Collaboration between civil society and Uganda Parliament to shape health budget allocation

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1 Collaboration between civil society and Uganda Parliament to shape health budget allocation Workshop on Enhancing Capacity for Budget Analysis and Advocacy for Women's and Children's Health August 2013 Nairobi, Kenya

2 Background/context 90 children for every 1000 live births die before the age of 5 (2011 UDHS) Maternal mortality stands at 438 per 100,000 live births. Uganda may miss the MDG targets Uganda signed the Abuja Declaration and committed to allocate 15% of the national budget to health sector (oscillates between 7% and 11%). FY 2013/14 has allocated 8.7% In 2012 Parliament declared crisis of human resources for health due shortage of midwives, doctors among other cadres at HCIIIs and IVs. Through district level consultations, shortage of mid-wives and doctors at health centers was a key advocacy priority adopted by the CSO coalition on MNCH In Uganda

3 Budget advocacy objective and strategy Organized a coalition meeting and generated consensus to focus on human resources for health as a key issue for health budget advocacy. A smaller team undertook health budget analysis and also held consultations with key MoH officials out of which a position paper was generated. The objective was to lobby MPs to increase allocation to the health budget by Shs.260 billion. The coalition later engaged the Parliamentary Health Committee and presented the case of more resources to cater for recruitment of more staff and their motivation, estimated at Shs.260 billion.

4 Outcomes of the advocacy strategy Just before the Parliamentary debated on the national budget began in preparation for approval, we mapped out about 30 key RMNCH champion MPs. Adopted the recruitment scenarios developed by MoH Organized breakfast meetings and lobbied them to fight for additional health budget allocation on top of about Ushs.710 billion, provided in the budget estimates Face-to-face meetings of MPs in the corridors of Parliament Mobilized and sensitized media on the key issues and had several press conferences and releases Testimonies from health workers and managers, VHT representative provided more evidences on grass-root experiences and working environment Presented a petition to Speaker of National Parliament with key recommendations and priority actions which she presented to the House through a Health committee MP The legislators committed to block the budget at the floor of Parliament. Public awareness and mobilization continued through media, text and sticker messages campaign which sustained pressure on the legislators.. Despite the political threats and arm-twisting by the state machinery, the MPs stood their grounds for a period of two weeks.

5 Hon. Bitekyerezo, a member of Health parliamentary committee committing his support in one of the lobby meetings

6 Cos, MoH officials meeting the health committee of parliament

7 Sticker messages produced for MPs and worn by every MP who supported additional funds as they entered the House for plenary discussions

8 Outcomes of the advocacy strategy Cont d Finally the executive yielded and an additional Ushs billion was allocated to the health sector to recruit all health workers that were required at HC IVs and IIIs as per the staffing norms. 10,231 posts were eventually advertised. At the end of FY 2012/13, 8079 health workers had been appointed of which 6839 reported to work. However, as Civil society we still consider this as unfinished business which we are perusing in the ongoing budgetary process at parliamentary level

9 Challenges to the implementation of advocacy strategy Difficulties faced during the implementation of the advocacy strategy - Inadequate capacity among CSOs to adequately analyze budget and tracking expenditures - Political interference - Limited resources for effective mobilization - Coordinated documentation for profile and visibility

10 Facilitating factors to the achievement of budget advocacy outcome Team work among the CSO coalition members Clarity and focus of the advocacy issue Mapping and building rapport with champions at parliament Use of media campaign The text message campaign that enabled communities voices to be amplified for the attention and action of decision makers. Effective coordination through which members contributed resources for implementation of the advocacy initiative. Cooperation and support from the MoH officials in terms of basic information.