Tracking RMNCAH Financing Accountability Workshop, Johannesburg, 3-4 March 2016
Monitoring RMNCAH Financing Objective: - Monitoring smart, scaled and sustainable - Monitoring outputs: Progress in developing health strategies Process: - Indicators first shared with GFF Investors Group last week - Ongoing consultation with WHO and other partners on appropriate indicators - Proposal to June Investors Group 2
Central to the GFF s theory of change is smart, scaled and sustainable 3
with a need to monitor progress along related performance dimensions of health systems in GFF countries SMART Dimensions Improve: Efficiency (allocative, technical, administrative) Equity SCALED SUSTAINABLE Increase: Domestic, public and private sources External sources Share of prepaid and pooled Tap economic growth for health Reduce reliance on external (grants) 4
A results framework has been proposed, with data for some indicators readily available from GFF countries SMART % of government recurrent health expenditure spent on prevention Indicator Kenya Potential targets Government budget execution rate for health 14.7% Country specific 70% 90% SCALED Prepaid, pooled expenditure per capita -- government plus compulsory and voluntary health insurance -- on health US$48.9 (2012/13) US$86 The ratio of GHE to GE 6.1% 15% SUSTAINABLE Growth rate in government expenditure compared to the GDP growth rate Growth rate in government health expenditure compared to the GDP growth Ratio 3:2.15 (2009/10 to 2012/13) Ratio 2.22:2.15 (2009/10 to 2012/13) Country specific Country specific 5
while for others, more work is needed SMART SCALED SUSTAINABLE Indicators % of government recurrent RMNCAH expenditure spent on prevention Incidence of catastrophic health expenditures among all key vulnerable groups Total health expenditure per capita for and RMNCAH Pooled expenditure per capita (government plus compulsory and voluntary health insurance) on RMNCAH Growth rate in government RMNCAH expenditure, compared to the GDP growth rate Growth rate in domestic expenditure on RMNCAH, compared to the growth rate in external sources of finance - - - - - - Data not currently available but could be generated with support: - e.g., adolescent health Data exist, but support is required with analysis - e.g., HH survey data Quality of data needs improvement - e.g., donor assistance 6
The framework also includes indicators to track progress in data availability and quality Indicator Timely audited report of government health expenditures including on RMNCAH is available for the last fiscal year Kenya X/ A set of national health accounts (NHAs) with distributive matrices has been produced in the last 3 years A more detailed distributive account for RMNCAH has been produced in the last 3 years A household expenditure survey/module including health expenditures has been undertaken in the last three years X 7
The results framework also captures HFS-related outputs PARTNERSHIP INPUTS FACILITY OUTPUTS INTERMEDIATE OUTCOMES OUTCOMES IMPACT Direct: Financing (domestic and external) Indirect: Guidance Technical assistance Knowledge and learning Influencing (e.g., through Investors Group) Domain 1: direct focused on results Investment Cases Health strategies Global public goods Domain 2: Indirect effects on the ecosystem Smart Scaled Sustainable Improved capacity to track progress RMNCAH, health systems, and multisectoral Reduced morbidity and mortality and improved quality of life of women, children, and adolescents 8
linked to smart, scaled and sustainable Indicator SMART Identifies strategies for addressing key inefficiencies Develops policies to reduce inequities in financial protection SCALED Sets targets for raising more domestic resources Develops approaches to reduce OOPs Includes an explicit strategy for transitioning from Gavi or GFATM support SUSTAINABLE Develops strategies to address fragmentation in risk pooling Contains an implementation plan Has been formally endorsed by an appropriate authority 9
providing a useful snapshot of country progress SMART Indicator Identifies strategies for addressing key inefficiencies Develops policies to reduce inequities in financial protection Kenya SCALED Sets targets for raising more domestic resources Develops approaches to reduce OOPs SUSTAINABLE Includes an explicit strategy for transitioning from Gavi or GFATM support. Develops strategies to address fragmentation in risk pooling Contains an implementation plan Has been formally endorsed by an appropriate authority X /X X 10
The results framework needs further elaboration PARTNERSHIP INPUTS FACILITY OUTPUTS INTERMEDIATE OUTCOMES OUTCOMES IMPACT Direct: Financing (domestic and external) Indirect: Guidance Technical assistance Knowledge and learning Influencing (e.g., through Investors Group) Domain 1: direct focused on results Investment Cases Health strategies Global public goods Domain 2: Indirect effects on the ecosystem Smart Scaled Sustainable Improved capacity to track progress RMNCAH, health systems, and multisectoral Reduced morbidity and mortality and improved quality of life of women, children, and adolescents 11
to identify and monitor determinants of success FACILITY OUTPUT HFS: Gov t health budget should to 3% GDP Political economy Health champions in positions of power Good communication between MoF & MoH Effective engagement of MoH with other ministries (Planning, Investment) CSOs (or others) provide voice to the poor / marginalized Windows of opportunity Knowledge & evidence Evidence on what mechanisms work when Good data for planning Capacities & systems Good PFM systems Health capacities within MoH INTERMEDIATE OUTCOME THE per capita GHE/ GE GHE grows faster than GE Other contextual Favorable economic conditions Satisfactory transparency and accountability 12
to foster learning that enables seizing opportunities to improve for RMNCAH and health Democratic Republic of the Congo Prime Minister committed to a significant increase in the share of health within central government budget and, for the first time, an explicit allocation of domestic resources to reproductive health Tanzania Government committed to increase share of health in government budget linked to a disbursement in an IDA operation 13
To advance the monitoring agenda over the coming months Next steps include the following: Consult with partners on draft results framework Incl. WHO: link with work on Global Strategy indicators Validate indicators by collecting data in the 12 GFF Trust Fund countries Determine targets Establish framework to monitor global progress (across individual countries) Establish costs and mobilize resources to improve and institutionalize data collection and analysis in GFF countries 14
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