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Teresa Guthrie Centre for Economic Governance and AIDS in Africa 23 May 2008, Geneva
Key Questions <ul><li>To prove the impact of the IHP+ will require strong, transparent financial information & accounting ...
HIV/AIDS Spending on HSS & gen.Health:  Zambia 15%, Swaziland 11%, Botswana 10% <ul><li>Zambia 2007 </li></ul><ul><li>Swaz...
Key Questions  (cont.) <ul><li>Evidence of basket funding for HIV/AIDS  and Partnership Forums – donors maintain dominance...
NB: Does not include funds from provinces' own budgets. 0 500 1,000 1,500 2,000 2,500 2000/1 2001/2 2002/3 2003/4 2004/5 2...
<ul><li>Govt Budget is a powerful  economic policy tool  to balance the revenue & expenditure, maintain fiscal discipline,...
Challenges in Monitoring Allocations & Expenditure <ul><li>Budget documents: </li></ul><ul><li>Do not give detail </li></u...
Data Required to Understand all Health Spending Programme/  Activity Programme/  Activity Programme/  Activity Programme/ ...
Recommendations <ul><li>All donor contributions to IHP+ must be indicated in the National Budget documents, and their allo...
Conclusions <ul><li>IHP+ could greatly enhance existing public financial information & accounting systems. Or cripple them...
Thank You <ul><ul><li>For more information contact: </li></ul></ul><ul><ul><li>Teresa Guthrie </li></ul></ul><ul><ul><li>C...
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Panel 1. Teresa Guthrie, Ihp+ Challenges And Opportunities For Financial Information Systems And Accountability

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Panel 1. Teresa Guthrie, Ihp+ Challenges And Opportunities For Financial Information Systems And Accountability

  1. 1. Teresa Guthrie Centre for Economic Governance and AIDS in Africa 23 May 2008, Geneva
  2. 2. Key Questions <ul><li>To prove the impact of the IHP+ will require strong, transparent financial information & accounting systems by governments. Are they ready for this? How will IHP+ improve public accountability? </li></ul><ul><li>Spending of pooled funds is difficult to track to the specific donor. Are donors ready to accept financial reports that indicate the outputs without linking these to their inputs? </li></ul><ul><li>Public contributions to health are key to sustainability of programmes, and therefore donor-dependency must be addressed. How will the IHP+ address this? </li></ul><ul><li>Funds for HIV/AIDS have contributed to health systems strengthening & the ‘horizontal vs vertical’ debate is not useful. How will IHP+ ensure diagonal funding? </li></ul>
  3. 3. HIV/AIDS Spending on HSS & gen.Health: Zambia 15%, Swaziland 11%, Botswana 10% <ul><li>Zambia 2007 </li></ul><ul><li>Swaziland </li></ul>2008. Draft NASA findings.
  4. 4. Key Questions (cont.) <ul><li>Evidence of basket funding for HIV/AIDS and Partnership Forums – donors maintain dominance in determining spending priorities, and can ‘gang up’ against govt. How will IHP+ empower govts? </li></ul><ul><li>Are donors ready to allow governments full determination of the use of funds? Will CS input be enabled? Will IHP+ enhance govt budget planning processes? </li></ul><ul><li>NGOs provide invaluable services, especially non-health activities. Evidence of funding via government agents to NGOs shows crippling bureaucracy, erratic funding, undermining sustainability, irrational allocative decisions. Will the IHP+ channel donor funds away from direct support to NGOs? Will IHP+ improve the public funding channels to NGOs? </li></ul><ul><li>HIV/AIDS has demanded and challenged a multi-sectoral response. It remains dominated by the health sector response, with little co-ordination between the other sectors. Will the IHP+ further entrench the “medicalisation of HIV/AIDS”? Eg…. </li></ul>
  5. 5. NB: Does not include funds from provinces' own budgets. 0 500 1,000 1,500 2,000 2,500 2000/1 2001/2 2002/3 2003/4 2004/5 2005/6 2006/7 R million (nominal) South Africa – HIV/AIDS allocations by sector Source: Guthrie & Hickey, 2004. ABU, Idasa. Dept. of Public Service & Admin. and Dept. of Science & Tech. Social Development: HIV/AIDS Programme (including condtl grants) Education: HIV/AIDS condtl grant Health: HIV/AIDS and TB Sub- programme includes condtl grant
  6. 6. <ul><li>Govt Budget is a powerful economic policy tool to balance the revenue & expenditure, maintain fiscal discipline, and translate policies into services. Undermined by IMF/ WB conditionalities. </li></ul><ul><li>Budget allocation is powerful indicator of the priority accorded to health (or other issue), more than policy or legislation, and are key to the sustainability of programmes. </li></ul><ul><li>Participatory, transparent, accountable budget & expenditure systems indicate degree democracy in the country. </li></ul><ul><li>Monitoring of allocations & expenditure depends upon strong financial information systems! </li></ul>Transparency & Accountability ~ Govt Allocation & Expenditure Processes
  7. 7. Challenges in Monitoring Allocations & Expenditure <ul><li>Budget documents: </li></ul><ul><li>Do not give detail </li></ul><ul><li>Not actual expenditure </li></ul><ul><li>Non-standardised </li></ul><ul><li>Some donor contributions off-budget </li></ul><ul><li>Limited CS participation in allocative decisions </li></ul><ul><li>Allocations not based on need/ equity </li></ul><ul><li>Not used as a planning tool </li></ul><ul><li>Expenditure records: </li></ul><ul><li>Not available/ accessible to CS </li></ul><ul><li>Not disaggregated (by programme/ facility / district) </li></ul><ul><li>Donors do not provide actual expenditure by recipients ( vs commitmts/ disbursmts) </li></ul><ul><li>NHA data impt but not detailed sufficiently (esp.public sources) </li></ul>FOI laws in few countries or not used for accessing public expenditure records.
  8. 8. Data Required to Understand all Health Spending Programme/ Activity Programme/ Activity Programme/ Activity Programme/ Activity Programme/ Activity Programme/ Activity Programme/ Activity Programme/ Activity Adjusted from UNAIDS NASA approach.
  9. 9. Recommendations <ul><li>All donor contributions to IHP+ must be indicated in the National Budget documents, and their allocation clearly indicated according to programme and activity. </li></ul><ul><li>Govt must account for spending against the allocations and intended priorities, and explain discrepancies. </li></ul><ul><li>Governments must improve financial info & accounting systems: accurate expenditure records, accessible, transparent, detailed/ disaggregated. </li></ul><ul><li>Civil society must be engaged in the priority setting & allocative decisions for IHP+ funds, & m0nitoring of spending & outputs. </li></ul><ul><li>There remains need for direct donor funds for NGOs. These could still be ‘co-ordinated’ by govt (without managing them). </li></ul><ul><li>Diagonal funding necessary in the initial phases ~ aligned with national priorities, health plan and HIV NSP. </li></ul>
  10. 10. Conclusions <ul><li>IHP+ could greatly enhance existing public financial information & accounting systems. Or cripple them… </li></ul><ul><li>IHP+ could lead to greater transparency & accountability, with pressure & monitoring by CS. Or enable greater corruption & misappropriation. </li></ul><ul><li>IHP+ could increase health sector spending & development, improving systems which will enhance the response to HIV/AIDS & other diseases requiring specific responses. </li></ul><ul><li>Many lessons to be learnt from issues of financing for HIV/AIDS. Lets benefit from those. </li></ul><ul><li>Role of CS is critical in monitoring the allocation utilisation, accounting and efficiency of IHP+ funds. </li></ul><ul><li>But primary responsibility is the govt’s to account transparently on its expenditure, providing accessible data, establish strong info.systems, and routine explanation of expenditures/ discrepancies. </li></ul>
  11. 11. Thank You <ul><ul><li>For more information contact: </li></ul></ul><ul><ul><li>Teresa Guthrie </li></ul></ul><ul><ul><li>Centre for Economic Governance and AIDS in Africa </li></ul></ul><ul><ul><li>Email: [email_address] </li></ul></ul><ul><ul><li>Teresa.cegaa@gmail.com </li></ul></ul><ul><ul><li>Tel/Fax: +27-21-425-2852 </li></ul></ul><ul><ul><li>Cell: +27-82-872-4694 </li></ul></ul>

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