The Power of Budget Line Items

Transcription

1 The Power of Budget Line Items March 2, 2015 Nancy Yinger, Rudolph Chandler, Sky Barlow and Juan Dent

2 Session Agenda Describe the seemingly simple strategy of adding a line item for family planning (FP) or reproductive health (RH) to a country s Ministry of Health budget Discuss the potential policy impact of targeted line items Listen to a parliamentarian from Malawi Present the findings of an assessment of FP expenditures from four countries health accounts and compared with global commitments Present an implementation assessment of a law that allocated 15% of alcohol taxes in Guatemala to FP/RH programming Discuss the benefits and constraints of expenditure tracking

3 Tracking Family Planning Expenditures and Commitments for FP2020 Data from Four Countries March 2, 2015 Rudolph Chandler Sky Barlow HPP

4 Introduction System of Health Accounts (SHA 2011) tracks all health spending in a given country over a defined period of time regardless of the entity or institution that financed and managed that spending. Launched in 2013 Replaces National Health Accounts (NHA) methodology Subaccounts/ diseases/conditions (HIV, tuberculosis, malaria, RH, etc.) made easier FP was rarely estimated in the past First round of data: July 2014 and subsequent updates

5 Introduction (continued) System of Health Accounts (SHA 2011)

6 Introduction (continued) FP2020 Global partnership to enable 120 million more women and girls to use contraceptives by London Summit on FP Governments commitments to address the policy, financing, delivery, and socio-cultural barriers to women accessing FP Donors have pledged US$2.6 billion Tracks progress and commitments

7 Methodology Health accounts 2012 data Provided/updated by WHO and countries Not all data provided HPP: minor estimation Converted with 2012 exchange rates FP2020 Financing commitments data from website:

8 Health Accounts Dimensions Financing Sources/Agents Where does the money come from? Governments, donors, households (out-of-pocket expenditures), and the private sector Inputs What types of inputs are used in producing FP goods and services? Salaries, pharmaceuticals, training, etc. Providers Where are FP services delivered? Hospitals, ambulatory care centers, ancillary care centers, retailers, etc. Functions For what purposes? Preventive, curative, epidemiological surveillance, etc.

9 Limitations of HA Data New software Data classification issues Functions, examples High proportion of FP services classified as curative No amount/data for monitoring and evaluation/planning and management

10 Findings Health Accounts BENIN BURKINA FASO LIBERIA TANZANIA Total Health Expenditures (THE) (in US$) 346 M 593 M 240 M 19,139 M THE FP (in US$) 577 K 6,411 K 6,453 K 17,566 K THE FP/THE Under 1% 1% 3% 1% THE FP per user (in US$)

11 Findings: Funding Sources, Family Planning 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Benin Burkina Faso Liberia Tanzania Government funding External funding Private funding Households

12 Findings: Inputs, Family Planning Benin (Inputs) Burkina Faso (Inputs) 42% Compensation of employees 57% 39% 15% Pharmaceuticals 17% 3% 1% Other healthcare goods 26% Liberia (Inputs) Training Technical assistance Tanzania (Inputs) 19% Other inputs 76% 4% 77% 1% 1% 11% 1% 1% 5% 4%

13 Findings (continued) Health Accounts data Vary by country All dimensions: sources, functions, providers, and inputs THE FP: small percentage of THE Expenditures per user: Under US$10 (except Liberia) One constant : Out-of-pocket expenditures (OOP) as a source of FP averages 11% (except Liberia) Liberia is reviewing its OOP

14 Findings (continued) Comparison of HA data and commitments Government expenditures for FP BENIN BURKINA FASO LIBERIA TANZANIA 2012 HA Government funding $ 313,926 $ 161,657 $ 963,840 $ 1,551,501 FP2020 Commitments (2012) $ 500,000 (2018) $ 1,000,000 $ 893,697 N/A

15 Next steps HPP brief: published on website FP guide: HPP, HFG and WHO Will be incorporated in a larger Health Accounts guide (HIV, immunization, tuberculosis, malaria, RH, and other diseases/conditions) Discuss data classification issues with WHO and countries (March 2015) More countries with 2013 health accounts data

16 Guatemala: Tracking the Innovative Use of Alcohol Taxes to Support Family Planning March 2, 2015 Juan Dent HPP

17 FP/RH Policy Legislation

18 Data Collection Methodology 1. Budget request made to Ministry of Finance before current revenue estimates are calculated 2. Budget based on previous fiscal year is allocated to MOH 3. Funds from Alcohol Tax used for FP/SH and alcoholism programs 4. MOH uses 30% of funds from Alcohol Tax to purchase FP/SH commodities

19 Budget Tracking Findings Year Amount MINFIN Estimated as 15% of Tax (Q Millions) Transferred from MINFIN to MSPAS Funds MSPAS used for FP/RH programs % 84.0% % 90.9% % 89.4% % 94.9% % 89.0% % 92.2% % 38.7% % 88.1% % 76.2% Percent of funds used as stipulated by Safe Motherhood Law 83.3% 50.7% Source: MINFIN s Integrated Accounting System (SICOIN). Accessed February 2013 and

20 Findings Alcohol Tax revenue has increased over time Ministry of Finance has regularly transferred the full 15% of the alcohol tax fund to MOH despite the budget timelines The MOH, excluding 2012, has used 88% of the alcohol funds as legislated MOH has not reported using 30% of the funds to purchase FP/SH commodities Civil society and stakeholders are aware of FP/RH budget; strong advocates for legislation

21 Alternative sources of funding can be used by the MOH to support health programs Strong policy initiatives led to the creation of FP line items in the Alcohol Tax Law and the Safe Motherhood Law Budget tracking is an evolving process Important for internal and external accountability In December, the Guatemalan Congress Published Decree State Income and Expenses Budget allowing: Purchasing contraceptives through international mechanisms Paying for them in advance What Worked Exemption from value added tax

22 Next Steps Case Study What we have: Quantitative information on how the Ministry of Health has received and used the Alcohol Tax funds What we are doing: Key informant interviews with representatives from relevant government ministries, civil society organizations, and international development partners. What should we ask?

23 Thank You! The Health Policy Project is a five-year cooperative agreement funded by the U.S. Agency for International Development under Agreement No. AID-OAA-A , beginning September 30, It is implemented by Futures Group, in collaboration with Plan International USA, Futures Institute, Partners in Population and Development, Africa Regional Office (PPD ARO), Population Reference Bureau (PRB), RTI International, and the White Ribbon Alliance for Safe Motherhood (WRA).