Transcript Aid effectiveness in Uganda by Enyaku Rogers ACHS ( B & F)

Aid effectiveness
in Uganda by
Enyaku Rogers
ACHS ( B & F)
Presentation at
Fifth IHP+ Country Health Teams Meeting
2-5 December 2014, Sokha Angkor Resort,
Siem Reap, Cambodia
1
Key features of health financing
• General Government Health expenditure per capita is
US $ 9 excluding external financing
• Health development partners contribute about 45%:
NHA report for FY 2011/12
• On average domestic resources constitute about 53%
of the CHE .
• GCHE as % of GDP is 1.38%, HSSIP recommends
minimum of 4%,
• GGHE as % of TGE is at an average of 9% for the last
three years
• Free access Health services in public facilities
2
Structure of Aid in the Health Sector
• In Uganda, on-budget aid is defined as aid that is
included in the Medium Term Expenditure Framework
(MTEF).
• General and sector budget-Targeted-support are
always classified as on-budget.
• General Budget support is aid that is not attached to
particular projects, but it is usually accompanied by
conditions for policies and/or governance
• Earmarked/Targeted aid resources, or project aid, may
be on-budget or off -budget.
3
Categories of General Budget Support
• MFPED registers four categories of General
Budget Support (GBS):
• grants,
• loans,
• debt relief and
• grants for the Poverty Action Fund (PAF
4
Off Budget Support
• Off budget aid includes donor resources
channeled to the government but also
resources transferred to the private for profit
or not for profit sector.
– support to the war zone in North Uganda. USAID
– Programme Funding-PEPFAR and PMI (the
President’s Malaria
5
Trends in Targeted Funding to the Health
Sector
• In 1999, the Government of Uganda and a large group of
donors agreed on a Sector Wide Approach (SWAp) in support
of HSSP 1.
 User charges for government health care facilities were abolished in
2001.
• the years 2005/06 to 2009/10. HSSP 1 brought an increased
 focus on primary health care (PHC) through a reallocation of
 resources towards districts, and via the districts to lower level health
units.
6
Trends in Targeted Funding Cont’d
• there has been substantial increase in project
funding for health from around 2003-4
onward,
 largely as a result of the global health funds and
other vertical funds for health.
• large part of this funding is off budget
• Declined 2007 due to suspension of GAVI &
Challenges with GFATM
7
Government allocation to health sector
2004/5-2013/14
Table: Government allocation to the Health Sector 2004/05 to 2013/14
.
Year
GoU
Funding(Ushs
bns)
Donor
Projects and
GHIs (Ushs
bns)
Total (Ushs
bns)
Per capita
public health
allocation
(UGX)
Per capita
public health
allocation(US
$)
GoU health
allocation as
% of total
government
allocation
2004/05
2005/06
2006/07
2007/08
2008/09
2009/10
2010/11
2011/12
2012/13
2013/14
219.56
229.86
242.63
277.36
375.46
435.8
569.56
593.02
630.77
710.82
146.74
268.38
139.23
141.12
253.00
301.8
90.44
206.10
221.43
416.67
366.30
498.24
381.86
418.48
628.46
737.6
660
799.11
852.2
1127.48
13,843
26,935
13,518
14,275
20,810
24,423
20,765
25,142
23,756
32,214
8.0
14.8
7.8
8.4
10.4
11.1
9.4
10.29
9
12
9.7
8.9
9.3
9.0
8.3
9.6
8.9
8.3
7.8
8.7
N.B. The per capita public allocation increased majorly due to financing by GAVI and Global Fund.
8
Health Sector Financing 2004/5-2014/15
9
Positive Effects of Targeted Aid in the
Health sector
• Increased funding to the Sector
• Focus on primary health care (PHC) through a
reallocation of resources towards districts
• More harmonized approach to Planning &
Monitoring in HSSP 1 thru; SWAP -Partnership
Instruments: HPAC, JAF. IHP+
10
Positive Effects of Targeted Aid in the
Health sector
• Thru the use of the Joint Budget Support Frame
work the following was put to practice:
Use by DPs of Data by provided by GOU as highlighted
by the Paris declaration of 2005
Emphasis on removal of barriers on Public Finance
management
Use of the Sector Results matrix
Inclusion of Donor Performance in the Assessment
• More Disease specific Interventions;
– HIV, Malaria, Tb..?
11
Increase of Health Facilities 2004-2011
that reduced length to nearest facility
Level
2004
2011
Hospital
55
65
HC IV
151
166
HC III
718
868
HC II
1055
1662
Total
1979
2761
12
Negative Effects of Targeted Aid in the
Health sector
• Unpredictability of the aid
• Less than appropriate input mix
• In accordance with a study commissioned by
ACCORDAIDI in 2011:
– In 2006/07, 74% of all donor funding to the health
sector was
• channeled to the private sector in health a
bulk of which procured non-HSSP inputs
13
Expenditure on Donor Project Aid by
Input 2004/5-2006/7
Input
2004/5
(%)
2005/6
(%)
2006/7
(%)
Average
(%)
Human
Resource
4
5
7
5
Training
0
14
24
13
Drugs
20
58
10
29
Other
Recurrent
7
2
20
10
Capital non
4
Infrastructure
7
1
4
Infra
structure
9
4
5
6
Non HSSP
Inputs
58
9
31
33
14
Effects of the Health Sector Financing
• On average an estimated 37% of the disease based
expenditure is spent on HIV/AIDS ,20% Malaria
and only 14% on reproductive Health.
• Only 16 % of the CHE was spent on prevention
according to the NHA latest report
• About 66% of the CHE is spent on infectious and
parasitic diseases and only 4.3% on average is
spent on non communicable diseases
15
Total Funding by commodity area 2010 2013
16
Percentage of total funding by commodity
area in 2012/13
Vaccines supplies
2%
Essential
Medicines
14%
Laboratory
supplies and
consumables
9%
Malaria
Commodities
11% Anti TB and
leprosy drugs
1%
Reproductive
Health
7%
ARVs + OI drugs
56%
17
Other Challenges to Maximizing Benefits
from Targeted Aid to Health
•
•
•
•
•
•
Institutional Capacity
Aligning Donor practices
Reducing GOU stewardship
Accountability
Overload of Senior Management
Movement of senior staff to Donor
organizations
• Epidemics (Ebola, Murberg)
18
Other Challenges to Maximizing Benefits
from Targeted Aid to Health
• Donors by passing LTIA arrangements e.g
HSBWG and funding departments and Local
Governments
• Direct targeting of Depts and LGs reduces
adherence to one M & E system
• More emphasis on outputs than outcomes
• More emphasis on curative vis avis prevention
• Weak inter sectoral collaboration
19
Government Efforts to Minimize
Challenges
• Revise the Health Financing Strategy including:
– Harnessing complementary financing schemes
• More emphasis on Prevention thru revision of VHT strategy
• Requirement by Donors to seek permission from
MoH before going to LGs
• Strengthening Accountability Measures
• Improve resource tracking of off & on budget
funds to ensure alignment and harmonization
20
THANK YOU
21