CEGAA-OSI EE Partners WorkshopMarch 2009

Teresa GuthrieCentre for Economic Governance and AIDS in Africa

Tracking Resources ~ What do we want to know?

To describe the financial flows for health issues – because not easily found in budget documents:

who pays (sources)?who manages the funds (financing agents)?who provides the services (providers)?what was provided (functions/ASC: prevention,

treatment, social mitigation, other sector activities)?

which are the components (Objects of expenditure)?

who benefits (beneficiaries)?

Methods and Steps in Budget Monitoring and Expenditure TrackingThe initial planning stages are critical, during which

time, understanding and agreement are reached on:The focus/ topic of the projectThe scope of the project:

Which phase/s of the budget are being considered (see next slide: preparation (need assessment, costing, resource allocation, processes), budgeted allocations analysis, expenditure analysis, output analysis, impact analysis)

Which years are to be coveredWhich sources of funds (public and/or external and/or private)Which providers of services – all, only district level, health

facilities, schools, etc etc?Use of the correct terminology – refer to next slide

Budget Monitoring, Expenditure Analysis and Resource Tracking

4

Assessment of Resource Need – costing analysis

Budget Allocations – indication of intended PUBLIC expenditure

Actual Expenditure – execution of budget. Can include

all sources of funds andby all service providers

PublicPrivateDonor

Budget MonitoringProcess

Actual amountsRevenue & taxSector analysis

Expenditure

Analysis

Process/finance channels

Actual amounts

Output analysis – interim indicatorscomparing with

objectives of expenditureOutputs

EfficiencyEffectiveness

Quality

Outcome analysis – long-term indicators.Impact assessment

Life years saved

Quality of lif

e

Reduced prevalence rates

Causal link

Effectiveness

(CEA/CBA/CUA)

Your use of the data

will influence all

these aspects

Resource Tracking: “Top down” & “Bottom up”

ASC1 ASC4 ASC5 ASC6 ASC7ASC2 ASC3 ASC8

A C

Source Provider

Functions

B

Objects of Expenditure Target Groups

Agent

Sources of Data for ETTop-down: from sources of funds eg

donor reports, commitment reports, government budgets etc.

Bottom-up: service provides’ expenditure records, facility level records, governmental dept. expenditure accounts.

Missing data: costing techniques are used to estimate actual expenditure

Resource Tracking ProcessThe broad steps in expenditure analysis:1. Developing the project ToR ~ identification of

potential advocacy issues, partners2. Agree on Sample and get permissions3. Planning and preparation4. Data Collection5. Data Processing6. Data Analysis7. Preliminary findings validation &

identification of advocacy campaigns8. Final Report & Dissemination9. Advocacy campaign implementation

Step 1: Planning (1) Establish core research team - including

research agency, advocacy organisation, assoc. of the people affected

Establish a reference group – broader group with representation of all sectors eg. National AIDS Commission (if appropriate), Parliamentary Portfolio Committee

Conduct stakeholder meetings and workshops, secure support for and buy-in to process

Stakeholders should advise on data required and purpose of data collection

Step 1: Planning (2) Collection of all background materials

epidemiological, socio-economic, demographics:

Description of the health sector, key programmes, and legislation

Description of the health financing mechanisms in the country, budget process

Collection of any costing studies in the health topic being examined

Background Information to collectHealth Issue in the

countryMagnitude, distribution,

composition, trends

National responseLaws/policiesNSP & programmesOrganisationServices & ProvidersGroups coveredStandard protocols

Health expendituresAmountsSources, agents,

providersFlows

Cost studies on AIDS/issueDate, coverage, source

Information sourcesAccess, quality

Budgeted allocations

Step 1: Planning (3) Agreement on focus, scope and

methodology - selection of the specific health programme (or beneficiary group)

Mapping the national response – ie. Identifying all sources, all agents, all providers, all functions, all service-providers – public, private and foreign (this can be done through questionnaires to stakeholders at initial meeting)

Step 1: Planning (4) Prioritisation of key respondents from

the list of all players – get contacts! Development of the necessary

sampling frames (e.g. of all NGOs providing health services for the selected programme/ beneficiary group), and selection of appropriate sampling technique

Planning the data collection steps – involves identification of key people within in each organisation/ institution, and setting up interview appointments.

Coding of the classifications and categories of functions (services provided), ensuring clear definitions and mutually exclusive categories

Note differences in terminology and standardise

Special projects, activities and services not specified in current classifications: include them in data collection forms

Data collection forms must reflect all the categories identified and coded

Step 1: Planning (5)

Selecting data sources:List all potential sourcesRank them by expected share of

expendituresRank them by quality of records

(complete, reliable, certified)Rank them by accesibilityPrioritise data sources with a large

share of the expenditures and better data quality

Step 1: Planning (6)

Step 1: Planning (7)

Define strategies & checklist for data collection (interviews, mailing forms, other)

Key informers are informed about the task at hand

Get appropriate permissions to access data, clinic records etc.

Development of data collection tools – different questionnaires for sources / agents and service providers

Step 2: Data CollectionPhone each respondent, explain project and

use of data, and send appropriate data collection form asking them to gather the sources of required data to complete form

Thorough explanation of project, confidentiality and use of the data are essential

Make an appointment with each and together complete the form using the information they gathered

Collect data using appropriate form, thoroughly and accurately

Step 3: Data ProcessingCompleted forms must be checked for

inaccuracies, missing data etc.Data is captured into excel sheets and

cleaned - checks data, identifies gaps, inconsistencies or double counting

If HIV/AIDS study – data can be exported to the NASA-RTS software (if available)

The data input reconstructs each transaction, Where estimates of expenditure have to be undertaken, all assumptions must be clearly explained

Step 4: Data AnalysisIn this Phase the financing and

expenditure flows are completed and cross checked

The indicators are calculated by relating them to other figures such as country population, PLWHA, national health expenditure and others.

Analyse and present the data in appropriate tables and graphs.

Conclusion are drawn.

Step 5: Final ReportThe draft report is circulated to key

stakeholders and government officials, to get their assistance in correcting any errors and filling any gaps. ‘Validation meeting’ suggested

The advocacy messages and strategies are agreed and the report is finalised

The report should point out the areas that need to be translate into action in the immediate future as well as in the mid and long term

The report should be disseminated widely to key audiences in appropriate formats

Awareness raising and advocacy campaigns

In your issue of studyIn your issue of study

Your Classifications must be: mutually exclusive and exhaustive.

standardized for international comparisons and comparisons at country level in time trends.

Comprehensive: An inventory of all resources addressed to the issue

Internally consistent: Totals must add-up and be congruent across different variable dimensions and tables.

The Groups of Classifications

Financing Sources Financing Agents Providers Production Factors Spending Categories Intended Beneficiary Populations

FINANCING:

PROVISION:

USE:

Or the Spending Activities in your Issue, ie. ALL the possible interventions/Services

Financing Sources are entities that provide resources to the Financing Agents to be pooled and distributed

Sources: Public (Ministry of Health, Social Security, etc), Private (Households, Corporations, NGOs, etc) and International (Multilateral, Bilateral, NGOs, Foundations, etc).

Financing Sources:

Financing Sources:

FS.1 Public Funds FS.1.1 Territorial Government Funds FS.1.1.1

Central or Federal authorities FS.1.1.1 Central Government Revenue FS.1.1.2 State / Provincial Government Revenue

…

FS.2 Private Funds…

FS.3 International Funds…

Financing Agents:

The Financing Agents are entities that concentrate financing resources from different sources and transfer them to finance a program or as a payment to buy good and services, such as health treatment, prevention activities, etc.

This entities make programmatic decisions on the use of the resources they receive from the Financing Sources.

Financing Agent: Agent Purchaser

Programmatic decisions:

What to buy? (selecting ASC)

For who? (selecting Beneficiary Populations)

Produced by whom? (selecting the Provider)OVC OVC

Hospital

NGONAP

Financing Agents: FA.1 Public Sector

FA.1.1 Territorial government FA.1.1.1 Central or Federal authorities

FA.1.1.1.1 Ministry (or equivalent sector entity) of Health FA.1.1.1.2 Ministry (or equivalent sector entity) of Education …

FA.1.1.2 State / provincial / regional authorities …

FA.1.1.3 Local / Municipal authorities …

FA.1.2 Public Social Security FA.1.3 Government employee insurance programs. FA.1.4 Parastatal organizations

FA.2 Private Sector… FA.3 International Purchasing Organizations…

Providers:

Entities that participate in the production of good and services for the response to HIV, or to your issue

To identify the provider, first identify the type of service and the final product (service/ intervention)

The provider is responsible for the delivery, provision and quality of the good and services.

The provider is responsible for the final product, but can either subcontract services or personal or the delivery of the product, or buy the inputs necessary for producing it itself.

Provider Example: Hospital

Opportunistic infections’ (OI) treatment

Production Factors (Input)AIDS Spending

Categories (Outputs)

Salaries

Drugs, Materials

Energy

Beneficiary Population

Equipment, Capital

Antiretroviral therapy

Specific HIV-related laboratory monitoring

BP.1 People living with HIV

Provider: Hospital

Providers: PS.1 Government Organizations

PS1.1 Public and Para-statal Providers PS1.1.01 Hospitals …

PS.2 Non-Governmental Organizations PS.2.1 Non-Profit Providers

PS.2.1.1 Non-Profit Providers (except Faith Based Organizations) PS.2.1.2 Faith Based Organizations non-profit …

PS.2.2 For profit Private Providers (including for-profit FBO)

PS.3 Bilateral and Multilateral entities – in

country offices PS.4 Rest-of-the world providers

Spending Categories (interventions / services):

The SC reflect programmatic interventionsprogrammatic interventions.

From policy and programs to interventions: Condom use, for example, is an interventionintervention that an individual can take to reduce risk from a range of diseases; condom distribution is a preventive programpreventive program to encourage this intervention; thus, the level of expenditureexpenditure in this programme reflects government decisions and public policiespublic policies.

List ALL the possible interventions for your Issue

The Beneficiary Population represents

resources allocated to a specific population as part of a programmatic intervention. The BP will be selected according the intention or target of the programmatic intervention…

Beneficiary Populations

OVCSW

Targeted / Intended -Beneficiary Population:

Brainstorm

Access to Information ChallengesAnnual Budgetary documentation is usually easily

available (hard copies mostly, some electronic)However, little disaggregation of allocations for a

particular issue (eg palliative care) - maybe one line-item only

Recorded budget allocations are rarely the actual expenditure & audited expenditure figures not easily available

Previously centralised governments – access difficult & general lack of CSO participation

Varying budgetary, accounting & classification systems – undermines comparability between countries

Donor allocations often not indicated on-budget ~ donors reluctant to share their expenditure records

Lack of centralised database of donor funds coming into the country

Challenges/ Gaps cont.Budget allocation analysis insufficient for issue –

need access to expenditure records, and outputs – to assess impact of expenditure.

Increasing analysis of the services/ functions provided (but still limited on target groups).

Limited district level analysis – but necessary to see real impact of spending.

Access to donor spending data (eg PEPFAR, USAID, EU structural funds), IMF conditionalities & public participation in their decision-making processes

Not aware of any use of FOI litigation to access spending data ~ perhaps needing awareness of options

Thank You

For more information contact:Teresa GuthrieCentre for Economic Governance and AIDS in

Africa Email: teresa@cegaa.orgTeresa.cegaa@gmail.com Tel: +27-82-872-4694Fax: +27-21-425-2852