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Assessing Fiscal Space For Health: Rwanda Case Study. Presenter: Chris Lane World Bank, HD learning week November 13, 2008. Acknowledgements.

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Assessing fiscal space for health rwanda case study

Assessing Fiscal Space For Health: Rwanda Case Study

Presenter: Chris Lane

World Bank, HD learning week

November 13, 2008


Acknowledgements
Acknowledgements

  • Fiscal space paper drafted with Pablo Gottret, June 2008. Contributions from Agnes Soucat, Banefsheh Siadat, Laurence Lannes, Annika Kjellgren (all World Bank) and Sabine Furure (UNICEF).

  • With special thanks to officials at the Rwanda Ministry of Health.


Outline of presentation
Outline of presentation

  • Context

  • Scale up health financing and improving health status

  • MBB costings (marginal budgeting for bottlenecks)

  • Fiscal space scenarios

  • Risks and policy implications


Why is fiscal space for health needed
Why is fiscal space for health needed?

  • 2005 health outcomes are similar to sub-Saharan Africa average. However: fertility rate is above average; HIV prevalence rate among adults is lower than average.

  • Malaria is the principal cause of morbidity and mortality.

  • Life expectancy and U5 mortality are in line with income per head.

  • Economic growth and aid per head are above SSA average

  • Rwanda aims to continue improving health status through 2015.


Health financing expansion
Health financing expansion

donors

households

government

Source: Rwanda, National Health Accounts 2003, 2006


Indications of progress to the health mdgs i
Indications of progress to the health MDGs I

Sources: Rwanda Ministry of Health, Rwanda Economic Devt and Poverty Reduction Strategy


Progress to the mdgs ii
Progress to the MDGs II

Sources: Rwanda Ministry of Health, Rwanda Economic Devt and Poverty Reduction Strategy


Simulation of health mdg costs using mbb
Simulation of health MDG costs using MBB

Sources: Rwanda Ministry of Health/ Unicef/ World Bank MBB simulations May 2008.



Prospective fiscal space for health
Prospective fiscal space for health

Assuming external finance remains

At $250 million per year from 2008

Source: Rwanda NHAs, 2008 Budget, 2008 health donor tracking, author’s assumptions.



Health share of budget macroframework
Health share of budget - macroframework

15 percent of recurrent spending by 2015

Some technical factors

Constant 8.3 percent of recurrent spending after 2010

Source: Rwanda, MoH; EDPRS, MTEF and author’s assumptions


Financing gaps from 2011
Financing gaps from 2011…

Fiscal space for health

High case

Low case

MBB costings

Source: MBB costings, authors estimates based on Budgetary framework,

MTEF, EDPRS.


Policy implications
Policy implications

  • Large increases in health financing have put health MDGs within reach. Expansion of fiscal space for health likely to slow or reverse as aid tops out.

  • Aid dependency of health sector will remain for the foreseeable future (now 80 percent, 67 percent by 2020 in financing scenario).

  • Long-term aid commitments are needed.

  • Achieving the Abuja target also important.

  • Efficiency gains will be needed to cover financing gaps from 2011.


How to realize efficiency gains
How to realize efficiency gains

  • Some mismatch between govt. health priorities and allocation of donor funds: despite aid surge (much of which focussed on HIV/AIDs

  • MoH reports in 2008 financing shortfalls in support for CH workers, human resources for health; rural health services; family planning and reproductive health.

  • Mechanism needed to improve donor alignment.

  • Government-Donor health compact could address the coordination problems.



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