REPUBLIC OF RWANDA MINISTRY OF HEALTH TOOLS THAT SUSTAIN CAPACITY AND HELP REDUCE COSTS: PILOTING THE HEALTH RESOURCE TRACKER IN RWANDA Jean Louis Mukunzi, Rwanda MOH Nirmala Ravishankar, Health Systems 20/20 Paris, October 2011
Outline The Rationale for the Health Resource Tracker (HRT) Overview of HRT Progress in developing the HRT Key outputs from HRT Challenges and Next Steps
Rationale 1 for the HRT Resource tracking involves tracking financial flows throughout the These health sector activities from collectively their sources to the ultimate health function place a they heavy serve burden on stakeholders. There is currently a large inventory of Resource Tracking Activities in Rwanda: The HRT harmonizes data National Health Accounts (NHA) collection, also making it NHA Subaccounts (HIV/AIDS, Malaria, RH, CH etc) routine, timely and National Aids Spending Accounts (NASA) comprehensive. Public Expenditure Review (PER) Joint Annual Work Plan (JAWP) Development Assistance Database (DAD) Central Public Investments and External Finance Bureau (CEPEX) Others. THE LIST IS GROWING!
Rationale 2: Production of Valuable Data for Health Sector Performance Management HRT is meant to generate data that can feed into RT activities including NHA to achieve the following: Enable joint planning at the national and district levels Improve accountability at the national and district levels Guide high-level discussions about health sector strategies Enable a better understanding of resource inequities
Introduction to the Health Resource Tracker (HRT) Web-based data reporting tool for hosting detailed health program information from all partners and government agencies active in the sector Key Players: Health Financing Unit: leading unit within MOH USAID-funded Health Systems 20/20 project: financial and technical support Siyelo, a South African firm: software developer Key stakeholders providing input in design of the tool: CHAI, UNAIDS, WHO, GIZ, MSH Oversight and guidance: the Health Financing Working Group chaired by the MOH PS
Basic Logic of the HRT Reporting Organization Project 1 Project 2 Activity 1 Activity 2 Activity 1 Activity 2
Basic Logic of the HRT Reporting Organization Project 1 Contact Person Organization s Fiscal Year Currency Project 2 Activity 1 Activity 2 Activity 1 Activity 2
Basic Logic of the HRT Reporting Organization Project 1 Project 2 Activity 1 Project Name Project Activity Description 2 Project Start & End Date Funding Source Disbursements received in past FY Activity 1 Planned Disbursements in current FY Activity 2
Basic Logic of the HRT Activity Name Project 1 Activity Description Spending in past FY & Budget in current FY Implementers Locations Reporting Purpose Organization Inputs Targets, outputs, beneficiaries, quarters of performance Project 2 Activity 1 Activity 2 Activity 1 Activity 2
10 Screenshots from the HRT
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Timeline 13 Discussions around HRT scope & requirements: Jan March 2010 Training of local programmers: April 2010 Phase 1 of software development: April August, 2010 Round 1 of data collection: August 2010 March 2011 Phase 2 of software development: April 2011 August 2011 Round 2 of data collection: September 2011 Finalizing results from Rounds 1 and 2: Now
Data Reporters to the HRT HRT tracks institutional health spending; it does not measure total health spending (private spending not included) 70.0% 60.0% 50.0% 40.0% 61.7% HRT Users by Organization 30.0% 20.0% 20.4% 10.0% 9.3% 8.7% 0.0% Implementing Partners Government Agencies Donoros Donors UN Agencies
HRT Outputs: Who finances health institutional spending in Rwanda? FY 2009-10 Expenditure by Funding Source Comparing executed budgets in 2009/10 with proposed budgets in 2010/11 shows a relatively stable picture in terms of the key financiers of institutional health spending.
HRT Outputs: Who finances health spending in Rwanda? USG and GF account for 70% of institutional health spending
HRT Outputs: Overall FY 2010-11 allocations to districts Many reporting issues remain over 70% of total spending is currently not being assigned to districts. Some of it is national spending, but not all. Is the distribution across districts equitable?
HRT Outputs: Exploring patterns within a single district
Key Challenges 19 Shortage of local experts to manage the HRT and overreliance on international consultants High investment required to develop the tool in the first years of its implementation Tension between stakeholders wanting a lot of data and the time it takes to report detailed data There is a lot of demand for RT information, but actual use remains low Technical challenges Complexity of flows increases danger of double-counting Harmonizing classifications MTEF, NHA, NASA etc - is difficult Getting the timing of data collection right has proved very challenging...
Difficult to align partners to the new GOR fiscal year 20 July 2009 Government of Rwanda FY June 2010 Oct 2009 FY for several donors and implementing partners Sept 2010 Implications of non-uniform fiscal years: Partners struggle to report spending especially planned spending according to GoR FY GoR wants budget data from partners in April-May when it does its planning but many partners do not have approved budgets then To generate timely budget and spending data, multiple rounds of data collection may be necessary in a year Budget data for upcoming FY needed in April-May Realized spending data for past FY is available in August-Sept
Next Steps 21 Build comprehensive output features to visualize data in the HRT Revisit and revise the classifications to make it more meaningful and less complex Build local capacity Use existing RT data Collect more RT data Maintain and further develop the tool
22 Thank you