Rapid Budget Analysis FY12/13: Results and Reflection

1. Rapid Budget Analysis FY12/13: Results and Reflection Prepared by DPG Health Troika (GIZ, USAID, DANIDA)

2. Context • Stated purpose: “…input for the GBS annual review … as well as sector reviews; inform planning and budgeting guidelines and MTEF preparations…” • Past: World Bank, with support of the IMF, prepared sector specific RBAs as part of its macro budget analysis (Synoptic Note) • For FY 11/12 no sector RBAs were completed • For FY 12/13 DPs were requested to support preparation of Sector Specific RBAs to feed into the WB/IMF Synoptic Note • Caveat: Only comparison between 11/12 and 12/13 – comparison to other years are not included!

3. Using RBA, PERs and the NHA • Figures are NOT directly comparable! • Different definitions of “Health Sector” • RBA does not capture off-budget aid, PER includes small amount, NHA bigger • NHA calculates health share of GOT expenditure by excluding all donor on-budget funding at MOH level – PER/RBA include the on-budget funding (if not specified otherwise)

4. Defining “Health” “All statements are true, if you are free to redefine their terms “

5. RBA Highlights

6. Strong points of the budget • Health Budget increased in nominal terms • Within the fiscal space left by debt service, the allocation to health as a share of the GOT discretionary budget has grown between FY 11/12 and FY 12/13 • GOT has been putting emphasis on its stated priorities, especially in the area of HRH (spending on health PE) • Main drag on budget was the reduction in foreign on budget funding

7. Weak points of the budget • High inflation has all but wiped out the nominal increase in the health budget • Heavy debt service limits the GOT’s fiscal space for health. • Abuja target seems increasingly unrealistic • Predicted donor support was reduced, especially Global Fund (but now new commitment) • Inter-district inequality in the availability of health resources remains substantial (esp. PE) • The reliability of data presented is not clear. • The inconsistency of LGA data from PMO-RALG and MOF • Lack of standardized district level population estimates

8. Reflections on the budget • Budget is not GOT only - When assessing GOT prioritization need to separate out foreign funding (e.g. GF this year) • Data suggests PE was prioritized – salary raises, increased numbers and/or incentives for more equitable distribution? • How should we define and advance a “goal” for the health sector budget: Amount, per capita amount, increase, budget share (Abuja)?

9. Reflections on the RBA process • How can data become more transparent, timely and reliable? • Data comes piecemeal, with delays and without proper explanations • Comprehensive data from LGAs is lacking – LGAs not included as such in budget, transfers do not distinguish between PE / OC,… • Reliable population for all districts needed • How is the RBA useful for Health DPs / Health Sector? – Macro-monitoring, DP reporting, budget advocacy,…? – How can we maximize its utility? Consideration of new budget circle. • Who should do it? - WB/IMF / Troika / CSOs? • How do we agree to a shared definition of “the health sector”?

10. Asantenisana!