Objective To further explore issues towards achieving smart scaled and sustainable financing of RMNCAH and health Outline Part I Health financing transition DAH flows for RMNCAH Discussion ID: 736813
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Slide1
Financing RMNCAH
SECOND INVESTORS GROUP, St Albans, United Kingdom, 17-18 February 2016Slide2
ObjectiveTo further explore issues towards achieving smart, scaled and sustainable financing of RMNCAH and healthOutlinePart I:Health financing transitionDAH flows for RMNCAHDiscussionPart II:Monitoring smart, scaled and sustainable financingMonitoring outputs: Progress in developing health financing strategiesDiscussion2Objective & outlineSlide3
3With growth, total health expenditure increases…Slide4
4… yet there is some variability across countriesSenegalSlide5
5The composition of finance also changes with a shift away from DAH and out-of-pocket to domestic, prepaid and pooled financingSlide6
6…with similar variability, highlighting the challenge of effectively tapping the growing wealth for healthSlide7
7… while external resources tend to decrease rapidly as a share of total health expenditureSlide8
8 … and out of pocket expenditures tend to remain high …Slide9
9In the 63 GFF countries, DAH increased significantly over the past decade and appears to level out around $14BDAH by donorSlide10
10Similarly, DAH for RMNCAH increased from $1.8 to $4.2B…DAH by health areaSlide11
11…and as a share of DAH since 2008…Health areas as a share of total DAHSlide12
12… mainly driven by growth in DAH for child health and nutritionDisbursements (in USD 2013 million)Slide13
13RMNCAH DAH in GFF countries is generally well-aligned with the GFF composite index (RMNCAH needs, population, income)13
ln (composite index, 2013)
ln (Average RMNCAH disbursements, US$, 2011-13)Slide14
14…the correlation between DAH per capita and individual indicators of need is much weaker though…Maternal health disbursements per capita, USD (average 2011-2013) Slide15
…and a set of countries receive little DAH compared to RMNCAH needs15CountryWestern & Central AfricaNatural-resource driven growthFragile and conflict affectedCentral African RepublicxxxChadxx
x
Democratic Republic of the
Congo
x
x
x
Guinea
x
x
Niger
x
x
Nigeria
x
x
Côte d’Ivoire
x
x
Togo
x
x
Somalia
x
(India)Slide16
16…and the same countries tend to underinvest in health Slide17
Key challenges for the GFF include:Mobilize and prioritize DAH to leave no country behindStrengthen support to building health financing systems that tap the growing wealth for RMNCAH and health17Looking forward…Slide18
Monitoring smart, scaled and sustainable financingMonitoring outputs: Progress in developing health financing strategiesDiscussion18Financing RMNCAH: Part IISlide19
19Central to the GFF’s theory of change is smart, scaled and sustainable financing… Slide20
20…with a need to monitor progress along related performance dimensions of health financing systems in GFF countriesDimensionsSMARTImprove:Efficiency (allocative, technical, administrative)
Equity
SCALED
Increase:
Domestic, public and private sources
External sources
Share of prepaid and pooled financing
SUSTAINABLE
Tap economic growth for health
R
educe reliance on external
financing (grants)Slide21
21A results framework has been proposed, with data for some indicators readily available from GFF countries…IndicatorKenyaPotential targetsSMART
% of government recurrent health expenditure spent on prevention
14.7%
Country specific
Government budget execution rate for health
70%
90%
SCALED
Prepaid, pooled expenditure per capita --
government plus compulsory and voluntary insurance and DAH
--
on health
US$48.9
(2012/13)
US$86
The ratio of GHE to GE
6.1%
15%
SUSTAINABLE
Growth rate in government expenditure compared to the GDP growth rate
Ratio 3:2.15
(2009/10 to 2012/13)
Country specific
Growth rate in government health expenditure compared to the GDP growth
Ratio 2.22:2.15
(2009/10 to 2012/13)
Country specificSlide22
22…while for others, more work is neededIndicatorsKenyaSMART% of government recurrent RMNCAH
expenditure spent on prevention
-
Incidence of catastrophic health expenditures among all key vulnerable groups
-
SCALED
Total health expenditure per capita for
RMNCAH
-
Pooled expenditure per capita (government plus compulsory and voluntary health insurance) on
RMNCAH
-
SUSTAINABLE
Growth rate in government
RMNCAH
expenditure, compared to the GDP growth rate
-
Growth rate in domestic expenditure on
RMNCAH
, compared to the growth rate in external sources of finance
-
Data not currently available but could be generated with support:
e.g., adolescent health
Data exist, but support is required with analysis
e.g., HH survey data
Quality of data needs improvement
e.g., donor assistanceSlide23
23And with data improvements, RMNCAH financing patterns will continue to emerge… Slide24
24The results framework also captures HFS-related outputs… Smart financingScaled financingSustainable financing
Improved
capacity to track
progress
Reduced morbidity and mortality and improved quality of life of
women, children, and adolescents
Investment Cases
Health
financing strategies
Global
public goods
Indirect:
Guidance
Technical assistance
Knowledge and learning
Influencing (e.g., through Investors Group)
Direct:
Financing (domestic and external)
RMNCAH, health systems, and multisectoral
Domain 1: direct financing focused on results
Domain 2: Indirect effects on the ecosystem
PARTNERSHIP INPUTS
INTERMEDIATE OUTCOMES
OUTCOMES
IMPACT
FACILITY
OUTPUTSSlide25
25… linked to smart, scaled, and sustainable financing, providing a useful snapshot of country progressIndicatorKenyaSMARTIdentifies strategies for addressing key inefficiencies√Develops policies to reduce inequities in financial protection
√
SCALED
Sets targets
for raising more domestic resources
√
Develops approaches to reduce OOPs
√
SUSTAINABLE
Includes an explicit strategy for transitioning from
Gavi
or GFATM support.
X
Develops strategies to address fragmentation in risk pooling
√
Contains
an implementation plan
√/
X
Has been formally endorsed by an appropriate authority
XSlide26
26The results framework needs further elaboration … Smart financingScaled financingSustainable financing
Improved
capacity to track
progress
Reduced morbidity and mortality and improved quality of life of
women, children, and adolescents
Investment Cases
Health
financing strategies
Global
public goods
Indirect:
Guidance
Technical assistance
Knowledge and learning
Influencing (e.g., through Investors Group)
Direct:
Financing (domestic and external)
RMNCAH, health systems, and multisectoral
Domain 1: direct financing focused on results
Domain 2: Indirect effects on the ecosystem
PARTNERSHIP INPUTS
INTERMEDIATE OUTCOMES
OUTCOMES
IMPACT
FACILITY
OUTPUTSSlide27
27…to identify and monitor determinants of success…HFS: Gov’t health budget should ↑ to 3% GDPFACILITYOUTPUT↑THE per capita↑GHE/
GE
GHE grows faster than GE
Other contextual
Favorable economic conditions
Satisfactory transparency and accountability
Political
economy
Health “champions” in positions of power
Good
communication between
MoF
&
MoH
Effective engagement
of
MoH
with other
ministries (Planning
, Investment
)
CSOs (or others) provide voice to the poor / marginalized
Windows of opportunity
Knowledge & evidence
Evidence on what mechanisms work when
Good data for planning
Capacities & systems
Good PFM systems
Health financing capacities
within
MoH
INTERMEDIATE OUTCOMESlide28
28… to foster learning that enables seizing opportunities to improve financing for RMNCAH and health
Democratic Republic of the Congo
Prime Minister committed to a significant increase in the share of health within central government budget and, for the first time, an explicit allocation of domestic resources to reproductive health
Tanzania
Government committed to increase share of health in government budget linked to a disbursement indicator in an IDA operationSlide29
29To advance the monitoring agenda over the coming months…
Next steps include the following:
Consult with partners on draft results framework
Incl. WHO: link with work on Global Strategy indicators
Validate indicators by collecting data in the 12 GFF Trust Fund countries
Determine targets
Establish framework to monitor global progress (across individual countries)
Establish costs and mobilize resources to improve and institutionalize data collection and analysis in GFF countries Slide30
Inaugural Annual Forum for Financing UHCWashington DC, April 14-15, 2016Theme: Resource mobilization for UHCObjectives:Review and debate the knowledge base to build consensus on policy recommendations and agree on research priorities, and Monitor, report and benchmark country and global progress to promote learning and foster accountability.Co-hosts: USAID and WBG30An upcoming opportunity to share experienceSlide31
Annex31Slide32
The share of prepaid and pooled financing is the result of both a government’s capacity to raise revenue…32Slide33
33…and the prioritization of health in public budgetsSlide34
34The framework also includes indicators to track progress in data availability and qualityIndicatorKenyaTimely audited report of government health expenditures including on RMNCAH is available for the last fiscal yearX/√A set of national health accounts (NHAs) with distributive matrices has been produced in the last 3 years
√
A more detailed distributive account for RMNCAH has been produced in the last 3
years
X
A household expenditure survey/module including health expenditures has been undertaken in the last three years
√