • Technical complexity • Institutional challenge

Stakeholders • Get the President´s Ear “First define the budget of Health and Education and after the rest of ministries”. • Engage with a wide range of stakeholders Input and support from other ministries in the Cabinet (most likely, social sectors) and Congress. Joint decision making with regional/local governments. Personal contact with influential media and academia representatives to keep them informed and supportive. When possible, form coalitions to bring political support but NOT against the MOF.

Time frame for the impact of reforms • Adopt a dual focus on short-term wins and medium-term planning Fully spending the year’s health sector budget and improving financial controls in the near term can help increase the MOF’s willingness to engage in three-year budgeting exercises that provide increased flexibility in health spending. “If I can tell you how much, you can tell me how long”.

Technical complexity • Institutionalize a regular consultative process between health and finance agencies among both senior and mid- level staff . This process should supplement formal budget negotiations with more frequent meetings, and can help to build rapport and understanding . • Support budget negotiations with good-quality, shared information on value . Value is a function of results over cost, and therefore it is important to present data on both health outcomes and expenditures.

Institutional challenge • Invest in personnel in both MOHs and MOFs that are well- versed in the technical language and mind frame of the counterpart institution For example, economists in the MOH and public health specialists in the MOF. “Hire them, train them and retain them” . Combined with a regular consultative process, this can help bridge the divide and sustain dialogue regarding the complexities of health reform and the need for health financing reform.

In a broader scope Assessing and monitoring institutional capabilities A tunnel vision to avoid The policy cycle to change

Institutional challenge: where are we starting from? 1996-2006 33% 19% 35% 13% Andrews, M., Pritchett, L., Woolcock, M. (2017) Building State Capability, Oxford University Press.

Avoid a “new” tunnel vision Much discussion about health financing reform. How do incentives finally impact on more efficient, equitable and better quality services? A black box for economists? A B Integrate discussion on health financing reform with service delivery reform.

A policy cycle to change or none at all

Not so difficult? Acknowledges and assesses previous reforms Formulates the solutions to fit the problems Identifies low hanging and the capabilities fruits from previous policies Prioritizes outstanding performance problems

Thank you Midori de Habich Montreux, 31st November, 2017