Budget Tracking for Health Sector Financing by Civil Society Organisation.

1. BUDGET TRACKING
for CSOs (Health)
Part 1
By
Ofoegbu Donald Ikenna
Researcher/Program Officer
Centre for Social Justice (CSJ)

2. Outline:
• Introduction
• What is budget tracking?
• CSOs & the Knowledge of Budget Process
• Why Track Budget/Expenditure
• Approaching Budget Tracking as an advocacy strategy
• Tracking Approach
• Tracking Health Sector Budget
• Public Expenditure Tracking Survey (PETS)
• A Simple Tracking Template
• Thank You.

3. Introduction
• The government is responsible for and accountable to the
citizens of a country for the protection of human rights and
provision of basic services such as health. Citizens therefore
have the right to influence policy decisions about what, where
and how public resources are spent.
• Advocacy efforts targeted at health budget tracking are critical for ensuring
that governments and donors are providing the services demanded by the
public and are accountable for the resources spent.
• At both the national and local levels, civil society organizations can play an
important role in ensuring transparency and accountability in government
and donor health spending. At the national level, organizations can get
involved in defining priority areas and planning processes. At the local
level, they can oversee and monitor expenditures, and use ground level
findings to call for changes in budget allocations and planning priorities.

4. Budget tracking refers to methodologies that civil society
organizations (CSOs) can use to examine how public
resources flow from one level of government to the
next, and eventually to the intended beneficiaries.
What is budget tracking?
Revenue
Tracking
Expenditure
Tracking
Budget
Tracking

5. CSOs & the Knowledge of Budget Process
• Civil society organizations (CSOs) play an important role in public budgeting. They can help improve budget
policies by providing information on public needs and priorities through their connections with citizens,
communities, and sectors. CSOs (along with legislators, auditors, the media, and the broader public) also can
play an important role in holding the executive accountable for how it uses public resources. When CSOs and
others lack access to budget information or opportunities to engage in budget processes, it opens the door for
the executive to choose unpopular or inappropriate programs, waste money, and allow or engage in
corruption.
• When CSOs can combine an in-depth knowledge of a policy issue, such as health or education, with a solid
knowledge of budgets and an effective advocacy strategy they can positively influence policy decisions.
• Strengthening civil society’s ability to analyze budgets and participate effectively can play an integral role not
only in policies and service delivery but also in constructing a more open and participatory democratic society.
• By engaging in the budget process from formulation through implementation and audit, civil society can:
– contribute critical information on the public’s needs and priorities that can lead to stronger policy choices;
– draw more people into the debate by collecting, summarizing into easily understandable formats, and
spreading budget information;
– train members of the public to understand and analyze government budgets themselves;
– supplement government’s capacity to budget effectively by providing technical support;
– give an independent opinion on budget proposals and implementation;
– hold public officials accountable for using public resources efficiently and effectively to achieve desired
outcomes; and
– develop important new allies in government, including program managers in government agencies,
legislators, and auditors.
However, the ability of civil society to participate in the budget discussion can be thwarted by legal,
institutional, and political barriers. This, combined with the general lack of publicly available information on
budget issues has seriously hindered the efforts of national and local organizations attempting to participate in
the debate on the use of public resources. Although the challenges remaining are substantial, there is
increasing energy pushing governments to open their budgets through information and participation.

6. Why track budget/Expenditure?
• To identify places where the system for transferring funds breaks down,
as well as cases of mismanagement and corruption, expenditure tracking
is yet another tool for CSOs to use to ensure that government budgets
are being executed on the ground as intended, and that scarce public
resources are being used effectively.
• Another place where leakages occur, and where expenditure tracking
tools can identify these, is during the procurement process. When a
government agency needs to purchase goods or services, the following
stages are typically involved: 1) the pre-bidding process, 2) the bidding
process, 3) issuance of a purchase order, 4) inspection of the goods or
services procured, and 5) documentation of accounts payable.
• Strengthen oversight
• Identify systemic problems in intergovernmental transfers
• Uncover instances of mismanagement, inefficiency, or corruption
• Generate evidence to inform ongoing and future budget debates
• Its a legal right; FRA 2007(51) A person shall have legal capacity to
enforce the provisions of this Act by obtaining prerogative order or other
remedies at the Federal High Court, without having to show any special
or particular interest.

7. Approaching Budget Tracking as a Strategy
The following key steps are relevant:
1. Develop advocacy strategy for budget tracking:
•ƒIdentify the key objectives that your organization would like to achieve through the advocacy
effort, based on the issues identified during the budget analysis.
•ƒDefine your ‘theory of change’ in a step-by step manner
describe the rationale and assumptions for each objective, how change will happen and
where you play a role in bringing about the change in government and/ or donor
accountability.
•ƒIdentify specific research questions to be answered through further analysis of the budget.
Understanding and analyzing the lifecycle of public service provision, from policy formulation to
budget-making to final delivery, can inform the identification of research questions.
•ƒIdentify the relevant players who influence the decision making process for the advocacy issue,
and ascertain their degree of influence on the entire process. Research on the decision-making
process.

8. 2. Build strategic alliances:
• ƒDevelop a multi-stakeholder network of partners based on
complementarities and potential for leveraging the partners’
skills, resources and experiences. These alliances can involve
individuals officially involved in the budget processes and
health system as well as research/ academic institutes. Seek
partner organizations that have expertise in budget analysis
and tracking, which is a technical and specialized activity.
• ƒIdentify ‘champions’ within the parliament and/ or the
government (or other decision-makers who can raise issues
in the appropriate forums), and build a relationship with
them.
• ƒApproach potential partners in a targeted manner, and build
trust and reciprocity with the partners by sharing
information, ensuring transparency and supporting each
other’s initiatives.

9. 3. Plan activities for each stage of the budget cycle:
• ƒIn-depth understanding of the budgeting process is critical for the success of
the advocacy initiative. Be aware of the workings of the Ministries of Finance
and Planning, and plan for activities for each stage of the budgeting/ planning
process.
• ƒBudget formulation – influence budget allocation by carrying out research on
the health needs of various groups, disseminating findings of analyses,
producing alternative budgets, and recommending changes to the budget.
• ƒEnactment – engage with media, officials and the general public to push for the
process of enactment to be more open and transparent; and work with
parliamentarians to influence changes.
• ƒImplementation – monitor implementation/ budget spending throughout the
budget cycle through engagement with authorities and service providers;
measure the impact of budget allocations, and disseminate this information to
relevant stakeholders.
• ƒAudit – contribute to the review process by carrying out research on the impact
of spend on specific population groups, weighing inputs against outputs, and
making recommendations on improving the health sector allocations in the next
budget.

10. 4. Manage and deliver communications:
• ƒIdentify the best available vehicles for messaging, e.g. talking
points to be delivered by key influencers in highly visible forums or
bilateral meetings; media products (Twitter, web packages, press
releases, etc.); presentations in parliamentarian forums.
Understanding what a specific audience needs and expects is
critical.
• ƒDelivering the message can fall under three areas – sensitizing the
target audience by cultivating interest, asking the target audience
to take concrete action towards an end, and following up after the
request for action to see if it has been undertaken.
5. Evaluate advocacy efforts:
• ƒEvaluate the advocacy effort on an ongoing basis and use the
feedback generated for streamlining and improving the systems and
processes employed in budget planning and analysis.
• ƒApart from the specific policy outcomes, evaluate advocacy on the
ability to address challenges normally faced in budget tracking and
advocacy, like access to reliable information in terms of the financial
aspects as well as the decision-making process and lack of
transparency and accountability among the government bodies.

11. Tracking Approach
• Tracking approach is a combination of monitoring and investigation. Tracking is
expected to be followed step by step, by patience enquiry or observation, to trace
and track, to search into; examine and inquire into with care and accuracy; taking
evidence, etc. Tracking involves formal ad informal engagement with agencies,
institutions and persons that would lead to voluntary disclosure of information
or the gathering of evidence from which analysis and deductions can be made
on a balance on a balance of probabilities.
• Budget tracking and the resultant report should in addition to the determining
whether a duty was performed or not, and in the traditional media approach seek to
provide answers to:
– What: what is the fiscal duty or assignment?
– Who: who or which institution or office is responsible for carrying out the assignment?
– Which: which institution/office has oversight responsibilities over the primary duty holder?
– When: at what time is the duty supposed to be performed?
– Where: where will the duty be performed?
– Why: why should the duty be performed? and
– How: how is the assignment to be undertaken/implemented?
– Was: was the assignment implemented as planned?
– What: What are the evidences/outcome from its implementation?
• It must be borne in mind that the authority/office being monitored/tracked will not always
be happy with the tracker/monitoring results especially when it is critical of their failing.
Thus it is imperative while highlighting the failure to also give due credit for successes
achieved by the authority.

12. • A first step entails an analysis of the health budget of the
government in terms of the following:
a) Is the budget adequate to meet the stated policy objectives?
b) Is the health sector being sufficiently prioritized?
c) Is there an earmarked budget for the different components under health?
d) Is progress being made in real terms?
e) Are budget allocations equitable?
f) Are resources being spent efficiently and effectively?
Answers to these questions would help identify the
objectives of the advocacy initiative and an appropriate
plan to achieve them. It would also ensure that the
advocacy efforts are evidence-based and starts at the stage
when objectives and need for budget analysis are defined.
Tracking Health Sector Budget

13. Year
Vision
20:2020
(First NIP)
(N'bn)
NSHDP (N'bn) TA (N'bn)
2010 67,277.03 189,244.09 -
2011 120,502.71 189,244.09 -
2012 148,408.09 189,244.09 45,310.00
2013 151,262.76 189,244.09 54,000.00
2014 - 189,244.09 60,000.00
2015 - 189,244.09 70,000.00
Financial Provisions of Components of the NDP on Health
Year
Approved Capital
Health Budget (N)
Actual Release (N) Cash Backed (N) Utilised sum (N)
% of Approved
Capital Budget
Utilised
% of
Released
Sum Utilised
% of Cash
Back Sum
Utilised
2009 50,803,276,901 48,643,289,834 48,658,789,834 24,509,417,925 48.2 50.4 50.4
2010 53,066,015,191 33,570,452,816 33,562,153,452 17,745,264,501 33.4 52.9 52.9
2011 55,414,957,377 38,785,000,000 38,716,000,000 32,165,000,000 58.0 82.9 83.1
2012 60,920,219,702 45,000,074,681 37,171,222,265 33,682,405,609 55.3 74.8 90.6
2013 60,047,469,274 28,838,429,775 28,838,439,775 19,108,867,782 31.8 66.3 66.3
Average 45.4 65.6 68.6
Health Capital Expenditure & Policy Documents (2009 – 2013)

14. Year Total Budget
(N’ Trillion)
Health Allocation
(N’ Brillion)
As % of
Total
As 15% of Total
(N’ Brillion)
Variance of 15%
Benchmark
(N’ Brillion)
1999 315,219,252,837 10,929,579,649 3.5 47,282,887,926 36,353,308,277
2000 537,569,135,062 15,613,509,364 3.0 80,635,370,259 65,021,860,896
2001 851,754,887,883 28,405,884,484 3.3 127,763,233,182 99,357,348,698
2002 840.853,787,128 39,741,137,140 4.7 126,128,068,069 86,386,930,929
2003 765,132,027,979 52,249,106,213 6.8 114,769,804,197 62,520,697,984
2004 918,295,494,202 59,787,376,511 6.5 137,744,324,130 77,956,947,619
2005 1,617,629,111,162 71,685,426,092 4.4 242,644,366,374 170,958,940,582
2006 1,876,302,363,351 105,590,000,000 5.6 281,445,354,503 175,855,354,503
2007 2,266,394,423,477 122,399,999,999 5.4 339,959,163,522 217,559,163,523
2008 1,893,838,933,017 138,179,657,132 5.6 284,075,839,953 145,896,182,821
2009 3,557,683,000,000 154,567,493,157 4.3 533,652,450,000 379,084,956,843
2010 4,427,184,596,534 164,914,939,155 3.7 664,077,689,480 499,162,750,325
2011 4,484,736,648,992 257,870,810,310 5.7 672,710,497,349 414,839,687,039
2012 4,648,849,156,932 284,967,358,038 6.0 697,327,373,540 412,360,015,502
2013 4,924,604,000,000 279,819,553,930 5.7 738,690,600,000 458,871,046,070
Shortfall in the 15% Benchmark to Health Sector
Funding Gap: 15% International Standard for Health Allocation Vs Appropriated Health Allocation. 1999 - 2013

15. Public Expenditure Tracking Surveys
(PETS): Ticking the Check List:
The Public Expenditure Tracking Surveys (PETS) are quantitative exercises that trace the flow of
resources from origin to destination and determine the location and scale of anomaly. These
are distinct, but complementary to qualitative surveys on the perception of consumers on
service delivery. They highlight not only the use and abuse of public money, but also give
insights into the concepts of capture, cost efficiency, decentralization, and accountability.
In absence of a strong institutional infrastructure to manage information flow, tracking surveys
provide a realistic portrayal of the status of demand and supply of services, potentially justifying
a need for creating of cost effective mechanisms of public accountability through, for example,
information dissemination on resource allocation and use.
– What: what is the fiscal duty or assignment or intervention?
– Which: which institution/office has oversight responsibilities over the primary duty holder?
– Who: who or which institution or office or contractor is responsible for carrying out the assignment?
– When: at what time is the duty supposed to be performed?
– Where: where will the duty be performed?
– Why: why should the duty be performed?
– How: how is the assignment to be undertaken/implemented?
– Was: was the assignment implemented as planned?
– What: What are the evidences/outcome from its implementation?
{HYPERLINKs} Tracking the 2015 Budget.
C:UsersCSJ-DonaldIkennaDesktopPROPOSED 2015 BUDGET OF MINISTRY OF HEALTH.doc
C:UsersCSJ-DonaldIkennaDesktopPULLED OUT OF LINE ITEMS THAT FOCUS ON WOMEN AND CHILDREN IN THE BUDGET OF MDAs FROM THE
PROPOSED 2015 BUDGET.doc

16. • CONTRACTING AGENCY/MINISTRY:
• Name & Description of Line Item/Intervention/Project: {is it suppose to be free for end users
or subsidized}:
• Name of Contractor (s):
• Date of Contract Award:
• Contract Number:
• Expected Delivery/Completion Period:
• Amount Awarded Over-time:
• Amount Released Over-time:
• Amount Received (in Fully/Part) Over-time:
• Amount Utilised Over-time:
• Items to be supplied:
– Quantity: is the quantity supplied sufficient?
– Quality: is it value for money? Skilled enough?
– Location of delivery
• Time of Delivery:
• Receiving Office/officer:
• Quantity & Quality Received:
• Disbursement Office: Quantity Disbursed Daily, Weekly, Monthly, Half Year, Quarterly,
Full Year.
• Public Awareness/User Feedback: level of public knowledge/ownership/benefit
A SIMPLE TRACKING TEMPLATE
Public Expenditure Tracking Survey Methodology: Expenditure Tracking, General Methodology-ikenna.pdf

17. Thank You