Health Public Expenditure Review for FY08

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Health Public Expenditure Review for FY08

• Joint Annual Health Sector Review 2007
• 24th 26th September, 2007
• Directorate of Policy and Planning

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Outline

• Introduction
• Review of FY06 Health PER Recommendations
• Trends in Government Spending
• Real and Nominal Expenditure/Budget
• Health as Share of Government Expenditure/Budget
• Conclusion

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1. INTRODUCTION

• Purpose and Key Objectives of PER FY08
• Since PER is now organized within the framework
  of MKUKUTA clusters, this PER focuses mainly on
  getting specific trends and allocation and
  expenditures in the health sector
• The FY08 Health PER will further undertake a more
  detailed analysis of income and expenditure at
  district level, through a district tracking study
  in 12 districts.

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INTRODUCTION (2)

• The main objectives of PER FY08 are to
• Strengthen Ministry of Health and Social
  Welfare's position in tracking health allocation
  and expenditure trends with the view of improving
  equity and efficiency in resource allocation
  within the sector.
• Improve ex-ante coverage of program support and
  development partner funded projects in the
  Ministry of Health and Social Welfare budget
• Provide support to the implementation and
  monitoring of the MKUKUTA

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INTRODUCTION (3)

• Phase I
• Review the PER Health FY06 findings and actions
  taken by the Sector in response to those
  findings, indicating unaccomplished/pending
  actions and reasons
• Analyze the recurrent and development budget
  performance for the past three-years (aggregate
  actual versus budget).
• Results for Phase one will be presented in this
  AJHSR

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INTRODUCTION (4)

• Phase II
• Establish trends of government allocation and
  expenditures to the health sector at sectoral and
  sub-sectoral level and assess whether and how far
  these trends reflect policy objectives
• Review deviations in overall budget performance
  and factors constraining the allocations of
  resources
• Determine the extent of off budget spending and
  suggest way to improve its coverage within the
  budget.
• Provide estimates to feed in to budget guidelines
  for 2008/09

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INTRODUCTION (5)

• Compare the financial requirements for meeting
  MKUKUTA targets to projected resource
  availability for the sector using mainly the ESRF
  Health Sector MKUKUTA Costing Document
• Assess the impact on the adoption of more
  expensive technologies for existing activities in
  the Health Sector
• Undertake a detailed analysis of health income
  and expenditure at the council level which should
  provide a good overview on financial flows and
  how the resources are being allocated in the
  assessed councils.

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2.0 REVIEW OF FY06 HEALTH PER RECOMMENDATIONS

• 1. High Level Committee on health financing
• The Committee has been constituted and been
  approved by the SWAP Technical Committee
• The ToRs for the Committee have been drafted
• Letters of appointment have been drafted
  awaiting circulation
• First meeting to be convened after notification
  of appointments

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2.0 REVIEW OF FY06 HEALTH PER RECOMMENDATIONS (2)

• 2. Creation of a specific Unit within the DPP to
  handle complementary financing schemes as a means
  of improving information in this area
• No specific Unit has been created but a Focal
  Person has been appointed to deal with all
  financing schemes (HSF, CHF, NHIF etc)

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2.0 REVIEW OF FY06 HEALTH PER RECOMMENDATIONS (3)

• 3. Annual report to be provided by NHIF showing
  clearly the distribution of claims on a
  geographic basis and by level of health care
• No action has been taken
• 4. Incorporate reports on CHF, DRF and NHIF into
  the Appropriation Accounts
• The funds collected from the schemes are
  deposited in Account No.6 and/or Sub Treasury and
  are reported in the councils reports and not
  MOHSW.

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3.0 REVIEW OF FY06 HEALTH PER RECOMMENDATIONS (4)

• 5. Separation of each financing source within the
  TFIR at council level in order to permit
  consolidated reporting at national level
• Each financial source is indicated in the Council
  annual reports (Basket Fund, Government,
  NGO/Donor, Council own revenues)
• 6. Further work to analyse all on-budget spending
  according to beneficiary level
• Partly done by the drug tracking study which shed
  some light on drug expenditures by health facility

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2.0 REVIEW OF FY06 HEALTH PER RECOMMENDATIONS (5)

• 7. Preparation of a comprehensive MTEF, as has
  been the intention, to incorporate all external
  funding, on and off-budget
• Some program funds have been incorporated in
  MTEF, for instance, Global Fund
• 8. High Level Committee on health financing to
  review full sector MTEF (ie not MOHSW alone) and
  determine desired shares for central, regional
  and local government by end of period
• Not done because the Committee has not been
  convened.

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2.0 REVIEW OF FY06 HEALTH PER RECOMMENDATIONS (6)

• 9. Review and analysis of the MOF External
  Finance database for the Health sector for
  completeness and accuracy, and to determine the
  extent to which off-budget spending is in line
  with MDG and MKUKUTA goals
• This has not been done.
• 10. Initiate annual analysis of council level
  spending patterns both for budgets (ie using
  CCHPs) and for expenditure (ie using fourth
  quarter TFIRs)
• District Health Services Section has on quarterly
  basis doing analysis of Comprehensive Council
  Health Plans and Financial Progress Reports.
• The national picture in terms of different
  funding sources can be gauged from aggregating
  all LGAs rather than individual analysis of
  council plans

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2.0 REVIEW OF FY06 HEALTH PER RECOMMENDATIONS (7)

• 11. Analysis of CCHPs and MTEF to enable a
  consistent comparison of ESRF costing with actual
  budgets
• Not done
• 12. Review timing and process of the PER to fit
  with agreed changes in the planning and
  monitoring cycle
• This has been done
• 13. On basis of decision on PER timing, initiate
  process for FY07 update (ensuring linkage with
  NHA)
• The FY07 PER has been initiated and the final
  report is expected in December 2007.
• NHA process has been initiated draft report
  expected in January 2008
• However, no linkage has been forged between PER
  and NHA

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3.0 TRENDS IN GOVERNMENT SPENDING
Trend in Nominal Health Spending (TSh Million)
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TREND OF MOHSW ALLOCATION 2005/06 - 2007/08
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Trends of OC and PE Allocations
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3.0 TRENDS IN GOVERNMENT SPENDING (2)

• Huge increase on Development Budget
• Per capita increase of basket fund allocation
  from 0.5 to 0.75
• Inclusion of Global Fund in the MTEF
• Increased Government allocation to Regional
  Hospitals
• The observed increase in recurrent expenditure is
  due to PE in expense of OC (Qn. Stay idle and get
  paid?).

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Spending Trend in Per Capita US Dollars
(FY06-FY08)
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4.0 CONCLUSION WAY FOWARD

• This preliminary analysis shows that trends in
  health spending are broadly positive.
• Further analysis during main PER exercise will
  look in more depth

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