Download - Health Financing Miano Munene
HEALTH FINANCING
Designing and Implementing Pro-poor
Financing Campaign
Miano Munene
HERAF
Importance of Students Involvement
In a democracy, citizens have a right To know what money is being spent on, What decisions their elected representatives make on
their behalf. It is only with this knowledge that elected officials can
be held accountable for their budget planning, allocations and implementation.
Monitoring government budgets is also conducive to better decision-making within government.
It provides a forum for purposeful and concrete engagement between the executive, the legislatures and civil society around critical choices and outcomes.
Budget Process and Systems
An in-depth knowledge of the budget decision-making process - leads to greater influence & participation
Stronger focus on openness and transparency in budget process is a prerequisite for independent analysis
Growth in budget process work also reflects the changing nature of reforms to the budget process e.g “The role of Parliament and the budget”
Participating Budgeting process ...
Is an innovative approach to budget decision making that began at municipal level in Brazil in 1989 - generated widespread interest
Involves general public directly in making policy decisions
Allows for open forums during budget process - opportunity for public to allocate resources, prioritize broad social policies and monitor public spending
Breaks the tradition that the budget process should exclusively occur in the executive with inputs from budget technicians and few politicians
Examples CSOs in Kenya have regular public forums (Pre & Post Budget Hearings) Kenya - “Mwananchi’s Budget’’ South Africa’s “People’s Budget”.
Understanding Budget Policies
Analysis of Executive Budget Proposals Thorough and broad assessment of the budget when it is
released by the executive
Sector Analysis Focuses on an important area or sector of the economy or
the government Reviews a sector in relation to other sectors, the entire
economy or its historic levels of support Might include cross-country, Sectors, Ministries,
departments etc comparisons. Also Recurrent vs Development vote
Understanding Budget Policies
Budget and Economic and Social Rights All economic and social rights can not be achieved
immediately and all at once, but they can and should be realized progressively over time
Examine how to operationalize rights by turning policy rhetoric or legal commitments to certain rights into budget allocations
Examine if budgets are consistent with rights conventions
Analysis of Effects on Different Population Groups Effects on different income groups: examine the spending
devoted to programs and projects that assist the poor Effects on a particular group not defined by income: examine
the impacts of the budget on a racial or ethnic minority, women, children, the disabled, people living with HIV/AIDS etc.
At Planning & Formulation Stage
At the Planning stage, students can; Collaborate with policy makers to make budget input Contribute in preparation of District Health Plans - DHSF Participate in Sector Working Groups – Health, Education etc Generate Proposals for Consideration for budget formulation Participate in Public Hearings
Implementation Stage: What to do
At this Stage, students can; Scrutinize the implementation schedule and timeframe Disbursement of funds Financial Resources management Human Resource management Documentation and records Procurement and use of materials Participation Impact assessment
Health Care Financing & Budgetary Allocations Trends Issues
Preventive Vs. Curative Health?
Development Vs. Recurrent Expenditure
Referral Vs Lower level facilities
Disproportionate allocation to HIV/AIDS
Challenges & Priorities in Access to Health Care Services Policies and institutional challenges
Mismatch between government priorities as outlined in key policy framework and resource allocation
Lack of Adequate Personnel
Decentralizing Health Care
Challenges & Priorities Access to Health Care Services
Inequalities in access to health care
Weak linkages between environmental factors and health
Widening disparities:
Inequalities in access to health care
Constraints & Challenges Weak & inadequate legal/ institutional involvement
Secretive nature of the process
Lack of capacity to effectively engage
Lack of inclusive & cross sectoral information
Inherent suspicion between stakeholders
Inadequate understanding of national policies, procedures, institutional arrangements, f/works, etc
Lack of co-ordination /synergy for discernable reforms
Lack of information pool (sharing)
New Budget format – GFS
Entry Points- Options & Strategies
Advocacy & Lobbying
Networking and Building Alliances
Use of Information and Communication
Public Education and Information outreach
Research capacity building
Creation of technical support team
Demand that all disbursements to spending units to be gazetted to enable easy tracking by interest groups.
CSO Strengths
CSO have a host of strengths Simplifying budgets and deepening the debate around budget
policies and decisions Collating and disseminating budget information in user-friendly
formats Providing independent critical analysis Bringing new information to the debate Providing training in budget analysis and advocacy Helping to build a culture of accountability Advocating for more access to budget decision-making Mobilizing stakeholders, interest groups and citizens Providing input into budget decisions through existing channels
of access (for instance submissions to parliamentary committees, SWGs)
THANK YOU