1. Abt Associates Inc. In collaboration with: I Aga Khan Foundation I Bitrán y Asociados I BRAC University I Broad Branch Associates I Deloitte Consulting, LLP I Forum One Communications I RTI International I Training Resources Group I Tulane Universitys School of Public Health Harmonization of resource tracking initiatives: Experiences from the Africa region Bangkok, January 26 2010 Douglas M Glandon, MPH Health Systems 20/20 Douglas_Glandon@Abtassoc.com

2. 2 Overview Why harmonize resource tracking (RT)? Progress so far Additional strategies that support harmonized RT Looking ahead

3. 3 Why harmonize resource tracking?

4. 4 National Health Accounts (NHA) NHA Subaccounts (HIV/AIDS, RH etc) National AIDS Spending Assessments (NASA) Public Expenditure Tracking Survey (PETS) Development Assistance Database (DAD) Quantitative Service Delivery Survey (QSDS) Public Expenditure Review (PER) Medium Term Expenditure Framework (MTEF) Others … Multiple, uncoordinated RT and planning efforts are a tremendous burden on countries …

5. 5 … and undermine the institutionalization of any of those activities, including NHA Zambia Mali Ghana Zimbabwe Nigeria Mauritius Mozambique South Africa Madagascar Burkina Faso Niger Togo Benin Namibia Botswana Ethiopia Uganda Kenya Malawi Tanzania Rwanda Liberia Egypt DRC Cote dIvoire At least 25 countries are completing or have done an NHA, some multiple times Most NHA estimations still require external technical assistance NHA countries

6. 6 What does RT harmonization mean? Coordinating and combining data collection for different RT exercises to: reduce the burden of data reporting on all partners minimize time and money wasted on duplicative tasks Build linkages between definitions and classifications used by RT systems so that they can speak to one another. Example: In Rwanda, JAWP tracks planned expenditures while NHA tracks actual expenditures. Synchronizing RT with the planning and budgeting cycle so that evidence is made available when it is most useful Example: In 2009, Rwanda switched its fiscal year from the calendar year to the East African Community s standard of July to June. RT exercises need to change accordingly to remain relevant.

7. 7 Harmonization of RT – part of Health Systems 20/20 strategy to institutionalize NHA Resource Tracking – Supply Household expenditure questions as part of routine surveys (no more stand-alone surveys!) Tool for mapping government expenditure categories to NHA Incorporate expenditure tracking into DHIS Donor and NGO online resource tracking databases Harmonization of resource tracking activities in-country Resource Tracking - Demand Country NHA websites with graphing tools Global NHA database Synergies between NHA and policy planning tools Communications techniques to reach civil society audiences 7

8. 8 Progress so far …

9. 9 9 National Health Accounts (NHA) & National AIDS Spending Assessment (NASA) http://www.healthsystems2020.org/content/resource/detail/2321/

10. 10 Harmonizing NHA & NASA in the field Rwanda (2007-8, 2010) NHA/NASA crosswalk tables applied to NHA estimation Namibia (2010) Joint NHA/NASA data collection with UNAIDS DRC (2010) Joint NHA/NASA data collection with UNAIDS, PNMLS Ethiopia (2009-10) Collaboration with UNAIDS in NHA estimation; NHA figures to be used to generate UNGASS tables Vietnam (potential 2010 collaboration) Malawi (potential 2010 collaboration)

11. 11 Harmonizing NHA and the Public Expenditure Review (PER) in the field NHA is a tool that can be used in the PER to map sources and used of funds in the health sector http://www.healthsystems2020.org/content/resource/detail/2240/ Picazo and Zhao of the World Bank conducted PER in Zambia (2009), incorporating NHA results into the analysis

12. 12 Harmonization of PETS and QSDS Public Expenditure Tracking Survey (PETS) with Quantitative Service Delivery Survey (QSDS) 2 micro-level surveys Together give a more complete picture of efficiency and equity of public service delivery 7 country experiences of joint PETS + QSDS* Working group on PETS/QSDS harmonization 2007- 2008 Bernard Gauthier 2006. PETS-QSDS in Sub-Saharan Africa: A Stocktaking Study. World Bank. September 7, 2006.

13. 13 Additional strategies that support harmonized RT

14. 14 Health expenditure questions in household surveys Rwanda (2009) Added health expenditure questions for next Demographic & Health Survey (DHS) DRC (2009-10) Joint Multiple Indicator Cluster Survey (MICS) with UNICEF, WFP, & UNFPA with health expenditure module http://www.healthsystems2020.org/content/resource/detail/2312/

15. 15 A key challenge for NHA is a lack of health expenditure data at the provider level Health Systems 20/20 is developing a health expenditure module to incorporate into existing District Health Information System (DHIS) in Liberia Module will collect data on unit costs of service delivery (drugs/commodities, provider time, etc.) to develop nationwide picture of health spending at public facilities Harmonizing NHA and country HMIS

16. 16 Consolidating health expenditure data from donors and NGOs Collecting donor & NGO health expenditure data currently requires surveys for each NHA estimation Health Systems 20/20 is developing a system for routine collection of donor and NGO health expenditure data that will: Increase the consistency, comparability, and availability of data for health policy planning Facilitate inter-agency coordination of health spending Feed directly into RT activities Currently developing pilot activity in Liberia

17. 17 Looking ahead …

18. 18 Looking ahead, the Health Systems 20/20 Project is ready to: Coordinate in-country activities Contribute to future discussions Collaborate on next action steps Learn from others

19. Abt Associates Inc. In collaboration with: I Aga Khan Foundation I Bitrán y Asociados I BRAC University I Broad Branch Associates I Deloitte Consulting, LLP I Forum One Communications I RTI International I Training Resources Group I Tulane Universitys School of Public Health Thank you Reports related to National Health Accounts are available at www.HS2020.org Health Systems 20/20 is USAIDs global health project to strengthen health systems in developing countries, focusing on integrated financing, governance, operational and capacity building.

20. 20 Annex 1: Illustrative comparison of NHA, NASA and PER National Health Accounts (NHA) Internationally-accepted framework for estimating health expenditures Detailed classifications for categorizing health expenditures by financing source, financial agent, health provider, or function Subaccount methodology allows for more detailed assessments of specific health areas – like HIV/AIDS, malaria, child health etc National AIDS Spending Assessment (NASA) Developed by UNAIDS to track all financial flows for responding to HIV/AIDS Detailed classifications for source, agent, function, provider, beneficiary population etc. Public Expenditure Review (PER) Developed by World Bank to assess public spending in social sectors, including health Policy review and analysis tool; examines whether spending is aligned with policy priorities No fixed or standardized classifications and reporting requirements

21. 21 Annex 2: Illustrative comparison of general NHA, subaccounts, and NASA General NHA HIV/AIDS SubaccountNASAPER Includes Public Sector ExpendituresYes Includes Private Sector ExpendituresYes No Includes Health ExpendituresYes Includes Non-Health ExpendituresNoYes* Yes No Focuses solely on HIV/AIDSNoYes No *As addendum

22. 22 Annex 3: HS 20/20 NHAs in 2009-2010 22 Country NHA TYPE GeneralHIV/AIDSMalariaTBChild Health Reproductive Health Health Information Systems Afghanistan Cote d'Ivoire Democratic Republic of Congo Egypt 2007 DONE Ethiopia Kenya 2008 DONE Liberia 2007/08 DONE Mozambique 08 DRAFT DONE Namibia Nigeria Rwanda Tanzania Uganda 07DRAFT DONE Zambia