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