Rethinking Public Finance for Children (PF4C) MONITORING FOR RESULTS

Rethinking Public Finance for Children (PF4C) MONITORING FOR RESULTS THE REPUBLIC OF UGANDA 1

RETHINKING PUBLIC FINANCE FOR CHILDREN (PF4C): MONITORING FOR RESULTS Acknowledgements Rethinking Public Finance for Children (PF4C): Monitoring for Results introduces a bold approach to identify and remove key implementation bottlenecks, enhance transparency and accountability, and ultimately improve the delivery of basic services for Government programmes affecting children. The research and drafting of the report was led by Imran Aziz, in close collaboration with the Budget Monitoring and Accountability Unit (BMAU) in the Ministry of Finance, Planning and Economic Development (MoFPED) and the Social Policy and Advocacy team in UNICEF, under the visionary leadership of Margaret Kakande and Diego Angemi. Throughout the formulation of this initiative, the team conducted in-depth consultations and field- based monitoring exercises. In doing so, it received excellent support from district officials and the UNICEF zonal office in Moroto. In addition, substantial contributions were provided by MoFPED s Budget Department and UNICEF s U-Report team. Frances Ellery provided editorial inputs for the report. Mark Turgesen and Rachel Kanyana designed the report and its associated advocacy materials, respectively.

Rethinking Public Finance for Children (PF4C) MONITORING FOR RESULTS THE REPUBLIC OF UGANDA

RETHINKING PUBLIC FINANCE FOR CHILDREN (PF4C): MONITORING FOR RESULTS TABLE OF CONTENTS Foreword 1 Abbreviations and acronyms 2 Executive summary 3 1. Introduction 6 2. Fulfilment of children s rights 9 Outcome trends in health, education and water 9 Trends in the quantity and quality of service delivery 12 Conclusion 15 3. The budget and child-related spending 16 Overall budget allocations and spending to education, health and water 16 Conclusion 19 4. Disaggregating the budget to better reflect investments in children 20 Methodology 20 Stage 1: Defining direct and indirect spending on children using Uganda s budget classification system. 21 Stage 2: Identifying specific expenditures that are likely to address outcome variances 23 Education sector 24 Health sector 24 Water and environment sector 26 Conclusion 26 5. Monitoring for results 27 Existing monitoring frameworks and data availability in Uganda 27 Expanding this framework to incorporate a child focus 28 CASE STUDY: Education sector / primary school completion 30 Pre-visit 30 Level 1: Spending vs. outcomes 30 Level 2: Input level trends 30 Level 3: Budget trends 31 Level 4: Beneficiary feedback 31 In the field 32 Level 5: Field validation of beneficiary feedback 32 Dissemination of findings 34 Conclusion 35 6. Conclusion and recommendations 36 References 39 Annex 1: Uganda s budget classification structure 40 Annex 2: Direct and indirect mapping of basic services affecting children 41

FOREWORD With close to 60% of the population below 18 years of age, and over 75% below the age of 35 years, Uganda s vision to become a middle-income country by 2040 remains highly contingent on the Government s ability to safeguard its children s right to contribute to national development. In a decisive attempt to enhance national efforts to safeguard children s rights, the Budget Monitoring and Accountability Unit (BMAU) of the Ministry of Finance, Planning and Economic Development, together with UNICEF Uganda, has embarked on an endeavour to generate comprehensive information that will help remove key implementation bottlenecks, enhance transparency and accountability, and ultimately improve service delivery for government programmes affecting children. As the Government takes progressive steps to base performance monitoring at the higher strategic outcome level, monitoring efforts need to be reoriented from focusing purely on the effective delivery of key outputs (i.e. following the money ) to further appreciating the impact of key public investments and vital outputs on social outcomes. This is a step change from traditional monitoring practices and demands a clearer link in the results chain between outcomes and spending. Enhancing the delivery of basic services is central to promoting and protecting the rights of children, who represent the future of our nation. I congratulate my colleagues, UNICEF, and everyone who contributed to reshaping the future of monitoring for results in Uganda. Keith Muhakanizi Permanent Secretary / Secretary to the Treasury Ministry of Finance, Planning and Economic Development 1

RETHINKING PUBLIC FINANCE FOR CHILDREN (PF4C): MONITORING FOR RESULTS ABBREVIATIONS AND ACRONYMS BMAU GoU LG MDG MoFPED MTEF NGO PAF SDI UNICEF UPE Budget Monitoring and Accountability Unit Government of Uganda Local government Millennium Development Goal Ministry of Finance, Planning and Economic Development Medium Term Expenditure Framework Non-governmental organisation Poverty Action Fund Service Delivery Indicator (World Bank) United Nations Children s Fund Universal primary education 2

EXECUTIVE SUMMARY EXECUTIVE SUMMARY Children and young people who already make up more than half of Uganda s fastgrowing population hold the potential to transform the country s economy and fulfil its vision of becoming a middle-income country by 2040. However, despite having made great progress in reducing income poverty in recent years, over 50% of Uganda s children still live in poverty. In some regions the percentage is much higher. Uganda has also made uneven progress in achieving the Millennium Development Goals (MDGs). While the targets for reducing child mortality and improving access to safe water and sanitation have been reached, primary school completion rates have actually declined and improvements in maternal mortality rates have stagnated. This suggests that, although Uganda has achieved much, there is still significant scope for improvement in child-related outcomes that would enable children to contribute to the country s socio-economic future. The Government is committed to strengthening service delivery in order to improve the lives of children and work towards the post-2015 Sustainable Development Goals. Already its per capita spend on health one of the three sectors along with education and water that have the greatest impact on children s development and well-being is higher than its regional peers. However, recent surveys using the World Bank s Service Delivery Indicator (SDI) framework show that investments in infrastructure, textbooks and medicines are not enough to guarantee the best outcomes. Service delivery outcomes depend on strong relationships of accountability between policy-makers, service providers and citizens. Over the past 15 years, spending in Uganda can be broken down into three phases. The first saw additional resources being allocated to the social sector. During the second, priorities shifted towards the productive and economic sectors. Now, in the third, the priority is value for money ensuring that money is well spent and maximises allocative efficiency. These concerns led the Government to set up the Budget Monitoring and Accountability Unit (BMAU) in 2008. As the monitoring landscape develops, and Government takes progressive steps to base performance monitoring at the higher strategic outcome level, monitoring efforts may need to be reoriented from focusing purely on the effective delivery of key outputs (i.e. following the money ) to further appreciating the impact of key public investments and vital outputs on social outcomes. This is a step change from traditional monitoring practices and demands a clearer link in the results chain between spending and outcomes. In this respect, Government and UNICEF Uganda set out to develop a joint monitoring framework for more detailed analysis on child-related spending and 3

RETHINKING PUBLIC FINANCE FOR CHILDREN (PF4C): MONITORING FOR RESULTS its effectiveness. Building on the BMAU s existing monitoring framework, and based on the changing fiscal and service delivery landscape, the BMAU/UNICEF framework tracks direct expenditures on basic services affecting children. This new approach involves looking more closely at budget trends at the regional level and at ways to promote relationships between policy-makers, service providers and citizens. The framework is intended to provide a basis for informed discussions on better spending and also to provide a platform to monitor the effective delivery of national programmes affecting children. Through a conceptual framework consisting of six levels of data analysis and three stages of monitoring pre-visit, fieldwork and findings, the BMAU/ UNICEF monitoring framework brings together performance and budget-related data that is publicly available and can help identify spending efficiency variations across different areas of the country. Level 1 aims to isolate key bottlenecks to identify effective response mechanisms to enhance the delivery of decentralised services affecting children. Level 2 explores whether the trends could be caused by variances in the level of inputs for basic services. Level 3 assesses financial trends and explores whether service delivery issues could be related to the allocation of decentralised grants. Level 4 explores beneficiaries feedback regarding identified bottlenecks in service provision. Level 5 introduces budget monitoring and explores what beneficiaries, local leaders and facilities managers say regarding bottlenecks in service provision. Level 6 disseminates findings back to local leadership and other stakeholders to discuss ways to mitigate service delivery bottlenecks and join the links in the accountability chain. 4 An education sector case study reveals that regional differences in output performances are not related to input but rather depend on complementary investments such as targeted social protection interventions and on contextspecific measures. The BMAU/UNICEF monitoring framework has three key advantages. It provides: (i) the ability to identify significant variations across the country when per capita spending is mapped with outcome performance (ii) verification of the complex mix of potential financial, non-financial and other factors that could affect outcomes (iii) a combination of data analysis, beneficiary feedback and budget monitoring to explore these issues further. The conceptual framework underpinning this initiative is depicted in the figure on the following page.

EXECUTIVE SUMMARY BMAU/UNICEF MONITORING FRAMEWORK A - Outcome trends - Budget trends - Beneficiary feedback ANALYSIS - Develop a monitoring question/themes - Using the analysis to frame monitoring plans BMAU EXISTING FRAMEWORK Spending Outputs B LOCAL LEADERSHIP COMMUNITY FACILITIES MANAGEMENT The space between the two thick lines (A and B) in the figure represents the BMAU s existing monitoring approach, which involves following expenditures on selected budget outputs and reporting whether they have been realised or not. The BMAU/UNICEF innovative design first introduces outcome analysis from the top down and, second, expands fieldwork techniques by introducing a more active role for beneficiary involvement from the bottom up. The expansion of the monitoring framework draws on the type of analysis presented in earlier sections of this study and the SDI fieldwork methodology. The top down element, which sits above line A incorporates outcome and spending analysis to derive a monitoring question or theme prior to going to the field. The objective of this upper extension is to use the disaggregated budget and outcomelevel indicator information to develop a monitoring question/theme to guide the monitoring plan that the team will aim to answer during bi-annual and annual visits. The bottom-up element which sits below line B involves incorporating feedback from beneficiaries who use the services, in addition to service providers (facilities managers) who provide such services, and the local authorities responsible for exercising oversight and ensuring the effective delivery of national programmes. It is anticipated that the outcomes of this initiative will help to strengthen advocacy channels, sharpen emphasis on the quality of service delivery, improve transparency towards expenditures on basic services for children and, ultimately, improve outcomes for children and the country s economic growth. 5

RETHINKING PUBLIC FINANCE FOR CHILDREN (PF4C): MONITORING FOR RESULTS 1 INTRODUCTION Uganda s vision of becoming a middle-income country by 2040 remains highly contingent on the government s ability to safeguard its children s right to contribute to national development. Over 56% of the population are below 18 years of age, and over 78% are below the age of 35. Investing in its young population will enable Uganda to reap an unprecedented demographic dividend. Put differently, over the next 30 years, today s children gradually transitioning into an already dynamic labour force hold the potential to transform Uganda s economy, and remodel the socio-economic future of the nation. Despite Uganda s remarkable achievement in reducing income poverty from 56.4% to 19.7% of the population between 1992 and 2012, child poverty 1 remains 6 1. Defined as the proportion of children suffering from deprivation in two or more of the following seven dimensions: (i) Nutrition, (ii) Health, (iii) Water, (iv) Sanitation, (v) Shelter, (vi) Education and (vii) Information.

high and widespread across the country. Nationally, over 50% of children under five live in poverty, and one in five live in extreme poverty. Children s experience of poverty and deprivation in Uganda varies widely by region, geographic location and socioeconomic status. Poverty and deprivation in childhood represent potentially irreversible violations of children s basic rights and could severely jeopardise Uganda s ability to reap the full benefits from the much-anticipated demographic dividend. Reducing child poverty will require public resources to be allocated and spent in a way that serves the interests of Uganda s young population. The National Budget is a key policy instrument that guides and finances government activity to achieve certain goals within a given period of time. Indeed, the UN Convention on the Rights of Children (UNCRC), ratified by Uganda in 1990, stipulates that States are required to ensure the realization of the economic, social and cultural rights of children to the maximum extent of their available resources. To achieve this objective, the UNCRC also recommends implementing a tracking system for the allocation and use of resources for children throughout the budget. Children s experience of poverty and deprivation in Uganda varies widely by region, geographic location and socioeconomic status. The Government and UNICEF Uganda remain committed to developing systematic approaches to monitor investments in basic services affecting children, which is the objective of this study. Through a combination of analytical support and technical assistance, the Government of Uganda and UNICEF have embarked on a strategic partnership to rethink the framework of public finance for the delivery of basic services affecting children. While traditional approaches have centred on more and earmarked resources for investments in children, the conceptual framework for this study aims to explore ways to work within the Government s fiscal realities and support investments in children through the broader remit of the better provision of basic services in the three predominant sectors affecting children: Education, Health, and Water and Environment. The methodology adopted in this study builds on the reforms implemented by Government to improve the budget classification system and monitor public expenditures. For the past several years, the Government has made considerable strides in developing budget reforms through the introduction of output- and programme-based budgeting. These reforms have led to major improvements in the budget classification structure. In addition, the institutional framework for monitoring public spending has been strengthened through the introduction of 7

RETHINKING PUBLIC FINANCE FOR CHILDREN (PF4C): MONITORING FOR RESULTS the Budget Monitoring and Accountability Unit (BMAU) in 2008, mandated to track the effectiveness of spending in priority sectors including Education, Health, and Water and Environment. This study is structured in six parts. Following this introduction, Section 2 discusses the fulfilment of children s rights, describing the context for the analysis and the key challenges going forward. Section 3 focuses on financing, firstly assessing broad sectoral trends followed by an assessment of direct and indirect spending on basic services affecting children and the implications for improving child-related outcomes. Section 4 disaggregates this spending based on Uganda s output and decentralised budget classification to identify clearer ways of identifying spatial investments in the basic services affecting children. Section 5 sets out a framework for using this analysis as a basis for budget monitoring as a means to identify and address constraints to basic service delivery. The final section sets out broad conclusions and options to take forward this new approach to monitoring service delivery. The key audience for this work is the Government of Uganda, where the BMAU is the main counterpart, UNICEF, development partners, and broader civil society. It is anticipated that the outcomes of this initiative will help to strengthen advocacy channels, sharpen emphasis on the quality of service delivery, and improve transparency towards expenditures on basic services for children. 8

FULFILMENT OF CHILDREN S RIGHTS 2 FULFILMENT OF CHILDREN S RIGHTS OUTCOME TRENDS IN HEALTH, EDUCATION AND WATER While the Government of Uganda (GoU) remains committed to strengthening service delivery in social sectors that will positively improve the lives of children, progress so far has been mixed. As seen in Table 1 on the following page, Uganda has made good progress in reaching different Millennium Development Goal (MDG) indicators such as gender equality, reducing child mortality, tackling malaria, and improving access to safe drinking water and sanitation. However, progress is slow, stagnant or off track in a number of key areas, including completion of primary education, maternal health care, and the spread of HIV/ AIDS. Given the mixed progress, there is an urgent need to reverse current trends in order to improve the well-being of children in the post-mdg environment as Uganda transitions towards the Sustainable Development Goals. 9

RETHINKING PUBLIC FINANCE FOR CHILDREN (PF4C): MONITORING FOR RESULTS Table 1: Status of selected education, health, and water and sanitation MDG indicators (2013) Goal 2: Achieve universal primary education Target 2.A: Ensure that, by 2015, children everywhere, boys and girls alike, will be able to complete a full course of primary schooling SLOW Goal 3: Promote gender equality and empower women Target 3.A: Eliminate gender disparity in primary and secondary education, preferably by 2005, and in all levels of education no later than 2015 ON TRACK Goal 4: Reduce child mortality Target 4.A: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate ON TRACK Goal 5: Improve maternal health Target 5.A: Reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio Target 5.B: Achieve, by 2015, universal access to reproductive health STAGNANT SLOW Goal 6: Improve maternal health Target 6.A: Have halted by 2015 and begun to reverse the spread of HIV/AIDS REVERSAL Target 6.C. Have halted by 2015 and begun to reverse the incidence of malaria and other diseases ON TRACK Goal 7: Ensure environmental sustainability Target 7.C: Halve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation ON TRACK Source: MoFPED (2013) Selection based on feedback during UNICEF/BMAU Workshop, January 2015 Uganda s progress is generally in line with peer countries although performance has been better in water and health, with less progress being made in education. In health, infant and child mortality rates have decreased substantially, although levels are still relatively high compared with peer countries (see Figures 1 and 2). The maternal mortality rate has reduced dramatically, but the pace of decline 10

FULFILMENT OF CHILDREN S RIGHTS has slowed in recent years (Figure 3). In education, primary education completion rates have actually declined since 2000, compared with Tanzania and Rwanda where rates increased, although Tanzania has most recently noted a decline (Figure 4). These trends suggest that, while Uganda has made progress, there is still significant scope to improve performance, particularly in education, in order to record similar progress compared with peers. Figure 1: Uganda s under-five mortality has declined at a steady pace but is still relatively high compared with peer countries Figure 2: Infant mortality rates have declined substantially but remain relatively high compared with peer countries Figure 3: While Uganda s maternal mortality ratio has reduced, the pace of decline has slowed in recent years Figure 4: Compared with peer countries Uganda has not substantially increased primary education completion rates 2 Figure 5: Compared with peer countries, access to safe drinking water has increased at an impressive rate Figure 6: Uganda has made slight progress in improving access to basic sanitation, but other countries have improved more rapidly Source: World Bank (2015) 2. Data earlier than 2001 are not available for Uganda. Where data is incomplete, UNICEF staff have estimated values based on trend data. 11

RETHINKING PUBLIC FINANCE FOR CHILDREN (PF4C): MONITORING FOR RESULTS TRENDS IN THE QUANTITY AND QUALITY OF SERVICE DELIVERY As part of Uganda s efforts to achieve the MDGs, the quantity of service provision has increased significantly in the health, education and water sectors. In education, primary school enrolment rose from 3 million children in 1996 to over 8 million in 2012, and lower secondary enrolment increased from 800,000 in 2005 to 1.3 million in 2013 (Figure 7). In health, annual outpatient visits to government clinics increased from under 10 million in 1997 to almost 40 million in 2012 (Figure 9). In the water sector, the number of people accessing safe water increased from 7 million in 1997 to 19 million in 2012 (Figure 11). These gains were maintained despite Uganda having one of the fastest rising populations in the world, which averaged 3.6% from 1997 2012. The net primary school enrolment rate has shown a steady continual increase from 1997 following the introduction of universal primary education (UPE), but has started to decline in recent years (Figure 8). The per capita outpatient attendance rate has followed a similar trend since the abolition of health user fees in 2001 (Figure 10). Safe water coverage (as a % of the population) increased significantly up to 2008, but has levelled out since (Figure 12). Figure 7: Primary enrolment rates have increased steadily, while secondary enrolment is improving at a slower pace (figures in millions) Figure 8: On a net basis, primary enrolment is also increasing 3 Figure 9: Total outpatient rates are rapidly increasing (figures in millions) Figure 10: and the increase can also be noted on a per capita basis 3. The net enrolment rate is the ratio of primary school children aged 6 12 years to the number of children of the same age range in the population. 12

FULFILMENT OF CHILDREN S RIGHTS Figure 11: The increase in the number of people accessing safe water is impressive particularly in;rural areas (figures in millions) Figure 12: reflecting an increase in safe water coverage, although the pace of improvement has declined Source: Uganda Bureau of Statistics (2014); Ministry of Water and Environment (2004 2012), Ministry of Health (2001 2013, Ministry of Education and Sports (2000 2012), Lister et al. (2006) The drive to increase service delivery inputs was supported by a rapid scale up in funding for these sectors particularly in the late 1990s and early 2000s, when the education, health and water budgets together made up over one-third of the national budget(figure 13). Even following the shift in government priorities from the mid-2000s, Uganda still has a higher per capita spend on health compared with regional peers (Figure 14). 4 Figure 13: The scale up of inputs for service delivery resulted in over one-third of the total budget being allocated to the three sectors in the early 2000s Figure 14: Health spending is higher than regional peers in US$ per capita terms Sources: Figure 13 MoFPED Approved Budget Estimates, various years; Figure 14 World Bank (2015). Comparable data from regional peers is not available for education and water. While the GoU scaled up the quantity of service delivery, the quality of service delivery has proved much more intractable (Figures 15 17). These figures firstly illustrate that in education, only 40% of pupils in their sixth year had reached acceptable levels of numeracy and literacy (Figure 15). Just under half of clinics nationwide suffer from drug stock outs an improvement from almost 80% in 4. Cross-country data only available for the health sector. 13

RETHINKING PUBLIC FINANCE FOR CHILDREN (PF4C): MONITORING FOR RESULTS 2010 (Figure 16). The functionality of urban and rural water points is generally high, but performance has fluctuated from 2008, despite the strong performance in increasing access (Figure 17). Figure 15: While literacy and numeracy rates have improved, there has been a recent decline Figure 16: Performance in achieving health indicators has been varied, but there has been a recent improvement Figure 17: There is varied functionality of safe water points Sources: Uganda Bureau of Statistics (2014), Ministry of Water and Environment (2004 2012), Ministry of Health (2001 2013), Ministry of Education and Sports (2000 2013), Lister et al. (2006) This increased quantity of services funding and spending on inputs has not led to improved outcomes for children, which raises some pertinent questions in the context of this study. This resonates with recent diagnostic work on service delivery undertaken by the World Bank. The Service Delivery Indicator (SDI) framework, adopted in several African countries including Uganda, 5 shows that more spending does not necessarily improve outcomes and that key human resources (teachers, nurses and doctors) can only help deliver effective services when they are skilled, knowledgeable and turn up for work. Without these criteria, investments in infrastructure, textbooks and medicines are likely to have a limited impact. 14 5. http://www.sdindicators.org/

FULFILMENT OF CHILDREN S RIGHTS Service delivery outcomes are determined by the relationships of accountability between policy-makers, service providers and citizens. When these linkages are weak or non-existent, incentives of service providers are reduced and can lead to adverse effects for basic service provision. Table 2 illustrates this phenomenon by summarising the results of the SDI study in 400 schools and health clinics across Uganda. Despite schools and clinics having relatively high levels of equipment and infrastructure, levels of knowledge and effort were comparably much lower. Table 2: Key SDI findings from the Uganda study Criteria Education Health Effort Knowledge Inputs - Almost a quarter of teachers absent from school in any given day - On average children are taught 3 hours and 17 minutes a day - 1 in 5 teachers had the minimum teacher standards for Maths, English and Science - Teaching equipment availability: 94% - Infrastructure availability: 55% Almost 50% of staff absent from the facility on a given day 42% could not diagnose basic conditions like malaria Equipment availability: 82% Infrastructure availability: 64% Source: World Bank (2013) CONCLUSION In the three main sectors providing basic services for children, progress towards achieving MDG targets has been varied, with primary completion, maternal health care and the spread of HIV/AIDS showing slow or stagnant trends. The GoU has been successful in scaling up the quantity of inputs for service delivery, with significant noticeable gains in primary and lower secondary school enrolment, outpatient attendance at health care facilities, and access to water points. These were maintained despite the country having one of the fastest rising populations in the world. Ensuring quality of service delivery has proved much more intractable. Despite the scale up of funding and inputs, which is higher than that of regional peers, there has not been a commensurate impact on child-related outcomes Recent surveys undertaken by the World Bank indicate that funding alone is not likely to result in improved service delivery outcomes unless the relationships of accountability between policy-makers, service providers, and citizens are strengthened something we explore further in Section 5. 15

RETHINKING PUBLIC FINANCE FOR CHILDREN (PF4C): MONITORING FOR RESULTS 3 THE BUDGET AND CHILD-RELATED SPENDING OVERALL BUDGET ALLOCATIONS AND SPENDING TO EDUCATION, HEALTH AND WATER Since the late 1990s, there has been a significant increase in financing to the health, education and water and environment sectors from both national resources and development partners to help achieve the country s MDG targets. This can be explained through three separate and varied phases of support, which are depicted in Figure 18. The first phase (1997 2003) is characterised 16

THE BUDGET AND CHILD-RELATED SPENDING by the vast scaling up of inputs to services driven by budget support inflows, which at its peak amounted to 40% of total GoU expenditure. The second phase (2003 2009) experienced a tightening of the Government s fiscal stance and the reorientation of spending to economic and productive expenditure. The third phase (2009 present) can be identified with measures to address blockages to service delivery and ways to improve the rate of return on spending to the social sectors. This period is associated with the creation of the Budget Monitoring and Accountability Unit (BMAU). Figure 18: GoU releases to health, education and water sector budgets (UGX Bn) in 2012/13 prices Source: MoFPED, Approved MTEF allocations 1997 2012/13 The first phase was associated with budget support directed specifically to the three sectors known as sector budget support. This had two broad objectives. The first was to finance directly government policy priorities such as universal primary education and the related education sector strategies later followed by health through the abolition of user fees. The second was to enable donor financing to provide additional resources for designated pro-poor government expenditures, through a ring-fenced mechanism in the budget known as the Poverty Action Fund (PAF). These funding arrangements were rapidly embedded through sector planning processes notably sector-wide approaches. Budget support during this phase grew from 5% of total GoU expenditure in 1997 to 40% in 2003 (Figure 19). The fiscal impact of this support was dramatic, with the rapid scaling up of decentralised grants for the three sectors (Figure 20). 17

RETHINKING PUBLIC FINANCE FOR CHILDREN (PF4C): MONITORING FOR RESULTS Figure 19: Budget support as a share of total GoU expenditures grew sharply in phase 1: Figure 20: This had a noticeable fiscal impact on decentralised transfers (Real US$ per capita) Sources: MoFPED, Detailed budget estimates and MTEF releases various years. The water sector was excluded from Figure 18 as its per capita value is relatively far smaller approximately 12 55 cents over the period. The second phase was associated with tighter fiscal control over additional increments to social sectors associated with budget support and the shifting priorities of GoU spending towards economic infrastructure. In 2003, the GoU embarked on a deficit reduction strategy and ended the notion of additionality to the three sectors, previously related to sector budget support and the PAF. In the absence of a significant improvement in the domestic revenue level, which remained around 12% of GDP, the Government s deficit reduction policy meant that relatively less money was available to fund new policy priorities. These new priorities were now clearly focused on economic infrastructure (Figure 21) and meant that social sectors had to rely more on external funding sources to maintain existing levels of investment, as was the case for health (Figure 22). Figure 21: GoU priorities began to shift in the mid- 2000s [Base Year: 1997 = 1] Figure 22: Social sectors began to rely more on external project support most notably the health sector (UGX Bn FY 2012/13 Prices) Source: MoFPED, Detailed budget estimates and MTEF releases, various years 18

THE BUDGET AND CHILD-RELATED SPENDING The third and current phase is associated with the declining influence of budget support and a shift to addressing issues of service delivery quality with declining resources. The fiscal realities identified during the second phase, meant that there could no longer be blanket increases to these sectors. The exception was the increments for the Peace Recovery and Development Plan (PRDP), which were targeted specifically at infrastructure development in selected northern districts. Instead, the Government (and new Joint Budget Support Framework JBSF) had a renewed emphasis on identifying the key blockages to service delivery. The creation of the BMAU was a direct reaction to this line of thinking. There was now a general perception within senior levels of Government that, despite the large increases in the social sectors, quality concerns and blockages remain unaddressed. The BMAU was tasked with assessing the value-for-money of government spending to explore these concerns. CONCLUSION Child-related spending can be distinguished by three main phases over the past 15 years. These phases illustrate how discretional expenditure for spending has become increasingly limited through the Government Budget. Focus has therefore shifted to improving the rate of return on social spending: (i) The first phase reflected how additional resources, dialogue and advocacy were inextricably linked (the golden days for social spending). (ii) A realisation of fiscal realities and the shifting of priorities to productive and economic sectors changed the fiscal landscape and reduced discretional spending for social sectors. (iii) Value-for-money concerns came to the fore, which led to the creation of the BMAU to explore service-delivery blockages. This departure on phase 3 leaves some testing questions for investing in basic services for children. On the one hand, the fiscal realities are pushing against the tide for advocating blanket increases for social spending. This is particularly the case with health. On the other, the relative outcome and spending performance compared with peers in education does need exploring as there could well be underfunded areas. Both scenarios require a more nuanced approach to exploring investments in children that goes deeper and explores intra-sectoral allocations. The remaining sections of this report attempt to do this by examining ways in which the Budget can be reoriented to explore more detailed analysis on child-related spending (Section 4) and how to build this into the BMAU s existing monitoring framework (Sections 5 and 6). 19

RETHINKING PUBLIC FINANCE FOR CHILDREN (PF4C): MONITORING FOR RESULTS 4 DISAGGREGATING THE BUDGET TO BETTER REFLECT INVESTMENTS IN CHILDREN METHODOLOGY The previous sections revealed that, despite progress made in child-related outcomes, some areas require further attention and this has to be done in the context of shrinking fiscal space for social sectors. This is a difficult circle to square when considering basic investments for children. On the one hand, cases identified illustrate a possible need to scale up more investments in certain 20

DISAGGREGATING THE BUDGET TO BETTER REFLECT INVESTMENTS IN CHILDREN areas. On the other, there is a need to be realistic and take into account fiscal and contextual realities when considering improved investments in children. This line of thinking would advocate for better spending within fiscal constraints. A common problem in advocating for better spending is that the budget is often complex and not practical as a basis for policy discussions. Thousands of expenditure lines and multiple forms of classification do not lend themselves to neat and digestible messages to use as a basis for dialogue about how the budget is allocated and spent. The default is often to use broad headline messages such as X% of the national budget to be spent on health or education. This form of earmarking does not lend itself to the fiscal realities identified previously in Section 3 and are rarely met. This section attempts to demystify the budget and illustrate variations in the efficiency of investments in children. The conceptual framework comprises two stages (Figure 21). Stage 1 breaks down Uganda s budget classification structure to identify direct spending on basic services affecting children, its composition, and the geographical level of this spending for each of the three sectors. Stage 2 then drills down into the direct expenditures to identify variations in composition and trend analysis. This conceptual framework is intended to provide a basis for informed discussions on better spending and also to provide a platform for childsensitive monitoring. Figure 23: Two-stage approach for disaggregating child-related investments in basic services Stage 1: Identify direct and indirect spending Stage 2: Examine specific expenditure trends Map budget classification Analyse composition of direct spending, e.g. levels of inputs, geographic disaggregation Within direct expenditures, assess per capita trends in real terms Identify possible areas affecting the delivery of basic services affecting children STAGE 1: DEFINING DIRECT AND INDIRECT SPENDING ON CHILDREN USING UGANDA S BUDGET CLASSIFICATION SYSTEM This first stage involves mapping the key programmes and outputs in the budget based on those that are likely to have the largest positive impact on basic services affecting children. A detailed explanation of Uganda s budget classification is 21

RETHINKING PUBLIC FINANCE FOR CHILDREN (PF4C): MONITORING FOR RESULTS provided as Annex 1 and the full mapping of direct spending is listed in Annex 2. Table 3 below summarises the main sectoral definitions used in identifying direct expenditures. Table 3: Sectoral criteria to identify direct spending on child investments Sector Education sector Health sector Water and environment Criteria used to identify direct spending Direct spending is limited to the primary and secondary programmes. If the budget structure allowed, this would be expanded to early childhood as recent studies have found that these investments have a high rate of return. While vocational training is critical, these investments are likelier to support less poor children who use those services. It has been omitted from the mapping to account for this equity dimension. Output selection considers the interlinkages in health provision of mothers accessing services through the continuum of care from pregnancy, to childbirth, and to the post-childbirth period. Accessing antenatal care services is most likely to lock mothers into receiving relevant services for a healthy disease-free childhood, so figures heavily. The sector has made good progress in increasing access to safe water, but the functionality and maintenance of water points has proved challenging. Outputs selection is targeted to both of these areas. In applying this definition, on average 77% of allocations have been orientated towards direct spending, although this figure varies considerably across sectors (Figures 24 and 25). This high level is not surprising given the spending trends depicted in Section 3. It suggests that allocative sector mechanisms, such as the Sector Working Groups and the PAF, have played an important role in guiding intra-sectoral budget allocations. Figure 24: On average over the period, more than three-quarters of the budget allocation directly affects children (GoU and donor) Figure 25: Direct spending has been highest in the health sector and lowest in the water sector, with education in between Source: MoFPED, Budget releases and spending IFMIS 22

DISAGGREGATING THE BUDGET TO BETTER REFLECT INVESTMENTS IN CHILDREN A glance at the direct spending lines listed in Annex 2 shows that the majority of this spending is input based. 6 Again, this is not a huge surprise given the scale up of inputs to service delivery in the late 1990s and in the MDG drive illustrated in Section 2. These trends do, however, reinforce the quality-versus-quantity argument and is something that needs to be unpacked further when we drill further into each of the sector budgets. The geographical contribution to spending on basic services affecting children varies across the three sectors. Figures 26 28 illustrate the trends in each sector and show that funding for services affecting children in the education sector are highly decentralised. The health sector has a mix, and in water and environment the provision of these basic services is mainly centralised. The different levels require different approaches to advocacy, dialogue and monitoring, so it is important to make this distinction when delving deeper into the budget details. Figure 26: In education, approximately three-quarters of the budget directly benefits basic services for children mainly at the decentralised level Figure 27: On average, cumulative direct spending on health was approx. 90%, with approx. 50% driven by central allocations Figure 28: In water and environment, the proportion of the budget directly affecting children has grown from half to approx. 60%, driven by growth in the centralised budget Source: MoFPED, IFMIS Expenditures FY 2010/11 2013 14. Note, figures reflect only direct spending allocations and therefore do not add up to 100%. STAGE 2: IDENTIFYING SPECIFIC EXPENDITURES THAT ARE LIKELY TO ADDRESS OUTCOME VARIANCES Analysis cannot stop at the aggregate level depicted above. There is a need to drill down further into direct expenditure lines to see if, within these, there is scope for further fiscal adjustments that support investments in basic services for children. The assessment illustrated above does not tell us, for example, the extent to which this spending is addressing the service delivery challenges identified in Section 3 nor the input composition of spending, which can have important implications for service delivery (for example, salaries, capital goods and services, etc.). Moreover, there is a need to account for inflation and per capita trends to ensure 6. Direct spending is defined in the GoU Chart of Accounts as outputs that are likely to significantly affect basic services that children use. This spending is not exclusive to children. Annex 2 provides details. 23

RETHINKING PUBLIC FINANCE FOR CHILDREN (PF4C): MONITORING FOR RESULTS that budget allocations are considering these factors. The following sections use this approach to provide examples for each of the three sectors. Education sector Trends in the education sector show a decline in non-salary transfers to primary schools, which form the backbone for free UPE schooling. Figures 29 and 30 show that non-salary transfers consisting of UPE capitation and the school facilities grant have fallen from approximately US$10 to US$3 per capita from the early 2000s to 2013. This has been a more or less consistent decline with the exception of a spike in the primary schools development grant for reconstruction efforts in northern Uganda through the Peace Recovery and Development Plan (PRDP), which is best illustrated in Figure 30. UPE capitation was intended to be a subsidy that ensures children can have the right to free schooling. Its decline therefore raises questions as to whether this is still occurring, which has a significant bearing on school completion and the slowing MDG trend depicted in Section 2. Figure 29: Per capita (US$) non-salary spending has fallen and been offset by salary increases for teachers which have also started to decline since the mid-2000s Figure 30: The UPE capitation and primary development grants were affected as a result. This chart reflects per pupil expenditure as a % of the maximum Source: MoFPED, Aggregate local government releases various budget performance reports Health sector Trends in the health sector show that spending on drugs and national and referral hospitals has declined in real per capita terms in recent years, which has important implications for maternal and child mortality. Drug supplies have fallen by almost US$1 in per capita terms since 2010 (Figure 31) and spending on national and regional hospitals by half this amount (Figure 32). These factors have an important bearing on the slow and stagnant maternal health trends identified in Section 2. 24

DISAGGREGATING THE BUDGET TO BETTER REFLECT INVESTMENTS IN CHILDREN Figure 31: Real per capita (US$) expenditure on the provision of drugs and medical supplies has fallen and stagnated in recent years Figure 32: As too has the real per capita (US$) expenditure on national and regional referral hospitals Source: MoFPED, IFMIS expenditures 2010/11 2012/13 At the decentralised level in the health sector, there is a similar decline in the real non-wage component in UGX per capita terms, which plays a similar function at the decentralised level (Figure 33). This component is critical in terms of supporting district hospitals through, for example, hard-to-reach allowances and medical supplies. When drugs and other medical supplies are not available at government health centres, the cost is often borne by the patient, which can act as a deterrent to attending clinical services such as antenatal care, which is detrimental for maternal outcomes. Figure 33: Real per capita allocations to decentralised health services (UGX Bn) Source: MoFPED, Aggregate local government releases various budget performance reports 25

RETHINKING PUBLIC FINANCE FOR CHILDREN (PF4C): MONITORING FOR RESULTS Water and environment sector In the water and environment sector, despite the scaling up of spending to expand the use of rural water points, there has been stagnation in funding for community management (rural) and operations and maintenance (in urban areas) (Figure 34). Despite early improvements in access, the pace of improvement has slowed significantly. Ensuring that existing water points are maintained and function is extremely important given the investment in hardware over the past 15 years. Support to community-based management programmes has, however, declined in real per capita terms and the transfer for urban operations and maintenance has remained constant. Figure 34: Real per capita allocations (UGX) Source: MoFPED, Aggregate local government releases various budget performance reports CONCLUSION The GoU s budget classification allows for a detailed analysis to identify direct and indirect spending on basic services affecting children. Direct investment is on average above three-quarters of the combined budget for the three sectors, although proportions for each sector vary significantly, with health the highest and water and environment the lowest. The majority of direct spending also comes in the form of inputs, which supports the continued drive to increase access and the quantity of services available. The geographical distribution of spending varies, with education being mainly decentralised, health spread between the centre, hospitals and local government grants, and water being predominantly centralised. A closer inspection of direct spending at the programme and output level shows that certain important areas may not be adequately served in real per capita terms, namely non-salary transfers in health and education, drug provision, spending on hospitals, and community management and maintenance in the water sector. These are likely to have an important impact on child-related outcomes that have slowed or become stagnant in recent years. 26

MONITORING FOR RESULTS 5 MONITORING FOR RESULTS EXISTING MONITORING FRAMEWORKS AND DATA AVAILABILITY IN UGANDA Uganda has two specific characteristics, which position it as a leader in budget monitoring across sub-saharan Africa. First, is the availability of public data to assess sector performance and the second is the establishment of the BMAU in 2008. Following years of investment in the Uganda Bureau of Statistics (UBOS) and in sector management information systems (MIS), data is available in abundance in Uganda. This provides an excellent platform for monitoring, as data ranges from the outcome level to the lowest levels of service delivery and user feedback (Table 4). 27

RETHINKING PUBLIC FINANCE FOR CHILDREN (PF4C): MONITORING FOR RESULTS Table 4: Data availability in Uganda used for monitoring sector and budget performance Data type Outcome level Input/Output level Decentralised releases Beneficiary feedback Data source Sector league tables in annual performance reports Sector management information systems provided as statistical annexes to annual performance reports Published quarterly in newspapers and on the MoFPED website U-Report data (over 7,000 reporters across the country). Feedback from beneficiaries at the sub-county level through the budget website and hotline The creation of the BMAU offered a fiscal link to budget monitoring. The Unit was established to follow resources spent at the output level by ministries and agencies. Following field visits, issues are flagged in a report and raised with accounting officers. Over the past seven years, different cases have resulted in budgetary or system changes, such as the introduction of direct transfers to primary and secondary schools following an expenditure tracking study. EXPANDING THIS FRAMEWORK TO INCORPORATE A CHILD FOCUS The GoU is striving to strengthen its current monitoring systems moving beyond an accountability trail for budgetary resources to a system of tracking service delivery performance and impact. 7 This is both commendable and logical as it plays to its strengths both in terms of the availability of statistical data through the MIS and the vast amounts of budget data both of which are available at the lowest levels of service delivery provision. This chapter introduces the BMAU/UNICEF joint monitoring framework which aims to marry the wealth of sector performance information with the budget monitoring process originally adopted by the BMAU team. This framework spans six levels of data analysis and three stages of monitoring as depicted in Table 5. The remainder of this chapter is structured around the application of this framework to the education sector. 7. It is important to note that the accountability component of monitoring budgetary resources will not be lost with the proposed expansion of the monitoring framework. Adopting such a framework will, however, require an expansion of human resources and an element of training for existing technical staff. 28

MONITORING FOR RESULTS Table 5: BMAU/UNICEF joint framework for monitoring basic services affecting children Level 1: Spending vs. outcomes Level 1 focuses on the juxtaposition of financial data vis-à-vis outcome level information at both the sub-region and district levels. Subsequent levels (2 4) of analysis aim to explore possible paths through which such variances may occur by testing different hypotheses. These hypotheses provide an anchor for the monitoring, which builds upon the standard approach of following resources and inspecting why things have or have not occurred. Ultimately, this initiative aims to isolate key bottlenecks with a view to identify effective response mechanisms to enhance the delivery of decentralised services affecting children. Data sources: Sector league tables in annual performance reports aligned to budget release trends at the decentralised level produced by the MoFPED PRE-VISIT Level 2: Inputs to basic services Level 2 explores whether the trends could be caused by variances in the level of inputs for basic services. For example, are input variations such as classrooms, drug provision and/ or staffing important factors for the services children receive? Data sources: Sector management information systems Level 3: Budget trends Level 3 assesses financial trends and explores whether service delivery issues could be related to the allocation of decentralised grants. For example, this level of questioning drills down into the decentralised grant structure to search for clues. For example, are there any outlying trends in the grant allocation for school construction or drug provision? Data sources: Decentralised budget release trends for specific grants Level 4: Beneficiary feedback Level 4 explores beneficiaries feedback regarding identified bottlenecks in service provision. This may confirm earlier trends or throw up new and different reasons for variations in social outcomes by using data from U-Report or the budget website and hotline. Data sources: 1. U-report 8 close to 300,000 reporters across the country 2. Ministry of Finance budget website user feedback on whether government funds have reached service delivery points and on the quality of the provision Level 5: Budget monitoring and field validation of pre-visit analysis FIELD- WORK Level 5 introduces budget monitoring and explores what beneficiaries, local leaders and facilities managers say regarding bottlenecks in service provision. This may confirm earlier trends or throw up new and different reasons for variations in social outcomes by using different fieldwork methods such as focus group discussions and observations in classrooms and clinics. Date sources: Feedback from beneficiaries, local leaders, and facilities managers Level 6: Dissemination and discussion of findings FINDINGS Level 6 disseminates findings back to local leadership and other stakeholders to discuss ways to mitigate service delivery bottlenecks and join the links in the accountability chain. This will be done at key decision-making points in the budget and planning cycle using joint policy briefs and other varied means such as software and local media. 8. U-report is a free SMS-based system that allows young Ugandans to speak out on what s happening in communities across the country, and work together with other community leaders for positive change: www.ureport.ug. 29

RETHINKING PUBLIC FINANCE FOR CHILDREN (PF4C): MONITORING FOR RESULTS CASE STUDY: EDUCATION SECTOR / PRIMARY SCHOOL COMPLETION PRE-VISIT Level 1: Spending vs. outcomes The Karamoja sub-region has the highest per pupil spend nationwide, yet it has the lowest completion rates (Figure 35). Within the Karamoja sub-region, Moroto spends almost four times in per capita terms as Napak, yet it has a lower completion rate (Figure 36). Figure 35: Karamoja has the lowest completion rates in the country despite having the highest per capita spend per pupil Figure 36: Moroto spends almost four times as much in per capita terms as Napak, yet it has a lower completion rate Source: MoFPED, Local government releases and performance information from league tables 2013 14 Level 2: Input level trends A closer look at input trends shows that the reasons for low performance in Moroto are not input-related. Within the sub-region, Moroto has the lowest number of pupils per teacher (Figure 37) and pupils per classroom (Figure 38). In Napak, the figures are the reverse, yet more children are completing primary school. This raises pertinent questions for the second hypothesis why is this the case? Figure 37: Moroto has the lowest number of pupils per teacher in the sub-region Figure 38: It also has the lowest number of pupils per classroom so congestion is not the issue Source: MoES, Education Management Information System statistical annex 2013 30

MONITORING FOR RESULTS Level 3: Budget trends An assessment of affordability and proxies for effort show that Moroto has the highest per capita spend on primary capitation (Figure 39) and the highest spending on primary school inspection (Figure 40). This evidence carries important implications in that it may suggest that there is not a direct correlation between UPE capitation and completion rates, and that the level of spending on school inspection may be sufficient to address common bottlenecks such as teacher absenteeism. Again, the trends in Napak are less positive, but still completion is higher why is this the case? Figure 39: Moroto s UPE capitation per pupil is above the national average of 7,000 shillings Figure 40: The average inspection release per school in Moroto is substantially higher than neighbouring districts Source: MoFPED, Local government budget releases 2013 14 Level 4: Beneficiary feedback Without clear trends in levels 1 3, ultimately, the quandary of education in Karamoja can only be answered by extensive beneficiary feedback. Reports from approximately 1,000 U-Reporters in Moroto cited affordability (i.e. hidden costs of education) [35%], followed by violence in schools [30%], then absenteeism [20%] as key factors affecting school attendance. If this is the case, low completion rates in Moroto may not necessarily be the result of insufficient inputs, rather the lack of complementary investments beyond the education sector such as targeted social protection interventions and other initiatives to stop violence in schools. Context-specific issues also have an important role to play. For example, in Moroto during the dry season, children are responsible for finding water for the family s cattle, so it is difficult for them to complete a full term of primary school. A policy measure for Moroto could be for schooling to be concentrated in the wet season. This would have no effect on resources, but would have implications for the processing of releases from the Ministry of Finance and would involve doubleshift classes. Key hypotheses to explore when visiting the two districts: 1. Children are more likely to stay in school when there are no additional charges incurred for attendance. 2. Children are more likely to complete school when the learning environment is safe and conducive. 3. Children are more likely to complete school when teacher performance is high. 31

RETHINKING PUBLIC FINANCE FOR CHILDREN (PF4C): MONITORING FOR RESULTS IN THE FIELD Level 5: Field validation of beneficiary feedback The analysis in levels 1 4 above serves as the bedrock for formulating an extensive line of questioning and observations to explore these issues further during monitoring visits. This stage of the framework is based on a pluralistic set of field survey instruments, combining interviews, focus group discussions, observations and benchmarking based on minimum sector standards. Tables 6 8 below show some sample questions and Table 9 captures methods of observing minimum standards and follow-up questions based on the SDI approach. Table 6: Sample interview questions to test hypothesis 1 affordability of free schooling Questions for whom? District Education Officer (DEO) Facility managers (Head teachers) Beneficiaries (school children, parents) Sample questions What level of UPE capitation do schools receive in sub-county X? Do schools receive any other form of subsidy from external actors (school feeding, instruction materials, etc.)? What regulation/follow-up does the DEO undertake with respect to how UPE funds are spent? How much UPE spending did you receive (per pupil)? How have funds been spent (evidence on the composition)? Is your school charging additional fees? Are there additional costs for attending UPE schools? If yes, what are they for? If yes, how are they affecting learning (a) attendance, (b) enrolment (c) performance, (d) all of the above? Table 7: Sample interview questions to test hypothesis 2 safe environment Questions for whom? District Education Officer (DEO) Facility managers (Head teachers) Beneficiaries (school children, parents) Sample questions Do you have the Circular banning violence against children in school (VACiS)? Have you distributed it to the schools in your district? Were any cases of violence in school reported in your district in the past 12 months? What steps were undertaken following the reporting of violence? Do you have the Circular banning violence against children in school (VACiS)? Have you distributed it to your teachers? Were any cases of violence in your school reported in the past 12 months? What steps were undertaken following the reporting of violence? Have you experienced violence in your school? If yes, who was the perpetrator (teacher, classmate)? What kind of violence have you experienced? Bullying, corporal punishment (caning), emotional violence, sexual abuse? Have you ever missed school due to violence in school? How does violence in school affect your concentration and learning? 32

MONITORING FOR RESULTS Table 8: Sample interview questions to test hypothesis 3 on teacher performance Questions for whom? District Education Officer (DEO) Facility managers (Head teachers) Beneficiaries (school children, parents) Sample questions How do you prioritise which schools are inspected? How frequent are inspections? Are guidelines for hard-to-reach allowances and teacher accommodation being followed? Have you experienced delays in the provision of wages to teachers? Do you incur additional costs for travelling to the school where you teach (travel/accommodation)? What level of community involvement is there in your school (e.g. an active PTA)? Is the hard-to-reach allowance sufficient or do you still incur additional costs due to where you live? Are you aware of teachers not turning up for school in your community? If yes, do you think it is because of (a) low salaries, (b) distance, (c) other work? Does your community have functional parent teacher associations (PTAs)? Table 9: Sample observation techniques and questions to address hypotheses 2 and 3 AREA OF ASSESSMENT OBSERVATIONS/QUESTIONS Hypothesis 2: Safe and conducive learning environment Equipment availability In the primary 4 classroom, establish whether there are the following minimum teaching resources (giving equal weight to each of the three components): (i) A functioning blackboard and chalk (ii) All students have pens (iii) All students have notebooks Hypothesis 3: Teacher performance School absence Classroom absence Classroom teaching time (also known as time on task) Availability of textbooks Student/teacher ratio Ask the head teacher: How many teachers the school has What proportion are absent from school on the day of your visit. If over half, establish the reasons for this. Observe: When you make your visit during a typical school day, do all classrooms have teachers teaching? If not, establish the reasons why. Ask the head teacher: What is the average amount of time a teacher spends teaching during a school day. Try to establish whether any seasonal factors affect teacher availability. Establish: Whether the primary classroom has any mathematics and language textbooks. If yes, try to find out who provided them and how many pupils have to share one book. Ask the head teacher: How many teachers are assigned to each class? How many pupils do they have to teach in the same class? If possible, request to visit the primary 4 class and make a quick count of students. 33

RETHINKING PUBLIC FINANCE FOR CHILDREN (PF4C): MONITORING FOR RESULTS FINDINGS Level 6: Dissemination of findings The objective of disseminating the key findings of the monitoring visits is to elevate service delivery bottlenecks affecting children into fiscal decision-making forums. This framework provides a powerful entry point to address key bottlenecks hampering the Government s delivery of basic services by feeding the evidence into key decision-making points of the national planning and budgeting cycle (see Table 10). Table 10: Key decision-making points of the national planning and budgeting cycle August Date Activity Purpose Local government consultations Service delivery bottlenecks and provisional findings discussed in the relevant local governments August October Annual sector reviews Annual sector performance assessed through multi-stakeholder sectors reviews October Cabinet retreat High-level findings discussed to inform possible fiscal adjustments and/or policy change October December December January June Budget consultations with sectors, the private sector and development partners Submission of the national Budget Framework Paper (BFP) Operational budget preparation Following political buy-in/endorsement of the fiscal adjustments and/or policy change, the finer details of funding modalities and specific activities are discussed within sectors and in consultation with key stakeholders, including the private sector and development partners The funding, implementation mechanism and potential impact of the intervention should be summarised for Cabinet approval and Parliamentary review Detailed work plans developed by ministries, agencies and local governments, based on agreed policy measures to be used as a basis for future budget monitoring 34

MONITORING FOR RESULTS CONCLUSION A BMAU/UNICEF joint monitoring framework with six levels of analysis can help identify spending efficiency variations across different areas of a country. This approach lends itself to being fully implemented in Uganda as a result of (i) the availability of data and (ii) the strategic role embraced by the BMAU. The analysis and indicator trends provided in the previous sections illustrate the importance of triangulating budget and indicator trends with beneficiary feedback and an assessment of local contextual factors. The education case study for Karamoja identified three key advantages built into the BMAU/UNICEF monitoring framework. It provides: (iv) the ability to identify significant variations across the country when per capita spending is mapped with outcome performance (v) verification of the complex mix of potential financial, non-financial and other factors that could affect primary school completion rates (vi) a combination of data analysis, beneficiary feedback and budget monitoring to explore these issues further. 35

RETHINKING PUBLIC FINANCE FOR CHILDREN (PF4C): MONITORING FOR RESULTS 6 CONCLUSION AND RECOMMENDATIONS This study has illustrated that the link between scaling up public resources and improving social outcomes is complex in Uganda. MDG performance has been mixed relative to peers, spending for social sectors is declining, and the examination of intra-sectoral spending trends has shown that certain important areas may not be adequately served in real per capita terms. Recent findings also indicate that service delivery bottlenecks cannot be resolved by funding alone, but instead require a necessary mix of stakeholders and accountability linkages (World Bank, 2013; MoGLSD, 2014). Based on the changing fiscal and service delivery landscape, this study has identified a method to track direct expenditures affecting basic services affecting 36

CONCLUSION AND RECOMMENDATIONS children and proposed a new BMAU/UNICEF monitoring approach to improve the efficiency of spending. This approach demands a closer inspection of budget trends at the decentralised level and ways to promote relationships between policy-makers, service providers and citizens. It has utilised performance and budget-related data that are publically available and has brought the two together through a conceptual framework consisting of six levels and three phases of monitoring. The BMAU/UNICEF proposed monitoring framework has attempted to incorporate the above nuances in addition to a growing realisation that the monitoring landscape is changing. The conceptual framework underpinning this initiative is depicted in Figure 41. Figure 41: BMAU/UNICEF Monitoring Framework - Outcome trends - Budget trends - Beneficiary feedback ANALYSIS - Develop a monitoring question/themes - Using the analysis to frame monitoring plans A BMAU EXISTING FRAMEWORK Spending Outputs B LOCAL LEADERSHIP COMMUNITY FACILITIES MANAGEMENT This effort builds on the BMAU s existing monitoring framework. To illustrate, the space between the two thick lines (A and B) in Figure 41 represents the BMAU s existing monitoring approach, which involves following expenditures on selected budget outputs and reporting whether they have been realised or not. The BMAU/ UNICEF innovative design first introduces outcome analysis from the top down and, second, expands fieldwork techniques by introducing a more active role for beneficiary involvement from the bottom up. The expansion of the monitoring framework draws on the type of analysis presented in earlier sections of this study and the SDI fieldwork methodology. 37

RETHINKING PUBLIC FINANCE FOR CHILDREN (PF4C): MONITORING FOR RESULTS The top down element, which sits above line A incorporates outcome and spending analysis to derive a monitoring question or theme prior to going to the field. The objective of this upper extension is to use the disaggregated budget and outcomelevel indicator information to develop a monitoring question/theme to guide the monitoring plan that the team will aim to answer during bi-annual and annual visits. The bottom-up element which sits below line B involves incorporating feedback from beneficiaries who use the services, in addition to service providers (facilities managers) who provide such services, and the local authorities responsible for exercising oversight and ensuring the effective delivery of national programmes. The overarching policy recommendation stems from a deeply rooted realisation that the monitoring landscape is changing. Government is taking progressive steps to base performance monitoring at the higher strategic outcome level. In order to meet these new demands, monitoring efforts may need to be slightly reoriented from focusing purely on the effective delivery of key outputs (i.e. following the money ) to further appreciating the impact of key public investments and vital outputs on social outcomes. This is a step change from traditional monitoring practices and demands a clearer link in the results chain between spending and outcomes. 38

REFERENCES REFERENCES Lister S, Baryabanoha W, Steffensen J and Williamson T (2006) Joint Evaluation of General Budget Support 1994 2004, Uganda Country Report: University of Birmingham International Development Department and Associates, Birmingham: IDD Ministry of Education and Sports (2000 2013), Annual Sector Performance Reports, Kampala: Government of Uganda Ministry of Education and Sports (2006 2013) EMIS Statistical Abstracts, Kampala: Government of Uganda Ministry of Education and Sports (2008, draft) Re-Costed Education Sector Strategic Plan 2007 2015, Kampala: Government of Uganda Ministry of Finance, Planning and Economic Development (1997 2012/13), Approved Budget Estimates and Medium-term expenditure frameworks (MTEFs), Kampala: Government of Uganda Ministry of Finance, Planning and Economic Development (2000 2014), Annual Budget Performance Reports, Kampala: Government of Uganda Ministry of Finance, Planning and Economic Development (2008 2014), Budget Monitoring and Accountability Unit Annual Reports and selected policy notes, Kampala: Government of Uganda Ministry of Finance, Planning and Economic Development (2010/11-2013/14) Integrated Financial Management Information System (IFMIS) Expenditures FY 2010/11-2013/14. Kampala: Government of Uganda Ministry of Finance, Planning and Economic Development (2013) Millennium Development Goals Report for Uganda 2013, Kampala: Government of Uganda Ministry of Gender, Labour and Social Development (2012) Uganda Status Report on the Implementation of the CRC and the optional protocols, Kampala: Government of Uganda Ministry of Gender, Labour and Social Development (2014) Situation Analysis of Children in Uganda, Kampala: MoGLSD. Ministry of Health (2001 2013) Annual Health Sector Performance Reports, Kampala: Government of Uganda Ministry of Health (2013) Midterm Analytical Review of Performance of the Health Sector Strategic and Investment Plan 2010/11 2014/15, Kampala: Government of Uganda Ministry of Water and Environment (2004 2012) Annual Water and Environment Sector Performance Reports. Kampala: Government of Uganda Ministry of Water and Environment (2010 2013), Annual Water Sector Performance Reports, Kampala: Government of Uganda Uganda Bureau of Statistics (UBOS) (2014), Uganda National Household Survey 2012/13. Kampala: UBOS UNICEF Uganda (2014) Draft Discussion Paper for 2016 2020 Country Programme (unpublished), Kampala: UNICEF Uganda United Nations (1989) Convention on the Rights of the Child, New York: United Nations World Bank (2013) Uganda Service Delivery Indicators: Country Report and Assessment Methods, Washington, DC: World Bank http://www.sdindicators.org/ World Bank (2015) World Development Indicators Database, Washington, DC: World Bank http://data.worldbank.org/data-catalog/world-development-indicators 39

RETHINKING PUBLIC FINANCE FOR CHILDREN (PF4C): MONITORING FOR RESULTS ANNEX 1: UGANDA S BUDGET CLASSIFICATION STRUCTURE Sector: Groups of institutions (votes) or parts of institutions, which contribute towards a common function, such as education. Vote: Institutions (ministries, departments, agencies and local governments) which are the basis of the annual budget and appropriations made by Parliament, such as the Ministry of Education and Sports. Vote function: Groups of related services or capital investments delivered by a vote or on behalf of that vote by another institution. Output: Strategically important services delivered by the vote function, which contribute directly to the vote s objectives, and indirectly to the sector s objectives. Capital Project: Time bound interventions, with specific objectives, normally over the medium term. Can be entirely GoU funded or co-funded with a donor. At the decentralised level these are classified as capital development grants, such as the grant for classroom construction. Recurrent Programme: Administrative departments within line ministries, agencies or local governments. Expenditure Item: The inputs that are used to fund activities. For example salaries, printing and stationary costs, fuel, etc. 40

APPENDIX ANNEX 2: DIRECT AND INDIRECT MAPPING OF BASIC SERVICES AFFECTING CHILDREN Education Sector - Direct Allocations Central Government and Kampala Capital City Authority (APPROVED BUDGET INCLUDING DONOR UGX BN.) 2010/11 2011/12 2012/13 2013/14 CENTRAL 261.05 203.59 217.34 254.47 Pre-Primary and Primary Education 40.15 38.75 45.92 45.04 Assessment of primary education (PLE) 5.40 5.40 5.97 5.97 Classroom construction & rehabilitation (primary) 2.08 1.80 17.12 17.39 Instructional materials for primary schools 19.96 18.44 20.49 20.15 Monitoring and supervision of primary schools 0.39 0.31 1.42 0.81 Primary teacher development (PTCs) 10.31 11.84 0.45 0.40 Pupil identification services 0.15 - - - Support to teachers in hard-to-reach areas 1.00 0.45 - - Support to war-affected children in northern Uganda 0.86 0.52 0.47 0.32 Quality and Standards 10.49 11.53 17.97 16.62 Curriculum development & training (NCDC) 5.92 6.07 7.54 6.19 Curriculum training of teachers 0.05 0.03 3.55 3.05 Inspection (primary/secondary BTVET) & monitoring of construction works in PTCs 0.14 0.08 0.09 0.09 Teacher training in multi-disciplinary areas 0.47 0.98 1.28 1.38 Training & capacity building of inspectors & education managers 1.88 2.09 3.09 3.09 Training of secondary teachers & instructors (NTCs) 2.03 2.28 2.42 2.82 Secondary Education 210.41 153.30 153.46 192.81 Classroom construction & rehabilitation (secondary) 96.95 117.54 88.14 78.40 Construction & rehabilitation of learning facilities (secondary) - - 22.02 60.77 Instructional materials for secondary schools 16.87 15.88 30.19 27.09 Latrine construction & rehabilitation (secondary) - 0.54 4.98 - Monitoring & supervision of secondary schools 1.70 1.38 1.70 2.60 Monitoring USE placements in private schools 0.15 0.20 0.20 0.35 Provision of furniture & equipment to secondary schools - 2.61-18.87 Teacher house construction & rehabilitation (secondary) 1.02-2.02 - Training of secondary teachers 6.27 0.69 2.97 4.70 USE tuition support 87.44 14.47 1.24 0.04 41

RETHINKING PUBLIC FINANCE FOR CHILDREN (PF4C): MONITORING FOR RESULTS (APPROVED BUDGET INCLUDING DONOR UGX BN.) 2010/11 2011/12 2012/13 2013/14 Kampala Municipal Services - 19.84 24.40 26.58 Education and Social Services - 19.84 24.40 26.58 Health training institutions - - 2.25 2.30 Primary education infrastructure construction - 1.56 1.00 1.56 Primary education infrastructure rehabilitation - - 1.30 - Primary education services - 0.44 0.44 0.44 Primary education services (wage) - 8.50 11.38 11.38 Primary teachers colleges - - 0.01 0.32 Provision of instruction materials (secondary) - 5.91 - - School inspection - 0.10 0.10 0.08 Secondary education infrastructure construction - 0.74-0.74 Secondary education services - 1.89 0.98 2.42 Secondary education services (wage) - 0.70 5.91 6.63 Tertiary education services - 0.00 0.32 0.01 Tertiary education services (wage) - - 0.70 0.70 Grand Total 261.05 223.43 241.75 281.05 Education Sector Direct Allocations Decentralised allocations (APPROVED BUDGET INCLUDING DONOR UGX BN.) 2010/11 2011/12 2012/13 2013/14 Decentralised 703 868 936 1,032 Education inspection and monitoring 3 2 3 3 Pre-primary and primary education 563 637 668 724 Secondary education 137 228 266 305 Grand Total 703 868 936 1,032 42

APPENDIX Education Sector - Indirect Allocations Central Government and Kampala Capital City Authority APPROVED BUDGET INCLUDING DONOR - UGX BN 2010/11 2011/12 2012/13 2013/14 CENTRAL Delivery of Tertiary Education Administration & support services 1.34 1.65 0.76 3.17 Construction & rehabilitation of accommodation facilities 0.60 - - - Construction & rehabilitation of learning facilities (universities) 1.90 2.66 8.78 7.40 Government buildings & administrative infrastructure 6.96 7.76 7.70 7.66 Outreach 2.33 1.19 1.00 1.83 Purchase of motor vehicles & other transport equipment 0.26 0.69 0.14 0.59 Purchase of office & ICT equipment, including software 0.17 0.60 0.30 0.33 Purchase of office and residential furniture & fittings 0.29 0.30 0.05 0.05 Purchase of specialised machinery & equipment 6.74 4.21 3.05 3.01 Research, consultancy & publications 6.38 9.58 19.85 3.08 Roads, streets & highways 0.21 0.21 0.26 0.26 Teaching & training 0.70 0.57 0.96 1.10 Delivery of Tertiary Education and Research Acquisition of land by government 0.47 0.40 0.34 0.20 Campus-based construction & rehabilitation (walkways, plumbing, other) - 0.05 0.05 0.05 Construction & rehabilitation of learning facilities (universities) - 0.12 0.12 0.12 Government buildings & administrative infrastructure 0.48 0.53 0.70 0.45 Lecture room construction & rehabilitation (universities) - 0.12 0.12 0.12 Purchase of motor vehicles & other transport equipment 0.43 0.27 0.24 0.29 Purchase of office & ICT equipment, including software 0.22 0.24 0.19 0.26 Purchase of office & residential furniture & fittings 0.17 0.14 0.14 0.14 Purchase of specialised machinery & equipment 0.30 0.18 0.16 0.39 Roads, streets & highways 0.01 0.03 0.02 0.07 Education Personnel Policy and Management Acquisition of land by government - - - 0.40 Acquisition of other capital assets - - - 0.08 Government buildings & administrative infrastructure - - 0.04 - Policy, monitoring, evaluation & research - 0.79 0.99 - Purchase of motor vehicles & other transport equipment 0.60 0.51 0.27 0.15 Purchase of office & ICT equipment, including software 0.03 0.03-0.03 Purchase of office & residential furniture & fittings 0.02 0.11 0.35 43

RETHINKING PUBLIC FINANCE FOR CHILDREN (PF4C): MONITORING FOR RESULTS APPROVED BUDGET INCLUDING DONOR - UGX BN 2010/11 2011/12 2012/13 2013/14 Higher Education Construction & rehabilitation of facilities - - 24.41 24.22 Operational support for private universities - - - 1.01 Purchase of office & ICT equipment, including software - - - 5.00 Physical Education and Sports Government buildings & administrative infrastructure 0.40 1.20 1.66 1.69 Policies, laws, guidelines, plans & strategies - - 0.09 0.09 Purchase of motor vehicles & other transport equipment - - 0.05 - Pre-Primary and Primary Education Policies, laws, guidelines, plans & strategies 0.43 0.38 0.75 0.55 Purchase of office & ICT equipment, including software - - 0.01 - Purchase of specialised machinery & equipment 0.01 0.03 - - Quality and Standards Government buildings & administrative infrastructure 7.98 7.45 5.74 17.56 Policies, laws, guidelines, plans & strategies 0.01 0.01 0.06 2.67 Purchase of motor vehicles & other transport equipment - 0.90 - - Purchase of office & residential furniture & fittings - - - 0.02 Secondary Education Acquisition of other capital assets - 1.9 - - Government buildings & administrative infrastructure - - 0.6 - Policies, laws, guidelines, plans & strategies 16.4 16.9 11.9 26.1 Purchase of motor vehicles & other transport equipment 0.4 1.3-0.7 Purchase of office & residential furniture & fittings - 0.0 0.1 - Purchase of specialised machinery & equipment 2.1 4.6 0.3 4.7 Skills Development Classroom construction & rehabilitation (BTVET) - 3.4 0.7 0.8 Construction & rehabilitation of accommodation facilities (BTVET) 0.2 3.2 0.9 1.1 Construction & rehabilitation of learning facilities (BTEVET) 19.7 21.5 20.6 28.5 Government buildings & administrative infrastructure 0.6 5.9 0.5 0.5 Monitoring & supervision of BTVET institutions 0.5 0.3 0.5 - Policies, laws, guidelines, plans & strategies 4.2 0.7 1.0 1.0 Purchase of motor vehicles & other transport equipment 0.9 - - - Purchase of office & residential furniture & fittings - - - 0.2 Purchase of specialised machinery & equipment 2.6 4.1 2.9 1.8 Roads, streets & highways - - - 0.1 Training & capacity building of BTVET institutions 1.4 0.9 2.0 8.5 44 Grand Total 88.40 107.44 121.30 157.99

APPENDIX Health Sector - Direct Allocations Central, National and Regional Hospitals and Kampala Capital City Authority (APPROVED BUDGET INCLUDING DONOR UGX BN.) 2010/11 2011/12 2012/13 2013/14 Central 287.89 374.81 402.35 628.00 Clinical and public health 19.92 23.61 39.15 35.72 Clinical health services provided (infrastructure, pharmaceutical, integrated curative) 1.10 1.52 1.66 2.16 Community health services provided (control of communicable & non-communicable diseases) 9.74 2.72 3.98 3.69 Co-ordination of clinical & public health, including the response to nodding disease 0.25-5.49 5.25 Government buildings & administrative infrastructure - - 7.66 11.38 Immunisation services provided 0.34 1.00 1.00 1.00 Indoor residual spraying (IRS) services provided - 2.02 2.00 1.93 Medical intern services 2.26 7.47 6.33 6.33 National endemic & epidemic disease control services provided 0.95 5.83 4.60 1.74 Photo-biological control of malaria 3.00 2.45 2.00 1.55 Provision of standards, leadership, guidance & support to nursing services 0.19 0.18 - - Purchase of office & ICT equipment, including software - 0.42 - - Purchase of specialised machinery & equipment - - 4.25 0.50 Technical support, monitoring & evaluation of service providers and facilities 2.10-0.18 0.18 Health systems development 27.59 121.20 122.93 190.22 Hospital construction/rehabilitation 15.05 108.04 70.36 165.32 Monitoring, supervision and evaluation of health systems 8.34 8.36 30.48 6.50 Purchase of specialised machinery & equipment 4.20 1.07 18.56 13.64 Staff houses construction & rehabilitation - 3.73 3.52 4.76 Pharmaceutical and Medical Supplies 201.73 206.81 208.29 219.37 Anti-malarial drugs provision (Global Fund) 40.00 - - - Diagnostic equipment for HIV, TB & malaria 10.00 - - - Government purchases of ACTs & ARVs 100.00 - - - Health supplies to LG units, general & regional hospitals 41.23 - - - Health supplies to national referral hospitals 10.50 - - - Supply of ACTs & ARVs to accredited facilities - 100.00 100.00 100.00 Supply of emergency and donated medicines - 2.50 2.50 2.50 Supply of EMHS to general hospitals - 16.86 16.86 18.11 Supply of EMHS to HC 11 (basic kit) - 11.16 11.16 11.16 Supply of EMHS to HC 111 (basic kit) - 18.36 18.36 18.36 Supply of EMHS to HC 1V - 7.99 7.99 7.99 Supply of EMHS to national referral hospitals - 11.87 11.87 12.37 Supply of EMHS to regional referral hospitals - 13.02 13.02 13.02 Supply of EMHS to specialised units - 17.05 18.53 27.86 Supply of reproductive health items - 8.00 8.00 8.00 45

RETHINKING PUBLIC FINANCE FOR CHILDREN (PF4C): MONITORING FOR RESULTS (APPROVED BUDGET INCLUDING DONOR UGX BN.) 2010/11 2011/12 2012/13 2013/14 Pharmaceutical and other Supplies 38.45 23.19 31.98 182.70 Diagnostic & other equipment procured 2.37 0.83 3.09 5.22 Preventive & curative medical supplies (including immunisation) 31.08 9.96 24.83 169.85 Purchase of specialised machinery & equipment 5.00 1.14 0.24 3.76 Strengthening capacity of health facility managers - 11.27 3.82 3.86 Hospitals 87.01 103.89 97.93 109.74 National Referral Hospital Services 34.62 51.04 37.32 38.19 Acquisition of land by government 0.20 0.20 - - Arrears 1.58-4.89 - Diagnostic services national referral hospital 0.14 0.14 0.14 0.14 Government buildings & administrative infrastructure 1.61 0.30 - - Hospital construction/rehabilitation - 18.00-0.20 Hospital management & support services national referral hospital 6.95 6.95 6.93 8.86 Inpatient services national referral hospital 18.06 18.06 19.07 23.42 Major bridges 0.05 - - - Medical and health supplies procured & dispensed national referral hospital 0.60 0.60 0.60 - OPD and other ward construction and rehabilitation - - 0.72 - Outpatient services national referral hospital 0.26 0.26 0.26 0.45 Purchase of motor vehicles & other transport equipment 0.30 - - - Purchase of office &ICT equipment, including software 0.05 0.15 0.10 - Purchase of office & residential furniture & fittings 0.05 0.30-1.20 Purchase of specialised machinery & equipment 2.91 4.07 0.70 0.72 Research grants national referral hospital 1.81 1.81 0.21 0.10 Roads, streets & highways 0.05-0.20 0.10 Staff houses construction & rehabilitation - 0.20 3.50 3.00 Regional Referral Hospital Services 52.30 52.85 60.62 71.55 Acquisition of land by government 0.04 0.15 0.27 1.18 Acquisition of other capital assets 0.60 0.21 0.05 - Arrears 0.48-1.59 - Diagnostic services 1.63 1.69 2.14 1.47 Government buildings & administrative infrastructure 4.82 5.38 1.68 0.69 Hospital construction/rehabilitation 1.37 0.85 2.66 3.16 Hospital management & support services 10.26 10.12 10.86 28.17 Inpatient services 11.65 13.25 16.86 18.03 Maternity ward construction & rehabilitation 0.02-0.46 0.69 Medicines & health supplies procured & dispensed 0.92 0.91 0.86 0.41 OPD & other ward construction & rehabilitation 0.98 1.63 1.23 1.30 Outpatient services 6.13 6.62 7.85 3.92 Prevention & rehabilitation services 2.67 3.31 3.07 1.88 Purchase of medical equipment - - - 0.04 46

APPENDIX (APPROVED BUDGET INCLUDING DONOR UGX BN.) 2010/11 2011/12 2012/13 2013/14 Purchase of motor vehicles & other transport equipment 0.84 0.15 0.71 0.64 Purchase of office & ICT equipment, including software 0.22 0.01 0.57 0.35 Purchase of office & residential furniture & fittings 0.26 0.11 0.83 0.59 Purchase of specialised machinery & equipment 1.63 3.16 3.28 3.54 Roads, streets & highways 0.19 0.17 0.35 0.45 Staff houses construction & rehabilitation 4.44 4.92 5.30 5.05 Theatre construction & rehabilitation 3.16 0.24 - - Kampala Municipal Services - 5.01 5.28 5.37 Community Health Management - 5.01 5.28 5.37 Health infrastructure construction - - 1.00 1.73 Health infrastructure rehabilitation - 0.98 0.73 - Primary health care services (operations) - 2.48 2.75 0.65 Primary health care services (wages) - - - 2.19 Provision of urban health services - 0.80 0.80 0.80 Purchase of ambulances & health-related transport - 0.75 - - Grand Total 374.90 483.71 505.57 743.11 Health Direct Allocations Decentralised Allocations (APPROVED BUDGET INCLUDING DONOR UGX BN.) 2010/11 2011/12 2012/13 2013/14 DECENTRALISED Primary Healthcare 208.07 225.01 245.38 299.96 Grand Total 208.07 225.01 245.38 299.96 Health Sector Indirect Allocations Central, National and Regional Hospitals and Kampala Capital City Authority (APPROVED BUDGET INCLUDING DONOR UGX BN.) 2010/11 2011/12 2012/13 2013/14 CENTRAL Cancer Services Government buildings & administrative infrastructure 2.10 2.65 2.89 4.10 Purchase of motor vehicles & other transport equipment 0.45 - - - Purchase of office & ICT equipment, including software 0.05 0.10 - - Purchase of office & residential furniture & fittings 0.10 - - - Purchase of specialised machinery & equipment 0.30 0.25 0.11 - Coordination of multi-sector response to HIV/AIDS Acquisition of other capital assets - - - 0.03 47

RETHINKING PUBLIC FINANCE FOR CHILDREN (PF4C): MONITORING FOR RESULTS Advocacy, strategic information & knowledge management 0.74 - - - Government buildings & administrative infrastructure 0.02 0.05 0.05 0.08 Major policies, guidelines, strategic plans 0.66 - - - Monitoring & evaluation 0.58 - - - NGO HIV/AIDS activities 11.95 - - - Purchase of motor vehicles & other transport equipment 0.13 - - - Purchase of office & ICT equipment, including software 0.03 0.08 0.08 0.02 Health systems development Acquisition of other capital assets 0.06 0.06 0.02 0.00 Government buildings & administrative infrastructure 1.20 1.21 0.40 0.25 Purchase of motor vehicles & Other transport equipment 0.58-0.80 1.15 Purchase of office & ICT equipment, including software - - - 1.25 Purchase of office & residential furniture & fittings - - - 2.50 Heart Services Government buildings & administrative infrastructure 0.90-0.20 - Purchase of motor vehicles & other transport equipment 0.10-0.80 - Purchase of office & ICT equipment, including software 0.05-0.17 0.16 Purchase of office & residential furniture & fittings - 0.25 0.05 0.23 Purchase of specialised machinery & equipment 0.45 1.25 0.29 2.11 Human Resource Management for Health Health workers recruitment services - 0.21 0.06 - Purchase of motor vehicles & other transport equipment 0.31-0.28 0.30 Purchase of office & ICT equipment, including software 0.02 0.03 0.01 0.05 Purchase of office & residential furniture & fittings 0.02 0.11 - - Pharmaceutical and other Supplies Government buildings & administrative infrastructure 6.20 10.69 43.00 11.93 Monitoring & evaluation capacity improvement 1.78 3.89 3.86 9.26 Purchase of motor vehicles & other transport equipment - 10.26 6.19 11.12 Purchase of office & ICT equipment, including software - 0.11 0.40 0.32 Purchase of office & residential furniture & fittings 0.09-0.06 - Policy, Planning and Support Services Policy, consultation, planning & monitoring services 5.74 6.56 6.00 14.61 Safe Blood Provision Government buildings & administrative infrastructure 0.02 0.20 0.20 0.20 Purchase of motor vehicles & other transport equipment - 0.17 0.17 0.17 Purchase of specialised machinery & equipment 0.06 - - - Hospitals Provision of Specialised Mental Health Services Administration & management 4.40 3.71 2.72 - Government buildings & administrative infrastructure 17.35 20.06 7.54 - Hospital construction/rehabilitation 0.03 0.04 0.05 0.08 48

APPENDIX Long-term planning for mental health 0.07 - - - Purchase of motor vehicles & other transport equipment - - - 0.20 Purchase of office & residential furniture & fittings 1.03 0.54 0.08 0.03 Purchase of specialised machinery & Equipment 4.34 2.16 1.10 0.14 Staff houses construction & rehabilitation - 0.68 0.68 1.36 Grand Total 61.89 65.30 78.25 61.64 Water and Environment Sector - Direct Allocations Central and Kampala Capital City Authority (APPROVED BUDGET INCLUDING DONOR UGX BN.) 2010/11 2011/12 2012/13 2013/14 Central 69.88 80.69 147.26 163.84 Rural Water Supply and Sanitation 17.43 13.87 36.80 28.85 Alwi dry water corridor - - - 8.00 Back-up support for operation & maintenance of rural water 2.65 2.45 1.60 2.49 Construction of piped water supply systems (rural) 12.07 7.50 31.22 10.92 Construction of point water sources 1.51 1.86 1.19 1.19 Construction of sanitation facilities (rural) - 0.85-0.06 Kahama Gravity Water Scheme - - - 0.60 Kanyampanga Gravity Water Scheme - - - 5.00 Monitoring & capacity building of LGs, NGOs & CBOs 1.03 0.93 1.38 0.29 Promotion of sanitation and hygiene education 0.16 0.28 1.40 0.29 Urban Water Supply and Sanitation 52.45 66.81 110.46 135.00 Back-up support for operation & maintenance 0.97 1.04 1.12 1.57 Construction of piped water supply systems (urban) 26.61 60.88 42.25 33.99 Construction of sanitation facilities (urban) 23.14 3.51 65.47 90.45 Energy installation for pumped water supply schemes 0.01 0.08 0.05 7.42 Improved sanitation services & hygiene 1.72 1.30 1.57 1.57 Kampala Municipal Services - 0.01 0.01 0.01 Sanitation and Environmental Services - 0.01 0.01 0.01 Policies, laws & strategy development - - 0.01 0.01 School inspection - 0.01 - - Grand Total 69.88 80.70 147.27 163.85 49

RETHINKING PUBLIC FINANCE FOR CHILDREN (PF4C): MONITORING FOR RESULTS Water and Environment Sector Direct Allocations Decentralised Allocations (APPROVED BUDGET INCLUDING DONOR UGX BN.) 2010/11 2011/12 2012/13 2013/14 Rural Water Supply and Sanitation 56.64 57.92 64.29 62.37 Urban Water Supply and Sanitation 1.56 1.50 1.50 1.50 Grand Total 58.20 59.42 65.80 63.88 Water and Environment Sector - Indirect Allocations Central and Kampala Capital City Authority APPROVED BUDGET INCLUDING DONOR - UGX BN 2010/11 2011/12 2012/13 2013/14 Central Environmental Management Access to environmental information/education & public participation increased 0.60 0.26 0.10 - Environmental compliance & enforcement of the law, regulations & standards 1.20 0.36 0.20 - Government buildings & administrative infrastructure 1.06 2.25 0.19 - Integration of ENR management at national and LG levels 0.07 0.07 0.10 - National, regional and international partnerships & networking strengthened 0.12 0.12 - - Purchase of motor vehicles & other transport equipment 1.12 1.12 - - Purchase of office & ICT equipment, including software 0.04 0.04 - - Purchase of office & residential furniture & fittings 0.04 0.04 0.04 - Purchase of specialised machinery & equipment - 1.10 - - The institutional capacity of NEMA & its partners enhanced 1.21 0.62 0.34 - Forestry Management Acquisition of other capital assets - 0.02 - - Establishment of new tree plantations 5.99 0.64 1.39 - Forestry licensing 0.26 0.28 0.05 - Government buildings & administrative infrastructure 0.11 0.27 - - Management of central forest reserves 6.49 1.11 0.51 - Plantation management 1.59 1.08 1.50 - Purchase of motor vehicles & other transport equipment - 2.16 - - Purchase of office & ICT equipment, including software - 0.40 - - Purchase of office & residential furniture & fittings - 0.03 0.01 - Purchase of specialised machinery & equipment - 0.14 - - Roads, streets & highways - 0.07 0.04 - Supply of seeds & seedlings 0.58 1.58 0.69 0.93 Natural Resources Management Acquisition of other capital assets 9.53 14.54 18.91 9.46 Administration & management support 0.87 1.27 2.22 0.52 50

APPENDIX Capacity building & technical back-stopping 1.19 0.74 1.30 0.67 Co-ordination, monitoring, inspection, mobilisation & supervision 1.07 4.92 1.46 0.93 Government buildings & administrative infrastructure 0.02-15.78 13.50 Operational support to private institutions - 0.26 0.50 0.50 Policy, planning, legal & institutional framework 0.44 4.31 0.24 1.22 Promotion of knowledge of environment & natural resources 1.24 3.46 1.34 0.64 Purchase of motor vehicles & other transport equipment 0.12 0.59-0.08 Purchase of office & ICT equipment, including software - 0.03 0.07 0.07 Purchase of office & residential furniture & fittings 0.00 0.01 0.01 0.01 Purchase of specialised machinery & equipment 0.53 0.10 0.06 0.05 Restoration of degraded & protection of ecosystems 2.15 5.65 1.77 1.99 Policy, Planning and Support Services Government buildings & administrative infrastructure 0.64 1.14 1.21 9.68 Membership of international organisations &support to LGs and NGOs 0.20 0.20 0.33 0.09 Ministerial & top management services 0.99 0.52 2.00 0.50 Ministry support services 0.99 1.37 2.09 1.63 Policy, planning, budgeting & monitoring 1.38 1.63 2.90 1.43 Purchase of motor vehicles & other transport equipment 0.27 0.31 0.27 0.39 Purchase of office & ICT equipment, including software - 0.04 0.06 0.04 Purchase of office & residential furniture & fittings 0.02 0.02 0.04 0.04 Purchase of specialised machinery & equipment - - 0.03 0.03 Rural Water Supply and Sanitation Acquisition of land by government - 0.10 0.10 0.40 Administration & management services 0.28 0.29 0.24 0.24 Purchase of motor vehicles & other transport equipment 0.29 - - 0.96 Purchase of office & ICT equipment, including software - 0.02 - - Purchase of office & residential furniture & fittings 0.06 0.02 - - Purchase of specialised machinery & equipment 3.00 1.50 - - Research & development of appropriate water & sanitation technologies 0.94 1.09 0.60 0.10 Urban Water Supply and Sanitation Acquisition of land by government 0.05 0.10 0.05 0.05 Acquisition of other capital assets - - - 0.10 Administration & management support 0.29 0.55 2.88 2.95 Government buildings & administrative infrastructure 0.50 0.51 0.79 2.30 Monitoring, supervision, capacity building for urban authorities & private operators 3.30 3.55 4.03 3.23 Policies, plans, standards & regulations developed 0.54 0.84 0.87 0.84 Purchase of motor vehicles & other transport equipment 0.60-2.04 0.87 Purchase of office and ICT equipment, including software - 0.02 0.13 0.30 Purchase of office & residential furniture & fittings 0.03 0.02 0.10 0.62 Purchase of specialised machinery & equipment - 1.27 0.65 4.77 51

RETHINKING PUBLIC FINANCE FOR CHILDREN (PF4C): MONITORING FOR RESULTS Water for Production Acquisition of land by government - 0.10 0.10 0.40 Construction of bulk water supply schemes 4.95 4.00 5.14 3.00 Construction of water surface reservoirs 15.17 13.71 10.83 10.54 Government buildings & administrative infrastructure 0.20 0.30 - - Purchase of motor vehicles & other transport equipment 0.18 - - - Purchase of office and ICT equipment, including software - 0.03 0.03 0.03 Purchase of office & residential furniture & fittings 0.07 0.03 0.03 0.03 Purchase of specialised machinery & equipment - - 3.45 4.00 Sustainable water for production management systems established 1.12 1.20 1.03 0.99 Supervision & monitoring of WFP activities 1.02 1.84 0.75 0.71 Water Resources Management Acquisition of land by government - 0.10 0.20 0.10 Administration & management support 3.63 4.46 2.00 2.31 Catchment-based IWRM established 1.75 0.54 1.07 2.15 Degraded watersheds restored & conserved 2.27 5.50 6.25 18.79 Government buildings & administrative infrastructure 1.23 1.25 0.58 1.53 Purchase of motor vehicles & other transport equipment 2.64 0.06 0.40 0.41 Purchase of office & residential furniture & fittings 0.04 0.07 0.08 0.08 Purchase of specialised machinery & equipment 0.02 0.05 3.93 1.25 The quality of water resources regularly monitored & assessed 1.98 2.44 2.79 3.73 Uganda s interests in transboundary water resources secured - - 2.26 2.19 Uganda s interests in transboundary water resources secured 5.33 5.17 - - Water resources availability regularly monitored & assessed 4.78 4.32 4.89 5.49 Water resources rationally planned, allocated & regulated 3.49 1.50 1.54 0.30 Weather, Climate and Climate Change Acquisition of land by government 0.18 0.12 0.12 - Adaptation and mitigation measures 0.33 0.62 0.07 0.97 Administration and management support 1.69 1.88 1.95 1.66 Government buildings and administrative infrastructure 0.67 0.20 0.38 0.03 Policy legal and institutional framework 2.78 1.93 1.17 3.66 Purchase of motor vehicles & other transport equipment 0.75 0.25-0.30 Purchase of office & residential furniture & fittings 0.19 0.08 - - Purchase of specialised machinery & equipment 0.59 1.96 1.97 0.50 Strengthening institutional & coordination capacity 0.62 0.49 0.09 2.14 Weather & climate services - 0.66 0.33 3.18 Grand Total 109.72 119.61 123.61 132.58 52

APPENDIX 53