HEALTH AND CHILD CARE

Transcription

1 Headine Messages ZIMBABWE HEALTH AND CHILD CARE 2017 BUDGET BRIEF The 2017 Nationa Budget aocated US$ miion, (6.88%) of the tota budget to Heath, representing a 14.76% nomina decine from the US$ miion aocated to the sector in The aocation is significanty short of the eves to deiver better heath outcomes. For instance: o The aocation is ony 21.28% of the Nationa Heath Strategy (NHS) requirements for 2017, eaving a financing gap of US$1.04 biion. o In addition, the 2017 aocation is, on average, 8 percentage points ower than the 15% Abuja target and 3 percentage points ower than the SADC average actua share of tota expenditures of 11.3%, and 4.6 percentage points ower than the SADC average of 6.57% of GDP. o Zimbabwe s per capita aocation has worsened from US$24.34 in 2016 to a projected US$20.54 in 2017, which is significanty ower than the SADC actua average of $ Such eves of funding do not support the socia incusion agenda as a ot wi be eft behind without access, particuary chidren, who aready suffer mutidimensiona deprivations, incuding access to heath care. This aso impies overdependency on offbudget donor support which is an additiona risk in the face of decining donor support for the heath sector. Recent donor support has been higher than 50% of tota resource fow and more than 80% of the nonwage budget. As in 2017, Government is targeting to spend 55.4% of the heath budget on empoyment costs but actua outturn is estimated to be much higher as was the case in 2016, wherein actua empoyment costs accounted for 83.78% of the tota budget, which meant very itte was expended on nonwage programs. To mobiise additiona resources for heath, the Government announced the introduction of a 5% evy on airtime, which wi be ringfenced for the purchase of drugs and equipment for pubic hospitas. The above measures need to be compemented by actions to enhance the efficiency, effectiveness and equity of expenditures. There is aso need to improve disbursement rates for nonwage spending and strengthening donor coordinating and efficiency in the use of Partner support. Some additiona fisca space coud be created from expenditure prioritization within the overa Heath Care budget, and across different eves of care and programs as we as innovations in heath financing such as Pubic Private Partnerships (PPPs). Heath care infation was above the genera infation in 2016, athough on a decining trend to cose 2016 at 0.7%, which can be a positive thing for improving heath care access, incuding by chidren.

2 INTRODUCTION The Ministry of Heath and Chid Care (MoHCC) is mandated to provide heath care services to a Zimbabweans in ine with the Primary Heath Care approach as set out in the Nationa Heath Strategy (NHS). In ine with the country s economic pan ZimAsset ( ), the Ministry s strategic objectives, among others, is to reduce morbidity through the provision of accessibe, affordabe, acceptabe and effective quaity heath services at community and heath centre eve. The Ministry is one of the ead ministries under the first phase of Programme Based Budgeting (PBB), and 2016 marked the fu year of impementing PBB. PBB entais the mapping of pubic expenditures according to programmes, and represents a paradigm shift, by the Government, from the traditiona ine item budgeting. By tying expenditures to resuts, the PBB enhances better monitoring and performance reporting. In that regard, the formuation of the Ministry s 2017 budget bid was guided by the PBB principe. The Ministry s key budget priority in 2017 was modeed aong the recommended scenario in the Nationa Heath Strategy (NHS) ( ), aiming at reducing mortaity through: Scaeup of RMNCH, Maaria, HIV, Nutrition and NonCommunicabe Diseases (NCDs) interventions with emphasis on ower eves of care; Shift provision of preventive services to the primary heath eve; Infrastructure improvements at the primary eve; Investments to improve avaiabiity and security of medicines and suppies and Capacitation of skied human resources. According to the NHS, this woud be achieved with funding amounting to US$1.33 biion in 2017, expected to rise to US$1.35 biion in Of which a significant chunk of these resources are expected to come from the government budget. Such eve of funding Figure 1: Materna and Chid Heath Indicators wi hep guarantee continued improvement in the overa heath care indicators, incuding materna and chid heath, (Figure 1). Recent data from the Zimbabwe Demographic and Heath Survey (ZDHS) for 2015, show that materna mortaity ratio remains high at 651 deaths per,000 (versus target 174 deaths per,000 ive births); under five chid mortaity rate is at 69 deaths (versus target of 43 per 0 ive births); stunting prevaence is at 28%, and HIV and AIDS, TB and maaria remain major causes of morbidity and mortaity. Simiary, the 2016 Source: MICS

3 Mutipe Overapping Deprivations Anaysis (MODA) showed that 59.6% of the chidren aged 017yrs are mutidimensionay poor, with access to heath care being among the prominent deprivations. This makes it important for the nationa budget of the country to make adequate, quaity and equitabe investment in chid heath. Whist poicy may have missed the oder generation, there is now an opportunity to correct and make an impact on the chidren, for better deveopment outcomes. REVIEW OF THE 2017 BUDGET Heath Care Infation Heath care infation was above the genera infation in 2016, athough on a decining trend to cose 2016 at 0.7%. Heath care infation gives the genera trends in the prices of heath care products and services, and is an important factor determining access by a, incuding the poor and marginaized chidren. For instance, an upward trend in the heath care infation means prices of heath care services in the sector are higher than they were in the previous year. This can be deterrent to seeking care, thereby increasing risks of excusion, particuary for chidren, who are naturay vunerabe. For Zimbabwe, however, the genera price eve as measured by the CPI for heath care has been trending downwards, meaning that prices in 2016 were significanty ower than they were in The major drivers of the downward trend, incude hospita services, and pharmaceutica products, (Figure 2). Some upward pressure on prices, however, emanated from paramedica services, particuary during the ast quarter of Percent Budget Aocation to the Heath Sector Figure 2: Trends in Monthy Heath Infation in 2016 Heath Infa on Outpa ent services Medica 'Denta services Hospita services Source: ZIMSTAT monthy infation updates (2016) pharmaceu ca products Medica Services Paramedica services Heathreated funding is primariy channeed through the MoHCC, which is the focus of this brief. However, other government ministries such as: Defense, Justice, Home Affairs, Education and Labor and Socia Wefare aso receive some funding from the budget for heath reated support. The 2017 Nationa Budget aocated US$ miion, representing 6.88% 1 of the tota budget (US$4.1 biion), to the MoHCC, making it the fifth highest vote, (Figure 2). Other Ministries such as Primary and Secondary Education (19.6%), Home Affairs (8.9%), Defense (8.3%) and Agricuture, Mechanisation and Irrigation Deveopment (7.1%) compete the top five aocations. Figure 3 shows the 2017 top ten budget aocations. US$ Miions Figure 3: Top Budget Aocations Heath ranks 5 th on overa aoca ons Percent of Tota Budget 1 The share for the Heath and Chid Care budget has been cacuated by using the vaue of the tota State Budget ess debtservice payments as a denominator. It incudes Statutory & Constitution and Vote Appropriations. Aoca on Source: 2017 Nationa Budget Estimates Share of Tota 3

4 The 2017 aocation represents a 14.76% nomina decine from the US$ miion aocated in 2016, (Tabe 1). A worrying decining trend in the heath care budget has been observed, from a high of 9.9% of tota budget achieved in 2013, mainy refecting a weakening fisca environment constraining Government spending in genera, and Heath and Chid Care in particuar. Tabe 1: Budgetary Aocations to Heath and Chid Care ( ) Tota Exp & Net Lending 3,824,519,908 4,562,000,000 4,,000,000 4,424,000,000 4,777,000,000 Vote Appropriation 3,551,469,000 3,398,128,000 3,426,289,000 3,456,289, ,192,000 Heath & Chid Care 311,925, ,789, ,976, ,435, ,536,000 As % of Tota Exp & Net Lending As % of Vote Appropriations As % of GDP Per Capita Source: Various Budget Statements ( ) US$ Miions 1,400 1, 1, Figure 4: Aocation Vs NHS Bid for 2017 Poicy and Administra on Pubic Heath Bid Aoca on Against this background of decining heath care aocation, the financing gap remains high. According to the costed NHS ( ), the heath sector funding for 2017 amounts to US$1.33 biion. However, government aocation is ony 21.28% of the requirement, hence a tota 795 Source: 2017 Nationa Budget Statement and NHS ( ) 247 Primary heath Care and Hospita Care 1, Tota Gap US$1.04bn financing gap of US$1.04 biion, (Figure 4). The biggest shortfa of US$ miion is experienced under primary heath care and hospita care, which is the entry point for accessing care. Without adequate funding, the country wi not be abe to cope with the heavy burden of disease, incuding some preventabe diseases such as maaria, tubercuosis and other vaccinepreventabe diseases, diarrhea diseases and heath issues affecting pregnant women and neonates. For instance, according to ZDHS (2015), under5 mortaity rate is estimated at 69 deaths per 1,000 ive births, and the infant mortaity rate is 50 deaths per 1,000 ive births. About one in 15 chidren in Zimbabwe dies before his or her fifth birthday, and about 70 percent of these deaths occur during infancy. A factor that is mainy attributed to, among other factors, the perennia underfunding of the heath deivery system. Despite the projected increase in aocation in 2018 through to 2019, tota Heath and Chid Care aocation remains beow the NHS requirements of US$1.35 biion and US$1.39 biion respectivey. Furthermore, the aocation to heath is projected to remain, on average, 8 percentage points ower than the 15% Abuja 4

5 target and 3 percentage points ower than the SADC average actua share of tota expenditures of 11.3%, (Figure 5a). As a share of GDP, the Heath and Chid Care budget is 4.6 percentage points ower than the SADC average of 6.57%. Figure 5a: Share of Tota Gvt Spending on Heath to Tota Spending Figure 5b: Per Capita Spending in Heath in the SADC Region Percent Average 11.3 US$ Average $134.9 Source: Goba Heath Expenditure Database (2014) Furthermore, Zimbabwe s per capita aocation is significanty ower than its regiona peers. The country s per capita aocation in heath care is expected to worsen from US$24.34 in 2016 to US$20.54 in 2017, against a SADC actua average of $ , (Figure 5b) and the WHO idea funding for heath of $86 per capita. This means many particuary the poor and vunerabe chidren wi continue to be excuded. Based on the 2014 Goba Heath Expenditure Database, the highest percapita spenders in Heath within the SADC region are Seychees (US$455), Namibia (US$299) and South Africa (US$275). Inadequacy in the Heathcare budget aocation, manifests in poor access and quaity of services in many of the country s pubic heath care centres. For instance, in September 2016, Harare Centra Hospita suspended a eective surgeries because of a critica shortage of medica suppies. Mpio Hospita in Buawayo had to shut its doors at some point whie Gwanda Hospita in Matabeeand North is facing acute water shortages which affects service provision. The situation is dire in most centers, impacting negativey on access by citizens in genera, particuary, women and chidren. Composition of Budget Aocation A high share of MoHCC aocation is earmarked for wage reated costs, thereby crowding out capita investment, maintenance, and other expenditures for programs and service provision. Empoyment costs were aocated 55.4% of the tota MoHCC aocation, whist tota nonwage investment accounts for 44.65% of the 2017 tota aocation. Hence, with regards to nonwage aocations, the MoHCC ranks 5th with US$125.9 miion, 3.64% ower than the nonwage aocation of US$ miion in Capita spending accounts for 10.4% of the tota MoHCC budget in 2017, (Figure 6a). Such a consumptive spending pattern skewed towards empoyment costs is unsustainabe and shoud thus be discouraged. 2 Goba Heath Expenditure Database (2014) 5

6 Figure 6a: Composition of the 2017 Heath Care Aocation Empoyment Costs other Current Exp Capita exp Percent of Tota Aoca on Figure 6b: Trends in the Composition of the Heath Care Budget Aocations Orig 2016 Est Empoyment Costs other Current Exp Capita exp Source: 2017 Nationa Budget Estimates Percent of Tota As in 2016, government is targeting a ower empoyment budget but actua outturn is estimated to be much higher. For instance, the 2016 Budget was targeting empoyment costs for Heath to account for 60.6% of the budget, but the fina outturn was 83.78%, (Figure 6b). With empoyment costs exceeding the target, the Ministry had to take resources from nonwage aocation to cover the December 2016 saaries 3. This is a major concern, particuary in 2017, given the cutback on partner support towards human resources for heath. This means the government wi have to increase its expenditure on empoyment costs to fi the gap and maintain current remuneration eves for heath care staff. The share of empoyment costs to the tota Heath and Chid Care budget aocation has increased significanty from 37.7% in 2010 to the proposed 55.36% in The net effect, of which, has been the crowding out of capita investments, maintenance, and other Figure 7: Composition of Empoyment Costs by Programme expenditures for programs and service provision. Capita aocations have remained beow 10%, which to a arge extent has resuted in diapidation and inadequacies in the heath care deivery systems. Subject to increased fisca space, the government woud need to increase the share of nonwage expenses, especiay on medicines and services Est Poicy & Admin Pubic Heath Pri Heath Care & Hospita Care Source: 2017 Nationa Budget Estimates Primary Heath and Hospita Care accounts for a significanty arge share of empoyment cost for Heath, mainy refecting the number of staff within the heath subvote, (Figure 7). However, despite the high share of empoyment costs, the Heath sector remains understaffed. For instance, recent statistics show that there are now 1.6 doctors for every peope. Most government rura heath 3 Presentation by the Ministry of Heath to the Pariamentary Portfoio Committee on Heath. 6

7 centers are manned by two doctors who have to perform mutipe tasks. Linked to this, there are just seven nurses and trained midwives for every peope in the country 4. Key programs under the nonwage aocation incude: support to hospitas and care centres (US$14.6 miion), rehabiitation and refurbishment of hospitas (US$17.9 miion), procurement of medica equipment (US$10 miion), (Figure 8). Zimbabwe s nonwage share of heath care expenditures has remained ower than most SSA countries. Most pubic expenditure reviews undertaken by the Word Bank in SSA show that empoyment costs average 50% of tota government spending in heath and above 80% of the nonwage budget. In genera, athough there are no specific benchmarks, Zimbabwe s wage share of expenditures, exceeding 60%, on average, is considered too high, unsustainabe and incompatibe with the provision of quaity and access to heath care 5. US$ Miions Figure 8: Non Wage Aocations to Heath and Chid Care 14.6 Support to Hospitas and heath centres 17.9 Rehabiita on and refurbishment of hospitas Source: 2017 Nationa Budget Statement 10.0 Procurement of medica equipment 6.9 Provision of Materna and Chid Heath Care 3.2 Preven ve Heath Programmes 1.0 Capitaisa on of NATPHARM Budget Aocation by Programmes In ine with the Primary Heath Care approach, the biggest share (87.44%) of the heath budget is aocated towards Primary Heath and Hospita Care. However, as aready been noted, this argey refects huge share of empoyment costs, given that most of the heath care staff are empoyed in primary and hospita care. On account of tightening fisca space, a the 3 programmes received reduced aocations from 2016, with Poicy and Administration having been reduced by $24.2 miion in 2016 to $16.3 miion in 2017 representing a 32.6% reduction, (Figure 9). Aocation towards Primary Heath Care and Hospita Care was aso cut by 14%, to $246.5 miion in 2017 whie Pubic Heath was reduced by 3.7%. Of the US$ miion aocated towards Primary and Hospita Care, 40% wi be spent on Centra Hospita services. District and Genera Hospita services wi account for 38.1%, whist Rura Heath Care Centers and Community Care accounts for 14.9%. Provincia Hospita services and program management accounts for 6.1% and 0.95% respectivey, (Figure 10a). US$ Miions Figure 9: Trends in the Composition of Heath Aocations by Program Poicy & Admin Pubic Heath Pri Heath Care & Hospita Care Source: 2017 Nationa Budget Statement Post Budget Anaysis Report for the Portfoio Committee on Heath and Chid Care. 5 Word Bank PER in Heath Zimbabwe

8 Figure 10a: Pri Heath & Hospitas Care 2017 Aocation Prog Management 0.9% Rura Heath Care Centers & community Care 14.9% Figure 10b: Pubic Heath 2017 Aocation (US$19.1 mi) Prog management 0.9% Communicabe Diseases 9.9% NCDs 3.2% Centra hospita Services 40.0% Famiy Heath 40.0% Environ Heath 1.8% District/ Gen Hospita services 38.1% R&D 44.3% Provincia Hospita Services 6.1% Source: 2017 Nationa Budget Statement With respect to the US$19.12 miion aocation towards Pubic Heath, Research and Deveopment accounts for the argest share of 44.3%, foowed by Famiy Heath Care, (40%), Communicabe Diseases (9.9%) and NCDs (3.2%), (Figure 10b). Figure 11: Composition of Tota Heath Resources in 2017 Statutory Funds 9.3% Other 19.1% Sources of Heath and Chid Care Financing In addition to direct budget aocations, the MoHCC is expected to receive additiona funding from deveopment partners and statutory funds. The 2017 Budget projects tota resources for heath amounting to US$393 miion, with government support accounting for 71.7% (Figure 11). Budget 71.7% Statutory funds, which come mainy in the form of user fees coected by heath faciities, are projected to mobiise US$36.5 miion, accounting for 9.3% of tota resource fow. Funds coected from user fees are administered through the Heath Services Fund (HSF) estabished under the Pubic Finance Management Act (Chapter 22:19) to coect and administer fees for the purposes of suppementing the heath budget for the deveopment and maintenance of heath services, programmes and reated activities, within the heath deivery system. Other resources, mainy from Deveopment partners are expected to account for 19.1% of the tota resources by injecting US$74.97 miion. Source: 2017 Nationa Budget Statement In addition to the above, the Government announced the introduction of a 5% evy on airtime. The evy, themed Tak, Surf and Save a Life, is expected to mobiise resources that wi be ringfenced towards the purchase of drugs and equipment for pubic hospitas. This is however, sti to be quantified and the modaities and administrative arrangements are sti being worked out. Whist Deveopment Partners may be contributing more to the heath sector, the 19.1% refects ony direct donor contributions through the government systems. Most of the funding from Deveopment partners is being channeed direct to programmes or through pooed funding mechanisms such as the Heath Deveopment Fund (HDF). In 2017, Goba Fund is expected to contribute US$

9 miion towards HIV, TB and Maaria. Other resources are expected to come from the Repubic of China US$13 miion towards refurbishment of Natpham warehouse, whist the UNICEF managed HDF is expected to provide support worth US$48.5 miion, (Figure 12). A detaied resource mapping for heath conducted by the MoHCC, with support from Partners estimates that tota resources amounting to US$881 miion coud be mobiized from the budget, externa (deveopment partners and househods), parastatas and oca authorities, (Figure 13). The report noted that government funding is heaviy skewed towards heath worker saaries and heath systems costs whie partner funding goes towards disease specific activities. This represents a costsharing imbaance between government and partners, which requires harmonized panning to ensure optima resuts. With funding partners consistenty contributing above 50% of the tota resource enveope, deveopment partner contribution is estimated to have grown from US$3.30 per capita in 2 to US$34.00 per capita in Whist this has been the cornerstone of heath care provision, sustainabiity requires that the Government raise additiona domestic funding and reduce donor dependency. For instance, severa disease areas receive a arge portion of funding from funding partners, (Figure 13b), exposing the programs to risk if donor priorities shift or if funding ends. Moving forward, there is need to improve aid effectiveness to ensure vaue for money is achieved from donor funds. Better aignment of donor priority areas and government s needs is aso caed for. US$ Miions Figure 12: Additiona Resources for Heath Care in China Goba Fund HIV Source: 2017 Nationa Budget Statement 11.5 Goba Fund TB 4.3 Goba Fund Maaria 48.5 HDF 36.5 User Fees Figure 13a: Resource Mapping for Heath ( ) US$ Miion Figure 13b: Gvt Vs Externa Funding for Seected Diseases in 2016 Externa Budget Parastatas Loca Authori es Source: MoHCC 2016 Resource Mapping Exercise 9

10 Aready, goba aid fows have been decining, on account of financia and economic crises in donor capitas, meaning fewer resources to finance basic socia services and infrastructures that are critica for chidren. Consistent with reduced aid fows, there has been shifts in donor priorities towards new emergencies and to the poorest countries, where the needs are argest. Zimbabwe, has aready witnessed a decine in Officia Deveopment Assistance (ODA) from a peak of US$1 biion in 2012 to US$651 miion by end of , representing a decine of 35%. The same trend is evident in aid fows to the Heath sector. For instance, the Heath Deveopment Fund (HDF), which for the past few years has been a major source of predictabe funding for materna and chid heath care equipment and suppies, has been decining from US$50 miion in 2015 to US$32 miion in 2016 and further to US$28 miion in With future increases in aid fows in genera and in heath care, in particuar, unikey, Zimbabwe woud need to fuy embrace the 2012 Tunis Decaration by African Ministers of Finance and Heath, for the mobiisation of domestic resources for heath and for achieving greater accountabiity and vaue for money in deivering heath services for a, incuding the chidren Heath Care Budget Execution Heath Budget impementation rate for 2016 is estimated at 98%, (Tabe 2) 7. Whist this might appear positive, it is important to note that most of the expenditures were towards empoyment. Expenditure overruns were experienced in empoyment costs hence an impementation rate of 106%, (Tabe 2). Seventyeight percent of the current budget aocation was disbursed whist just 23% of the capita budget was actuay spent. It is aso worth noting that a significant chunk of the disbursements were made during the ast week of 2016, affecting the timeous impementation of the panned programmes. This is mainy on account of the cash fow constraints, worsened by the cash budgeting approach by the government. Cash budgeting impies that the government has to first receive cash before they can actuay spend it. Where the fows are underperforming, as is the current situation, it makes panning difficut as disbursements to Ministries are often deayed. Tabe 2: 2016 Heath Budget Actua Disbursements 2016 Revised Budget 2016 Actua Expenditure Burn Rate 2017 Budget Aocation Empoyment Cost 277,119, ,848, ,916,000 Recurrent Expenditure 28,940,000 22,537, ,600,000 Capita Expenditure 24,730,000 5,780, ,460,000 Tota 330,789, ,166, ,976,000 6 Review of Goba ODA fows in Financing Deveopment, A specia focus on chidren, October 2016 by UNICEF Zimbabwe, Harare. 7 MoHCC presentation during the Pariamentary Portfoio Committee on Heath and Chid Care, 17 January

11 Therefore, the per capita actua spending of US$23.78, remains significanty beow the WHO threshod of US$86.00 and the SADC average of US$ This demonstrates the eve of underfunding of the Heath sector. It is therefore important for the government to expore options of increasing fisca space, such as Pubic Private Partnerships (PPPs), whist at the same time improving its expenditure mix and prioritization of expenditures. Efficiency gains can aso be achieved by ensuring vaue for money in service deivery. Actua budget expenditures in heath, and indeed overa budget, have been ower than aocations, refecting cash budgeting constraints. However, the Ministry of Finance revised downwards, the Heath Care aocations to match average annua disbursements to the sector (Figure 14). As such, neary % of the budget was disbursed in 2015 through to Worth noting is the fact that expenditure overruns were experienced with regards to empoyment costs, resuting in higher actua expenditure outturn. This came at the expense of nonwage spending, which has continued to trend downwards from a high of US$150 miion in 2012 to US$28 miion in 2016, (Figure 14). US$ Miions Figure 14: Trends in the Actua Utiisation of the Heath Care Budget (201216) Empoyment Non wage Actua Exp Aoca on Source: Various Audited Genera Financia Reports The cash fow chaenges meant that some programmes/institutions did not receive anything from their 2016 Budget aocations (Tabe 3) 8. Of the US$3.86 miion aocated to Grant Aided institutions ony US$1.95 miion was actuay disbursed, representing an impementation rate of 50.52%. Institutions such as the Zimbabwe Nationa Famiy Panning Counci (ZNFPC), oca authorities and vounteers did not receive anything from their aocated budgets, whist Mission Hospitas received 44% of their aocated budgets. Tabe 3: Actua Disbursements to Grant Aided Institutions in 2016 Institution 2016 Budget 2016 Expenditure 2017 Budget Vountary 120, ,000 HSB 1,000, ,663 1,000,000 Loca Authorities 110, ,000 Missions 450, , ,000 PGH 1,682,700 1,375,162 1,400,000 ZNFPC 500, ,000 Tota Aocation 3,862,700 1,953,825 3,290,000 8 Ibid 11

12 CONCLUSIONS It is no secret that fisca space is shrinking, thereby imiting the government s capacity to adequatey support the Heath sector, aong with other socia and economic infrastructures. Hence, the focus of pubic spending shoud be to improve the efficiency and quaity of expenditures of the avaiabe resources. Expenditure prioritization of the overa heath care budget and within across different eves of care and programs is imperative. For instance, the Government spent more money in 2016 on foreign trave (US$51 miion), compared to nonwage spending in Heath (US$28 miion). Equay, better targeting and enhancing efficiency of expenditures, especiay primary care, medicines, and suppies, whie reducing the share of empoyment costs (both overa and in the heath sector), shoud be a key poicy priority for the Government. Need to improve disbursement rates for nonwage spending, to achieve better heath outcomes, incuding for chidren. Disbursements aso need to be timey to ensure the impementation of programs in ine with schedues, particuary towards NCDs which are now a eading cause of mortaity and morbidity. This is in ight of the recent shortages of drugs and commodities experienced within the heath deivery chain. Equay, the Nationa Heath Insurance (NHI) programme shoud aso be prioritized to aow universa access to heathcare services, to ensure that no one is eft behind. Budget tracking and monitoring is aso critica. This coud hep ensure that resources reach programmes and beneficiaries, to produce the intended heath outcomes. Equay important is the need for pubic spending in heath to be guided by the equity objective. Thereby, ensuring that pubic spending targets reach the most vunerabe, neediest areas and chidren to achieve equitabe heath outcomes. In the short term, particuary in view of poor economic growth prospects, Deveopment Partners remain crucia. However, given the unpredictabiity of donor support, such resources shoud be considered compementary to domestic resources, whist the country strengthens its domestic resource mobiization capacity. Sustainabiity requires that the government increases its domestic resource mobiisation efforts incuding innovative financing mechanisms such as Pubic Private Partnerships, and private investments to increase resource fows into the economy in genera and the heath sector, in particuar. It is equay important to ensure that vaue for money is achieved from the domesticay mobiized resources. Modaities for coection and management of the 5% airtime tax need to be speediy finaized, to pave way for its impementation. Reated to the above, strengthening donor coordinating and efficiency in the use of Partner support coud hep improve resource aocation and heath outcomes. In addition, the avaiabe support coud be used strategicay to crowdin domestic resources, incuding through, creating an environment where private sector growth directy benefits women and chidren. 12

13 List of Acronyms GDP HDF HSF MICS MODA MoHCC NHA NHI NHS ODA PBB PPP SSA WHO Gross Domestic Product Heath Deveopment Fund Heath Services Fund Mutipe Indicator Custer Survey Mutipe Overapping Deprivations Anaysis Ministry of Heath and Chid Care Nationa Heath Accounts Nationa Heath Insurance Nationa Heath Strategy Officia Deveopment Assistance Programme Based Budgeting Pubic Private Partnerships Sub Saharan Africa Word Heath Organization UNICEF, 2017 UNICEF ZCO 6 Fairbridge Avenue, Begravia, Harare 13