Health Sector Resource Mapping Increasing Access to Information to Inform Decision Making CHAI slide warehouse 29 August 2013
Objectives Share with Parliamentarians, Civil Society, and the Media the context and benefits of a forward looking resource & activity mapping Discuss how the results of resource mapping exercises advocate for more funds directed towards women s and children s health Provide examples of how resource mapping fits within the Ministry of Health s work and expenditure analysis processes Share some of the work and experience on Resource Mapping
Key Features of Resource Mapping Key Characteristics: Simple approach that aims to rapidly capture both forward-looking budget data and high level past expenditures from government and external partners Health sector wide and can be easily tailored to country s particular context and needs with deep dives into programs that are significant drivers in a given country (i.e. RMNCH, Human Resources) Annual exercise built into a country s annual strategic planning structure Timing aligned with a country s fiscal year to integrate within and inform the annual financial planning and decision making processes Budget and expenditure data is collected from across the health sector: Bilateral donors Multilateral donors Govt budgets NGO donors 3
The Increasing Relevance of Resource Mapping Multiple challenges Increasing resource constraints Increasing attention on greater value for money and efficiency and effectiveness Need for more transparency and accountability from all stakeholders can be addressed with a resource mapping tool A planning tool to reduce duplication and improve coordination and allocation A resource mobilization tool to derive detailed gap analyses against costed national plans An advocacy tool to minimize multiple financial and programmatic data requests 4
Basic Information Captured in the Resource Mapping Tool Who is providing resources for health programs and who is implementing them? Source of funding Financing agent Implementing agent What are available funds being spent on or budgeted? What activities are being funded? Which strategies or programs do these activities fall under? Which impact, outcome or output of the national plan do these activities contribute to? Which cost categories do these activities cover? Where are the resources being spent or budgeted? How are funds allocated geographically? How are funds allocated across different levels of the health system? 5
How is the data collected? Resource Mapping Tool Snapshot What? Who? What strategic plan objectives does it contribute to? Where? With how much? When? Malawi Ministry of Health Resource Mapping Tool: Activity Input Worksheet Section 1: Activity and Actors Section 2: Program/Systems Area and Details of Activity Section 3: Categorization of Activity ion 4: Geogra Duplicate Last Row Is there a subimplementing agent? Sub- National Strategic Plan Primary FY Ending 2012 If OTHER please Implementing (Activity conducted Implementing Project Name Description of Activity Financing Agent Programmatic Function Programmatic Sub - Function Primary Cost Category HSSP - Strategy HSSP - Objective Please enter "NSP Not National Strategic Plan - Strategic Action Currency specify Agent (list only should be attributed to Agent (list only Applicable" if the activity is not Row Complete? Row Number one) the lowest level of one) related to HIV ( 2011 - December 2012) implementer) Central Commodity Procurement The tool is a basic spreadsheet that is easy for data to be inputted by multiple stakeholders and then aggregated into a master data set All categories are pre-defined and standardized so to collect a standardized data set that is comparable across development partners, and government Web-based platform is possible, but should be considered on a case-by-case basis 6
Resource Mapping Fits within the Broader Financial System 1 How much will the RMNCH plan cost to execute? Projected Demand i.e. costed plans Impact and Outcomes (US$ million) 2009/2010 2010/2011 2011/2012 2012/2013 Total Relative 1. The incidence of HIV in the general population is reduced by half by 2012 total gap 1.1. Reduced sexual transmission of HIV Resource Needs 46.3 49.5 53.1 58.1 207.0 Resources Available 20.8 19.2 18.9 18.6 77.5 Financing Gap 25.5 30.4 34.2 39.5 129.5 63% 1.2. Reduced mother to child transmission of HIV Resource Needs 16.6 15.0 15.6 16.5 63.7 Resources Available 8.3 7.0 6.6 6.1 27.9 Financing Gap 8.3 8.0 9.0 10.4 35.7 56% 1.3. Maintenance of low levels of blood-borne transmission of HIV Resource Needs 5.2 5.0 5.1 5.1 20.4 Resources Available 1.2 1.2 1.2 1.2 4.9 Financing Gap 4.0 3.8 3.9 3.9 15.5 76% IMPACT 1 TOTAL GAP 37.7 42.1 47.1 53.8 180.7 62% 2. Morbidity and Mortality among people living with HIV are reduced by 2012 2.1. People living with HIV systematically receive prophylaxis and treat. for OIs and other coinfections Resource Needs 11.4 12.0 12.3 12.9 48.6 Resources Available 10.0 8.3 7.8 7.3 33.3 Financing Gap 1.4 3.7 4.5 5.6 15.3 31% 2.2. All people living with HIV eligible for ART receive it Resource Needs 53.3 57.4 63.4 70.9 245.1 Resources Available 41.2 39.3 39.1 38.9 158.5 Financing Gap 12.1 18.1 24.3 32.1 86.6 35% 2.3. People living with HIV receive care and support according to needs Resource Needs 6.4 7.7 9.0 10.7 33.8 Resources Available 3.7 3.7 3.7 3.7 14.7 Financing Gap 2.7 4.0 5.4 7.0 19.1 57% IMPACT 2 TOTAL GAP 16.2 25.9 34.2 44.7 121.0 37% 3. Persons infected and/or affected by HIV/AIDS have equal opportunities 3.1. People inf./aff. by HIV (incl. child headed households) have improved eco. Opp. and social protection Resource Needs 10.2 4.9 4.9 5.0 25.0 Resources Available 2.2 2.2 2.2 2.2 8.9 Financing Gap 8.0 2.7 2.7 2.8 16.1 65% 3.2. Social and economic protection are ensured for orphans and vulnerable children Resource Needs 25.8 35.1 41.8 46.5 149.3 Resources Available 16.7 16.4 16.3 16.2 65.5 Financing Gap 9.1 18.8 25.6 30.4 83.8 56% 3.3. Reduction of stigma and discrimination of PLHIV and OVC in the community Resource Needs 1.1 1.0 1.1 1.0 4.0 Resources Available 0.4 0.4 0.4 0.4 1.6 Financing Gap 0.7 0.6 0.7 0.6 2.4 60% IMPACT 3 TOTAL GAP 17.7 22.0 28.9 33.7 102.4 57% 4. Strengthen the coordination institutions at central and decentralised level Resource Needs 18.2 19.9 20.0 20.3 78.4 Resources Available 17.9 16.2 15.8 15.3 65.2 Financing Gap 0.3 3.8 4.2 5.0 13.3 17% 5. M&E, Data, and Research Resource Needs 11.8 14.6 16.8 15.9 59.0 Resources Available 9.1 8.8 8.7 8.6 35.1 Financing Gap 2.7 5.8 8.1 7.3 23.9 40% COORDINATION AND M&E TOTAL GAP 3.0 9.6 12.3 12.3 37.2 27% Unallocated resources from USG 4.1 4.1 4.1 4.1 16.6 - TOTAL GAP 70.5 95.4 118.4 140.5 424.7 45% 2 What resources are available to fund this plan? Projected Supply i.e. resource mapping Administrative Equipment (e.g. ICT) Vehicles Research CHW support Food Supplies Medical Equipment Budget Support Mutuelle financial support Running costs - fuel, electricity, communication, office supplies Behavio(u)r Change Communication PBF financial support Training Other Other - USG undetermined Infrastructure Technical Assistance Salaries Drugs, Commodities & Consumables 0% 5% 10% 15% 20% 25% Operational Investment 3 What is the gap between the $$ needed and the $$ available? Demand Supply = Gaps Millions 400 300 200 100 0 7
These activities can enable countries to reallocate funds to critical areas where current resources are insufficient in reaching targets 250 EXAMPLE 1: 200 150 A robust gap analysis can uncover inefficiencies in spending that might potentially fill major gaps on other interventions Millions 100 50 0 ART (Universal HIV Access) PMTCT Antenatal (Switch care to B+) Counseling Deliveries and Testing Gap Overage Available Resources Total Need EXAMPLE 2: In a country facing significant funding shortfall through 2015, a gap analysis can quantify the need and advocate for fundraising to fill any gaps Millions 100 90 80 70 60 50 40 30 20 10 - ART (Universal Vaccines Access) Antenatal Behavior Change care Resource Resource Mobilization Programs Mobilization Available Gap New Resources Total Need 8
Resource Mapping is Complementary to Other Expenditure Analysis Processes Resource Mapping NHA NASA Government Expenditure Data* Development Partner Expenditure Data* Government Expenditure Data* Development Partner Expenditure Data* Government Expenditure Data (HIV/AIDS) Development Partner Expenditure Data (HIV/AIDS) Government Budget Data* Development Partner Budget Data* Out of Pocket Expenditures* Private Expenditures* Out of Pocket Expenditures (HIV/AIDS) Private Expenditures (HIV/AIDS) Non-Health Portion of HIV/AIDS Expenditures RM can be complementary to NHA and NASA through two key ways: (1) Alignment of timelines, (2) Leveraging of data across the exercises * Health Sector Wide 9
Resource Mapping country example: Rwanda Total Institutional Health Spending in Rwanda (in 2010 US dollars) Over time, analysis can cut across years, comparing budget and expenditures Example of District Analysis -- Top Implementers within the Burera District Detailed information at subnational level to facilitate decentralization and implementation In this current fiscal year, PIH expects to spend three times more than any other implementer in Burera.
Resource Mapping country example: Country geographical breakdowns Rwanda Per Capita Budget and Expenditure by District It appears as though Gasabo and Nyarugenge receive the greatest amount of funding Total Per Capita Expected Resources for Health by County FY 2012-13 $36 Montserrado $22 $16 $29 Margibi $18 $47 Bong 83% $34 $21 $17 Only $106M of the total $196M is allocated to specific counties. Per capita information here only incorporates resources identifiable by county. Nimba 84% Sinoe 73% $37 $38 $29 River Gee 86% $17 Looking at on- and off-budget resources together provided a complete picture of what was happening in each district Neno Likoma Chiradzulu Nkhotakota Nkhata Bay Mwanza Thyolo Chitipa Rumphi Nsanje Karonga Phalombe Balaka Mulanje Blantyre Zomba Chikwawa Lilongwe Mzimba Machinga Mangochi Salima Ntcheu Dowa Kasungu Per Capita Mchinji Dedza Ntchisi County Lofa $47.73 Sinoe $38.08 Nimba $37.10 Grand Cape Mount $36.13 Grand Kru $34.94 Bong $34.57 Gbarpolu $29.19 Grand Gedeh $29.14 Montserrado $22.50 Grand Bassa $21.38 Margibi $18.50 River Gee $17.94 Maryland $17.09 River Cess $17.00 Bomi $16.89 Malawi Per capita funding, FY 2012-13 Of total $163 M allocated directly to districts Supported by MSF District 30% $- $20 $40 $60 $80 Sources: 2008 Population and Housing Census, 2010 Demographic and Health Survey, and Resource Mapping Other 70% Mulanje and Salima had highest rates of maternal & child mortality in 2010 DHS. Mulanje also has high HIV prevalence Per capita funding is highest in Neno, supported by Partners in Health. Levels of maternal & child mortality are lower than in neighboring districts Map of per capita funding, FY 2012-13 Of total $163 M allocated directly to districts Mzuzu Blantyre Lilongwe FY 2012-13 Funding per capita > $30 $21-30 $11-20 < $11 Allocation of funding 1 Source: MOHSW Resource Mapping $34 National Average $27.88 Mary land $17 4 Liberia
Key Takeaways for Resource Mapping The results from the resource analysis empowers the government and stakeholders with information on how to use funds most efficiently Encourages stakeholders to better coordinate their work to reduce duplication and align their work with national strategic plans Maps financial resources for women s and children s health improves accountability and transparency