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In plenty and in time of need The political economy of allocating public resources to health in Barbados. Jamila Headley (BA, MPH), PhD Student, University of Oxford Priorities 2010, April 23-25, Boston MA. Objectives.
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Jamila Headley (BA, MPH), PhD Student, University of Oxford
Priorities 2010, April 23-25, Boston MA
To make the case for more public health research on the allocation of public resources to health
To discuss general trends in health expenditure in Barbados from 1974 to present
To describe the nature of the budgetary process, especially as it relates to health
To consider how public expenditure on health is affected in times of economic crisis
To consider the implications for changes in the overall size of the health budget for priority setting
Governments must divide scarce financial resources between health, education, the building of roads etc.
At the national level, this is done through the public budgetary process
The process determines both the overall size of the health budget and often how these resources will be distributed at the macro-level
Yet the study of public budgets, and the overall allocation of public resources for health, has been largely neglected in the field of public health
A mechanism for allocating scarce resources
A historical record
A plan for the future
The result of a political process
What do they tell us?
How government will generate revenue and how much government will spend
What government’s priorities are
National consensus about the role of government
A whole lot about the distribution and dynamics of power
Why are they important?
They redistribute wealth
They have fiscal and economic consequences
They allow citizens to hold government accountable
Financial resources are critical to implementation
Wildavsky A. The Politics of the Budgetary Process. Boston: Little, Brown; 1964.
Budgets are “the most operational expression of national priorities in the public sector”
Aaron Wildavsky (1964) “The Politics of the Budgetary Process”
MoH, Heads of Agencies, HPU
Prime Minister, Cabinet, MoF
Each agency/service area prepares their budget
Internal consultations with Minister, PS and HPU
Central Bank, MoF
Prime Minister, Parliament, Senate
MoF, MoH, Heads of Agencies
Ceilings are set for each ministry/area based on Cabinets priorities
Policies for revenue generation devised
MoF advises health ministry of ceiling
Estimates are debated
Any changes are made and vote is taken to approve estimates
Consultations to finalize health budget
Any ceiling overruns and defended and considered
Targets are set for deficit and inflation
Level of revenue estimated and total expenditure recommended
Political and socio-economic environment
Domestic interest groups
International actors (e.g. WB, IMF, IADB)
Effects of the health sector
Ministry of Finance
Ministry of Health
In this clash of concerns, the Ministry of Finance generally comes out on top