Resource Tracking for RMNCH: (reproductive, maternal, neonatal and child health)

Transcription

1 Resource Tracking for RMNCH: (reproductive, maternal, neonatal and child health) Tessa Tan-Torres Edejer WHO Health Systems Financing Department

2 Country Level Recommendations from Commission 4. By 2015, all 74 countries where 98% of maternal and child deaths take place are tracking and reporting, at a minimum, two aggregate resource indicators: 1) total health expenditure by financing source, per capita; and 2) total reproductive, maternal, newborn and child health expenditure by financing source, per capita. 5. By 2012, in order to facilitate resource tracking, compacts between country governments and all major development partners are in place that require reporting, based on a format to be agreed in each country, on externally funded expenditures and predictable commitments. 6. By 2015, all governments have the capacity to regularly review health spending (including spending on reproductive, maternal, newborn and child health) and to relate spending to commitments, human rights, gender and other equity goals and results. 8. By 2013, all stakeholders are publicly sharing information on commitments, resources provided and results achieved annually, at both national and international levels.

3 Why monitor expenditures on health and RMNCH? Hold decision makers accountable to their commitments as expressed in their national health strategic plans and also on MDGs 4 and 5 (and/or other RMNCH goals), and MDG6. Assess the level and distribution of resources regarding alignment with health sector priorities. Evaluate sustainability of financing over time Improve allocation of current spending, reduce waste of resources and improve efficiency. 3 Tracking RMNCH expenditure Manila, March 2012

4 Country level Commitments to implement the Global Strategy Examples from WPRO 4 Tracking RMNCH expenditure Manila, March 2012

5 THE BUDGET PROCESS I- Strategic plan II- Operational plan and budget proposal III- Budget negotiation IV- Budget consolidation and approval V- Financial tracking and audit Timeline Strategic areas Policies Targets Activity plan Input requirements Input costs Preliminary budget Internal revision Negotiation with Ministry of Finance Budget approval by Ministry of Finance Distribution of the budget by line items Monitoring of financial disbursements by budgetary line items 5 Tracking RMNCH expenditure Manila, March 2012 Slide taken from a presentation by Tania Dmytraczenko

6 Reproductive and Maternal Health Includes 5 priority areas identified in the Global Reproductive Health Strategy Antenatal, delivery, post-partum and newborn care High-quality services for family planning, including infertility services. Eliminating unsafe abortion. Combating STIs including HIV, reproductive tract infections, reproductive health-related cancers, and other gynaecological morbidities. Promoting sexual health. 6 Tracking RMNCH expenditure Manila, March 2012

7 Child Health Expenditures during a specified period of time on: goods, services and activities delivered to the child after birth or its caretaker whose primary purpose is to restore, improve and maintain the health of children between zero and less than five years of age. 7 Tracking RMNCH expenditure Manila, March 2012

8 Three levels of reporting There are three main sources of funding for health and RMNCH External resources (ODA), government and private (household) Depending on current level of health expenditure reporting: Minimum all countries, annual: RMNCH government expenditure tracking tool; to include ODA outside of government once compacts are developed If with periodic national health accounts, full distributional table, including RMNCH If already with yearly NHA, full distributional table and subaccounts (RMNCH) 8 Tracking RMNCH expenditure Manila, March 2012

9 Examples of preliminary estimates presented by participants on 3rd day of workshop 9 Tracking RMNCH expenditure Manila, March 2012

10 Example: government and external resource funding (annual) Cambodia The Philippines 10 Tracking RMNCH expenditure Manila, March 2012

11 NHA Distributional Tables: Preferable to stand-alone subaccounts 11 Tracking RMNCH expenditure Manila, March 2012

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13 Increasing demand for child and reproductive health subaccounts at country level, but limited implementation to date Child Health subaccounts: Reproductive Health subaccounts: Bangladesh Ethiopia Liberia Malawi Sri Lanka Tanzania Egypt Ethiopia Georgia Jordan Karnataka State, India Malawi Mexico Morocco Rwanda Senegal Sri Lanka Tanzania Ukraine 13 Tracking RMNCH expenditure Manila, March 2012

14 Type of RMNCH expenditure / budget data 4 components 1. Shared Resources (e.g., Service delivery costs, HRH, general care) 2. Commodities (e.g., vaccines, ITNs) 3. Programme-management specific activities (i.e., national programme budget) 4. Incentives Service utilisation data used to apportion % budget / expenditure to RMNCH Direct estimates and/or a % share allocated to RMNCH Direct estimates Direct estimates 14 Tracking RMNCH expenditure Manila, March 2012

15 Indicators for RMNCH Total amount: Government expenditure/budget Child Health Maternal health Reproductive health (+ Family Planning (as a subset of RH)) RMNCH share of Government health exp (%) Child Health Maternal health Reproductive health Amount spent per beneficiary Government expenditures per capita on MH, RH, CH Government expenditures on child health per child under five years old Government expenditures on MH per live birth Government expenditures on RH per woman of reproductive age 15 Tracking RMNCH expenditure Manila, March 2012

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17 NATIONAL HEALTH ACCOUNTS (NHA) FRAMEWORK AND GOVERNANCE There is an officially approved NHA framework built upon international guidelines There is a formal governance mechanism that specifies coordination, management, national indicators and budget for i mpl ementing the NHA COMPACT There is a formal agreement (or compact) between government and partners that requires reporting on partner commitments and disbursements, and donor funded expenditures on health, (including on RMNCH). COORDINATION There is an NHA steering committee that provides technical oversight on data needs, methods of production and data use Key stakeholders are actively involved in the production of NHA (including government stakeholders at national and subnational level, CSOs, NGOS, partners, health insurance companies ) 17 Tracking RMNCH expenditure Manila, March 2012

18 PRODUCTION There is adequate human capacity at national and subnational levels to produce NHA data and core indicators. Government expenditure data conversion into NHA format is automated There is a central database for automated production of standard NHA tables, and methods and sources are well documented and accessible ANALYSIS Analytical summaries are produced annually including time series, policy and equity analyses NHA indicators and analyses are publicly accessible DATA USE NHA data including RMNCH data are an essential element of annual reviews and are used in the development of national policies, including RMNCHspecific policies. 18 Tracking RMNCH expenditure Manila, March 2012