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UN-WATER GLAAS
“TRACKFIN INITIATIVE”
IRC 2013 SYMPOSIUM, ADDIS ABABA

                Marie-Alix Prat and Sophie Trémolet
                                         April 2013
Presentation Overview
2


       Overview of UN-Water GLAAS TrackFin initiative
         Why track WASH financing?

         What is TrackFin?

       Overview of the proposed methodology
           What is the approach to building WASH-Accounts?
           What are the main methodological issues raised?
       What can we expect from implementing WASH-
        Accounts?
           What can countries learn from WASH-A?
           What can we learn from the implementation of Health
            Accounts?
       Next steps for TrackFin
Why track WASH financing?
3


       Benchmark countries and track implementation of commitments
           e.g. eThekwini declaration: countries committed to spend at least 0.5% GDP on
            sanitation but there is no existing method to track this type of commitment

       Support policy development and implementation
           Is current and projected public funding sufficient to achieve objectives?
           Does funding need to be increased and, if so, by how much?
           What is the financial burden on households? Are current public policies effective at
            leveraging private investment?

       Encourage better utilization of existing funds, e.g.:
           Is financing going to the segments of WASH sector and regions that need it most?
           Is sufficient financing allocated to operations and maintenance as opposed to
            investment?
           Is funding to the WASH sector effectively channelled? (especially for donor’s
            contribution) How can local governments be supported?

       Attract additional financing to the sector vs. other sectors which are
        better able to track financing (e.g. National Health Accounts in more than 100
        countries)
        There is also a consensus that this is a difficult and challenging task,
How is WASH financing tracked
    now?
4

       There is no consolidated methodology to track financing to WASH
           Existing studies (WSP work in 2004/2005, AICD, CSOs, WASHCost, PERs of the
            World Bank) provide useful data and methodologies, but:
            •   One-off snapshots, no clear prospect of being repeated
            •   Tend to be externally-driven with substantial consultant input
            •   No consistent methodology across countries or institutions
           UN Department of Statistics has launched SEEA-W with broad (and ambitious)
            objectives of tracking all hydrological and financial flows

       Contributions of previous GLAAS reports in this area :
           GLAAS 2010 report focused on reporting ODA flows
            •   Hardly any mention of tariffs: the “paradox” of WASH financing

           GLAAS 2012 report identified a lack of reliable sector financial data
            •   Sought to improve the methodology: focus on the 3Ts
            •   Limited number of countries provided data + data reliability is low
            •   Proposed a methodology to improve financial tracking (Annex B)
Why should GLAAS pick up the
5
    baton?
       Policy needs expressed at High-Level Meeting (Washington, April
        2012)
            Highlighted “substantial financial gap to meet targets”
             Countries committed to increase funding and, overall to:
             • Put in place realistic sector financing plans and track their
               achievement using standard methodology and formats
             • Create specific trackable national budget lines for water, sanitation
               and hygiene
             5 countries have committed to track financing at the meeting

       Identifying GLAAS’s mandate and potential role re. financing
            GLAAS is a key input into the High-Level Meeting (alongside JMP)
            GLAAS review: agreement that GLAAS should maintain a strong
             focus on investment flows and be embedded in national systems

       GLAAS report: an excellent opportunity to develop methodologies to
        track financing at national level in a comparable and consistent
        manner through the application of a globally accepted methodology
What is the “TrackFin Initiative” ?
6

       Objectives
           Define and test a globally accepted methodology to track WASH
            financing at national level
           Develop a methodology to build WASH Accounts (on the model
            of National Health Accounts), building upon governments’
            statistical systems and mainstreams data collection
           Encourage countries to adopt this common framework to track
            their financial data of WASH sector

       TrackFin proposes to address four “simple” questions:
        1. What is the total expenditure in the sector?
        2. How are the funds distributed to the different WASH services and
           expenditure types?
        3. Who pays for WASH services and much do they pay?
        4. Which entities are the main channels of funding in the WASH
           sector?
Overview of the proposed methodology
    to track financing to WASH at national
7   level
Defining the “boundaries” of the WASH
      sector
8

         The guidance document proposes common classifications to ensure that the
          information produced for the GLAAS exercise (and beyond) is consistent,
          comprehensive and comparable.
Cod
      Category           Proposed definition
e
                         This category includes all activities necessary for water distribution :
                              Collection of rain water and water from various sources, from rivers, lakes, wells
                              Purification of water for water supply purposes, desalting of sea or ground water
      Water supply            Distribution of water through mains, by trucks or other means.
S1
      services           It also includes the construction activities to build water distribution and water resources management
                         infrastructures and the associated assets:
                              Construction of dams, aqueducts and other water supply conduits, except pipelines
                               Water well drilling services
                         This category includes :
                              Installation of septic systems
      Sanitation
S2                            Collection of sewage by sewer systems or sewage treatment facilities (Septic tank emptying and cleaning
      services
                              services)
                               Treatment and disposal of sewage by sewer systems or sewage treatment facilities
      Unallocated        This category includes the construction activities for both water and sanitation infrastructures and the associated
      construction       assets:
      activities (for         Construction services of pipelines and long distance transport of water and sewage
S3
      both water and
      sanitation              Construction services of local pipelines
      services)                Construction services of sewage and water treatment plants
                         This category includes the public administrative services related to water and sanitation services :
                              Administration of potable water programmes
S4    Support services
                              Administration of waste collection and disposal operations
Establishing a common classification of
          WASH actors and financing flows
9
                                                                                                                 Correspondence
                                                                                            Correspondence
    WASH-Account financing                                                                                       with SEEA-Water
                                 Proposed definition                                        with OECD Typology
    sources                                                                                                      categories of
                                                                                            of financing sources
                                                                                                                 financing sectors

          Tariffs for services   Payments made by users to service providers for                                   Part of funding via
    FS1
          provided               getting access to and for using the service.                                       “Corporations”

                                 Funding provided by households to invest in or provide          TARIFFS
          Households’ out-of-
                                 the service themselves. This can be in form of cash,
    FS2   pocket expenditure                                                                                          Households
                                 material or time (sometimes referred to as “sweat
          for self-supply
                                 equity”).
                                 Public transfers from government agencies (central or
          Domestic public        local government) to WASH actors. These are often
    FS3                                                                                           TAXES              Governments
          transfers              subsidies that come from taxes or other sources of
                                 revenues of the government.
                                 Funds from public donors and multilateral agencies
                                 that come from other countries. These funds can be
          International public
    FS4                          contributed either in the form of grants, concessionary                            Rest of the world
          transfers
                                 loans (i.e. through the grant element included in a
                                 concessionary loan) or guarantees.
                                 Funds from international and national non-
                                 governmental donors including from charitable                 TRANSFERS
                                 foundations, Non-Governmental Organizations (NGOs)
                                                                                                                      Non-for-profit
                                 and civil society organizations. These funds can be
    FS5   Voluntary transfers                                                                                      institutions serving
                                 contributed either in the form of grants, concessionary
                                                                                                                       households
                                 loans (i.e. through the grant element included in a
                                 concessionary loan, in the form of a subsidised interest
                                 rate or a grace period) or guarantees.
                                 Refers to sources of finance that come from private
          Private repayable      sources and ultimately need to be repaid, such as              REPAYABLE          Part of funding via
    FS6
          financing              loans, equity investments or other financial instruments        FINANCE            “Corporations”
Mapping financial flows for WASH
10
       service provision




 Source: adapted from Trémolet & Rama (2012)
Defining methodologies to capture
     information on national expenditure to
11   WASH
Defining a common set of tables to
     present the information
12


                               WASH- Accounts tables
     Table WA 1 (SxR)- WASH expenditure by main WASH service and regional
     subdivision
     Table WA 2 (SxU)- WASH expenditure by type of WASH service and user
     Table WA 3 (SxP)- WASH expenditure by type of WASH service and provider
     Table WA 4 (PxFS)- WASH expenditure by type of WASH provider and financing
     source
     Table WA 5 (SxFS)- WASH expenditure by type of WASH service and financing
     source
     Table WA 6 (SxFA)- WASH expenditure by WASH service and financing agent

     Table WA 7 (PxFA)- WASH expenditure by WASH provider and financing agent

     Table WA 8 (CxP)- WASH expenditure by type of cost and WASH provider
     Table WA 9 (CxS)- WASH expenditure by type of cost and main WASH service
     Table WA 10 (ASxP)- Asset stocks by type of WASH provider
Defining a common set of indicators to
        present the information
13

                                                  Indicator (I)
     Total expenditure on the WASH sector at the national level
     Total expenditure on WASH in the country as share of GDP
     Total expenditure on WASH per capita
     Total expenditure on WASH as a % of total public spending
     Total expenditure on urban and on rural drinking-water as a % of total WASH expenditure
     Total expenditure on urban and on rural sanitation as a % of total WASH expenditure
     Total expenditure on urban and on rural hygiene as a % of total WASH expenditure
     Total expenditure per type of service user as a % of total WASH expenditure
     Total expenditure per type of WASH service as a % of total WASH expenditure
     Total expenditure per type of WASH provider as a % of total WASH expenditure
     Total expenditure per type of financing source as a % of total WASH expenditure
     Total government domestic transfers expenditure and as a % of WASH expenditure
     Total international transfers expenditure and as a % of WASH expenditure
     Total household expenditure as a % of WASH expenditure
     Total expenditure channelled through regional and local authorities as a % of WASH public
     expenditure
     Recurrent and capital expenditures as a % of total WASH expenditure
     Total CAPEX expenditure on water supply as a % of total water expenditure
     Total OPEX expenditure on water supply as a % of total water expenditure
     Total CAPEX expenditure on sanitation as a % of total sanitation expenditure
     Total OPEX expenditure on sanitation as a % of total sanitation expenditure
What can we expect from
14
     implementing WASH-Accounts?
        WASH-A will help address policy questions so as to
         provide the basis for better planning, budgeting,
         monitoring and coordination of financing to the sector
        The expected uses of WASH-A are based on the
         experience of Health Accounts (HA) in the health sector
         :
            HA have generated useful evidence for country-level
             policymaking as well as for cross-country comparisons
            HA have been increasingly institutionalised in developing
             countries and used by policymakers to reform health systems
             and allocate financing more efficiently.
1. What is the total expenditure on
         WASH ?
15


        Related policy questions :
             Is current funding sufficient?
             What is the trend in funding? Is it increasing or decreasing?
             How does the level of funding compare to neighbouring countries?
             How does the level of funding compare with other social sectors (health,
              education)?
        Input in policy development :
             Monitor WASH expenditure trends over time
             Benchmark funding to the WASH sector, against other countries or other
              sectors (health, education)
             Raise awareness on the need to attract more financing to the WASH
              sector so as to meet agreed physical targets and objectives
             Compare financial to outputs and outcomes in the WASH sector to
              estimate the efficiency of financing
2. How is funding distributed?
16

        Related policy questions :
            Is funding going to regions/areas that need it most? (rural vs urban)
            Is spending allocated to WASH subsectors and services that need it most?
             (water vs sanitation)
            Is sufficient spending allocated to operations and maintenance as opposed
             to investment?
        Input in policy development :
            Identify inequities in the distribution of spending across regions and
             population groups
            Allocate funds to sub-sectors, services, providers and programmes
            Plan national WASH policies and strategies
            Monitor policies’ outcomes and effectiveness.
        Evidence from Health Accounts:
            In Mexico, HA enable to compare per capita health expenditure between
             state. They are used to identify funding needs and allocate budget to the
             neediest states allocation.
3. Who pays for WASH services?
17

        Related policy questions :
            By whom is each type of service financed? What is the share of public vs. private
             expenditure?
            What is the financial burden on households? Are policies and utilisation of public
             funds effective at leveraging private investment, including from households?
            What is the share of donor’s contribution? How much is donor spending out of
             the total government’s budget?
            Are government and donors’ commitments on WASH financing respected?
        Input in policy development :
            Define financing strategies;
            Monitor trends and outcomes of financing strategies over time;
            Coordinate donor aid and international transfers;
            Track commitments and targets expressed in financial terms.
        Evidence from Health Accounts:
            In Rwanda, sub-accounts for HIV /AIDS revealed that households were carrying
             93.5% of the expenditures for prevention and treatment of this disease. These
             findings were used by the Ministry of Health to design targeted interventions to
             improve HIV/AIDS prevention financing
4. How is funding channelled?
18


        Related policy questions :
            E.g. What % of WASH public expenditure is channelled via local
             governments?
        Input in policy development :
            Define and monitor financing strategies
            Evaluate the performance of decentralized financing policies
            Identify ways to support local governments that channel such budgets


        Evidence from Health Accounts:
            In the Philippines, HA have been used to evaluate the impact of the
             government’s decentralization reform in 1993. They showed that
             spending on public health care (that benefit to the community at large)
             actually increased between 1991 and 1997, largely thanks to increased
             funding from local governments, which allocated more than half of their
             health resources to public health care .
Next steps
19


        Test the TrackFin draft Guidance Document in 3-4
         countries :
            Morocco, Brazil, Ghana and Vietnam have expressed interest
            Inviting interest from other countries to join the initiative


        Results of these exercises will be presented in an annex
         of GLAAS 2014 on the TrackFin process and findings in
         test countries

        Learn from this testing for development of a revised
         methodology for GLAAS 2016 and development of
         WASH Accounts in other countries
20   Thank you for your attention!

               Sophie@tremolet.com
               Marie-alix@tremolet.com




                gordonb@who.int
                allelyd@who.int

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UN-Water GLAAS "TRACKFIN Initiative"

  • 1. UN-WATER GLAAS “TRACKFIN INITIATIVE” IRC 2013 SYMPOSIUM, ADDIS ABABA Marie-Alix Prat and Sophie Trémolet April 2013
  • 2. Presentation Overview 2  Overview of UN-Water GLAAS TrackFin initiative  Why track WASH financing?  What is TrackFin?  Overview of the proposed methodology  What is the approach to building WASH-Accounts?  What are the main methodological issues raised?  What can we expect from implementing WASH- Accounts?  What can countries learn from WASH-A?  What can we learn from the implementation of Health Accounts?  Next steps for TrackFin
  • 3. Why track WASH financing? 3  Benchmark countries and track implementation of commitments  e.g. eThekwini declaration: countries committed to spend at least 0.5% GDP on sanitation but there is no existing method to track this type of commitment  Support policy development and implementation  Is current and projected public funding sufficient to achieve objectives?  Does funding need to be increased and, if so, by how much?  What is the financial burden on households? Are current public policies effective at leveraging private investment?  Encourage better utilization of existing funds, e.g.:  Is financing going to the segments of WASH sector and regions that need it most?  Is sufficient financing allocated to operations and maintenance as opposed to investment?  Is funding to the WASH sector effectively channelled? (especially for donor’s contribution) How can local governments be supported?  Attract additional financing to the sector vs. other sectors which are better able to track financing (e.g. National Health Accounts in more than 100 countries) There is also a consensus that this is a difficult and challenging task,
  • 4. How is WASH financing tracked now? 4  There is no consolidated methodology to track financing to WASH  Existing studies (WSP work in 2004/2005, AICD, CSOs, WASHCost, PERs of the World Bank) provide useful data and methodologies, but: • One-off snapshots, no clear prospect of being repeated • Tend to be externally-driven with substantial consultant input • No consistent methodology across countries or institutions  UN Department of Statistics has launched SEEA-W with broad (and ambitious) objectives of tracking all hydrological and financial flows  Contributions of previous GLAAS reports in this area :  GLAAS 2010 report focused on reporting ODA flows • Hardly any mention of tariffs: the “paradox” of WASH financing  GLAAS 2012 report identified a lack of reliable sector financial data • Sought to improve the methodology: focus on the 3Ts • Limited number of countries provided data + data reliability is low • Proposed a methodology to improve financial tracking (Annex B)
  • 5. Why should GLAAS pick up the 5 baton?  Policy needs expressed at High-Level Meeting (Washington, April 2012)  Highlighted “substantial financial gap to meet targets”  Countries committed to increase funding and, overall to: • Put in place realistic sector financing plans and track their achievement using standard methodology and formats • Create specific trackable national budget lines for water, sanitation and hygiene  5 countries have committed to track financing at the meeting  Identifying GLAAS’s mandate and potential role re. financing  GLAAS is a key input into the High-Level Meeting (alongside JMP)  GLAAS review: agreement that GLAAS should maintain a strong focus on investment flows and be embedded in national systems  GLAAS report: an excellent opportunity to develop methodologies to track financing at national level in a comparable and consistent manner through the application of a globally accepted methodology
  • 6. What is the “TrackFin Initiative” ? 6  Objectives  Define and test a globally accepted methodology to track WASH financing at national level  Develop a methodology to build WASH Accounts (on the model of National Health Accounts), building upon governments’ statistical systems and mainstreams data collection  Encourage countries to adopt this common framework to track their financial data of WASH sector  TrackFin proposes to address four “simple” questions: 1. What is the total expenditure in the sector? 2. How are the funds distributed to the different WASH services and expenditure types? 3. Who pays for WASH services and much do they pay? 4. Which entities are the main channels of funding in the WASH sector?
  • 7. Overview of the proposed methodology to track financing to WASH at national 7 level
  • 8. Defining the “boundaries” of the WASH sector 8  The guidance document proposes common classifications to ensure that the information produced for the GLAAS exercise (and beyond) is consistent, comprehensive and comparable. Cod Category Proposed definition e This category includes all activities necessary for water distribution : Collection of rain water and water from various sources, from rivers, lakes, wells Purification of water for water supply purposes, desalting of sea or ground water Water supply Distribution of water through mains, by trucks or other means. S1 services It also includes the construction activities to build water distribution and water resources management infrastructures and the associated assets: Construction of dams, aqueducts and other water supply conduits, except pipelines Water well drilling services This category includes : Installation of septic systems Sanitation S2 Collection of sewage by sewer systems or sewage treatment facilities (Septic tank emptying and cleaning services services) Treatment and disposal of sewage by sewer systems or sewage treatment facilities Unallocated This category includes the construction activities for both water and sanitation infrastructures and the associated construction assets: activities (for Construction services of pipelines and long distance transport of water and sewage S3 both water and sanitation Construction services of local pipelines services) Construction services of sewage and water treatment plants This category includes the public administrative services related to water and sanitation services : Administration of potable water programmes S4 Support services Administration of waste collection and disposal operations
  • 9. Establishing a common classification of WASH actors and financing flows 9 Correspondence Correspondence WASH-Account financing with SEEA-Water Proposed definition with OECD Typology sources categories of of financing sources financing sectors Tariffs for services Payments made by users to service providers for Part of funding via FS1 provided getting access to and for using the service. “Corporations” Funding provided by households to invest in or provide TARIFFS Households’ out-of- the service themselves. This can be in form of cash, FS2 pocket expenditure Households material or time (sometimes referred to as “sweat for self-supply equity”). Public transfers from government agencies (central or Domestic public local government) to WASH actors. These are often FS3 TAXES Governments transfers subsidies that come from taxes or other sources of revenues of the government. Funds from public donors and multilateral agencies that come from other countries. These funds can be International public FS4 contributed either in the form of grants, concessionary Rest of the world transfers loans (i.e. through the grant element included in a concessionary loan) or guarantees. Funds from international and national non- governmental donors including from charitable TRANSFERS foundations, Non-Governmental Organizations (NGOs) Non-for-profit and civil society organizations. These funds can be FS5 Voluntary transfers institutions serving contributed either in the form of grants, concessionary households loans (i.e. through the grant element included in a concessionary loan, in the form of a subsidised interest rate or a grace period) or guarantees. Refers to sources of finance that come from private Private repayable sources and ultimately need to be repaid, such as REPAYABLE Part of funding via FS6 financing loans, equity investments or other financial instruments FINANCE “Corporations”
  • 10. Mapping financial flows for WASH 10 service provision Source: adapted from Trémolet & Rama (2012)
  • 11. Defining methodologies to capture information on national expenditure to 11 WASH
  • 12. Defining a common set of tables to present the information 12 WASH- Accounts tables Table WA 1 (SxR)- WASH expenditure by main WASH service and regional subdivision Table WA 2 (SxU)- WASH expenditure by type of WASH service and user Table WA 3 (SxP)- WASH expenditure by type of WASH service and provider Table WA 4 (PxFS)- WASH expenditure by type of WASH provider and financing source Table WA 5 (SxFS)- WASH expenditure by type of WASH service and financing source Table WA 6 (SxFA)- WASH expenditure by WASH service and financing agent Table WA 7 (PxFA)- WASH expenditure by WASH provider and financing agent Table WA 8 (CxP)- WASH expenditure by type of cost and WASH provider Table WA 9 (CxS)- WASH expenditure by type of cost and main WASH service Table WA 10 (ASxP)- Asset stocks by type of WASH provider
  • 13. Defining a common set of indicators to present the information 13 Indicator (I) Total expenditure on the WASH sector at the national level Total expenditure on WASH in the country as share of GDP Total expenditure on WASH per capita Total expenditure on WASH as a % of total public spending Total expenditure on urban and on rural drinking-water as a % of total WASH expenditure Total expenditure on urban and on rural sanitation as a % of total WASH expenditure Total expenditure on urban and on rural hygiene as a % of total WASH expenditure Total expenditure per type of service user as a % of total WASH expenditure Total expenditure per type of WASH service as a % of total WASH expenditure Total expenditure per type of WASH provider as a % of total WASH expenditure Total expenditure per type of financing source as a % of total WASH expenditure Total government domestic transfers expenditure and as a % of WASH expenditure Total international transfers expenditure and as a % of WASH expenditure Total household expenditure as a % of WASH expenditure Total expenditure channelled through regional and local authorities as a % of WASH public expenditure Recurrent and capital expenditures as a % of total WASH expenditure Total CAPEX expenditure on water supply as a % of total water expenditure Total OPEX expenditure on water supply as a % of total water expenditure Total CAPEX expenditure on sanitation as a % of total sanitation expenditure Total OPEX expenditure on sanitation as a % of total sanitation expenditure
  • 14. What can we expect from 14 implementing WASH-Accounts?  WASH-A will help address policy questions so as to provide the basis for better planning, budgeting, monitoring and coordination of financing to the sector  The expected uses of WASH-A are based on the experience of Health Accounts (HA) in the health sector :  HA have generated useful evidence for country-level policymaking as well as for cross-country comparisons  HA have been increasingly institutionalised in developing countries and used by policymakers to reform health systems and allocate financing more efficiently.
  • 15. 1. What is the total expenditure on WASH ? 15  Related policy questions :  Is current funding sufficient?  What is the trend in funding? Is it increasing or decreasing?  How does the level of funding compare to neighbouring countries?  How does the level of funding compare with other social sectors (health, education)?  Input in policy development :  Monitor WASH expenditure trends over time  Benchmark funding to the WASH sector, against other countries or other sectors (health, education)  Raise awareness on the need to attract more financing to the WASH sector so as to meet agreed physical targets and objectives  Compare financial to outputs and outcomes in the WASH sector to estimate the efficiency of financing
  • 16. 2. How is funding distributed? 16  Related policy questions :  Is funding going to regions/areas that need it most? (rural vs urban)  Is spending allocated to WASH subsectors and services that need it most? (water vs sanitation)  Is sufficient spending allocated to operations and maintenance as opposed to investment?  Input in policy development :  Identify inequities in the distribution of spending across regions and population groups  Allocate funds to sub-sectors, services, providers and programmes  Plan national WASH policies and strategies  Monitor policies’ outcomes and effectiveness.  Evidence from Health Accounts:  In Mexico, HA enable to compare per capita health expenditure between state. They are used to identify funding needs and allocate budget to the neediest states allocation.
  • 17. 3. Who pays for WASH services? 17  Related policy questions :  By whom is each type of service financed? What is the share of public vs. private expenditure?  What is the financial burden on households? Are policies and utilisation of public funds effective at leveraging private investment, including from households?  What is the share of donor’s contribution? How much is donor spending out of the total government’s budget?  Are government and donors’ commitments on WASH financing respected?  Input in policy development :  Define financing strategies;  Monitor trends and outcomes of financing strategies over time;  Coordinate donor aid and international transfers;  Track commitments and targets expressed in financial terms.  Evidence from Health Accounts:  In Rwanda, sub-accounts for HIV /AIDS revealed that households were carrying 93.5% of the expenditures for prevention and treatment of this disease. These findings were used by the Ministry of Health to design targeted interventions to improve HIV/AIDS prevention financing
  • 18. 4. How is funding channelled? 18  Related policy questions :  E.g. What % of WASH public expenditure is channelled via local governments?  Input in policy development :  Define and monitor financing strategies  Evaluate the performance of decentralized financing policies  Identify ways to support local governments that channel such budgets  Evidence from Health Accounts:  In the Philippines, HA have been used to evaluate the impact of the government’s decentralization reform in 1993. They showed that spending on public health care (that benefit to the community at large) actually increased between 1991 and 1997, largely thanks to increased funding from local governments, which allocated more than half of their health resources to public health care .
  • 19. Next steps 19  Test the TrackFin draft Guidance Document in 3-4 countries :  Morocco, Brazil, Ghana and Vietnam have expressed interest  Inviting interest from other countries to join the initiative  Results of these exercises will be presented in an annex of GLAAS 2014 on the TrackFin process and findings in test countries  Learn from this testing for development of a revised methodology for GLAAS 2016 and development of WASH Accounts in other countries
  • 20. 20 Thank you for your attention! Sophie@tremolet.com Marie-alix@tremolet.com gordonb@who.int allelyd@who.int

Editor's Notes

  1. In Mexico, in order to identify funding needs and inform budget allocation, HA were disaggregated to show per capita health expenditure by state and compare it with health status data. After HA revealed that states with major health needs were receiving lower transfers via the system, a policy was set up to channel public funds to protect the population of those states in major need. HA is the tool that is now monitoring the implementation of this policy (The World Bank , 2010).HA are used to allocate spending according to cost-efficiency of service provision. In Sri Lanka, HA estimated the total costs of diseases by types of providers (hospitals, ambulatory services, pharmaceutical companies, etc.) and revealed the weight of hospitals costs. This finding influenced policymakers to focus on enhancing primary health care and promoting specific preventive interventions (Hernandez, 2012).
  2. Rwanda: HA have also contributed to prioritise funding to major diseases according to different strategies of care provision. In Rwanda, the government developed sub-accounts for HIV /AIDS in their first round of NHA in 1999 to better understand the sources and distribution of financing for HIV/AIDS care services. It revealed that 10% of all health funds were used for the prevention and treatment of this disease. Only 1% of donors’ funds were targeting HIV /AIDS and households were carrying 93.5% of those expenditures. These findings were used by the Ministry of Health to design targeted interventions to improve HIV/AIDS prevention financing and to encourage donors to increase funding allocated to HIV/AIDS (Barnett & al, 2001). Other example on the coordination of donor aid in TanzaniaHA findings are also used to gain support for donor aid coordination. In Tanzania for instance, the first NHA study conducted in 1999 revealed that an important part (23%) of health sector expenditures was financed by donors “off-the-government” budget, bypassing the government and directly funding their own health programs. The government used NHA findings to convince donors to strengthen the coordination between their interventions with the adoption of a Sector Wide Approach (SWAp) and to channel their funds through a basket of funds managed by the government. This increased its leadership and oversight over the use of health funds (De & al, 2003).
  3. In the Philippines, HA have been used to evaluate the impact of the government’s decentralization reform in 1993. Prior to the reforms, both central and regional government funding for public health care (services such as immunization, which benefits the community at large as well as the individual) was low, with central government funding actually decreasing significantly. The comparison of national HA conducted before and after decentralization showed that spending on public health care actually increased from 25% to 35% of total government health spending between 1991 and 1997 (see figure below). This increase was largely due to increased funding from local governments, which allocated more than half of their health resources to public health care in 1997. The annual production of national HA provided significant insight on the impact of decentralization on health care ( Partners for Health Reformplus, 2002).