Teresa GuthrieCentre for Economic Governance and AIDS in

Africa23 May 2008, Geneva

Key QuestionsTo prove the impact of the IHP+ will require strong,

transparent financial information & accounting systems by governments. Are they ready for this? How will IHP+ improve public accountability?

Spending of pooled funds is difficult to track to the specific donor. Are donors ready to accept financial reports that indicate the outputs without linking these to their inputs?

Public contributions to health are key to sustainability of programmes, and therefore donor-dependency must be addressed. How will the IHP+ address this?

Funds for HIV/AIDS have contributed to health systems strengthening & the ‘horizontal vs vertical’ debate is not useful. How will IHP+ ensure diagonal funding?

HIV/AIDS Spending on HSS & gen.Health:

Zambia 15%, Swaziland 11%, Botswana 10%Zambia 2007 Swaziland

2008. Draft NASA findings.

Key Questions (cont.)Evidence of basket funding for HIV/AIDS and Partnership

Forums – donors maintain dominance in determining spending priorities, and can ‘gang up’ against govt. How will IHP+ empower govts?

Are donors ready to allow governments full determination of the use of funds? Will CS input be enabled? Will IHP+ enhance govt budget planning processes?

NGOs provide invaluable services, especially non-health activities. Evidence of funding via government agents to NGOs shows crippling bureaucracy, erratic funding, undermining sustainability, irrational allocative decisions. Will the IHP+ channel donor funds away from direct support to NGOs? Will IHP+ improve the public funding channels to NGOs?

HIV/AIDS has demanded and challenged a multi-sectoral response. It remains dominated by the health sector response, with little co-ordination between the other sectors. Will the IHP+ further entrench the “medicalisation of HIV/AIDS”? Eg….

NB: Does not include funds from provinces' own budgets.

0

500

1,000

1,500

2,000

2,500

2000/1 2001/2 2002/3 2003/4 2004/5 2005/6 2006/7

R m

illio

n (n

omin

al)

Dept. of PublicService &Admin. andDept. ofScience &Tech.

SocialDevelopment:HIV/AIDSProgramme(includingcondtl grants)

Education:HIV/AIDS condtlgrant

Health:HIV/AIDS andTB Sub-programmeincludes condtlgrant

South Africa – HIV/AIDS allocations by sector

Source: Guthrie & Hickey, 2004. ABU, Idasa.

Govt Budget is a powerful economic policy tool to balance the revenue & expenditure, maintain fiscal discipline, and translate policies into services. Undermined by IMF/ WB conditionalities.

Budget allocation is powerful indicator of the priority accorded to health (or other issue), more than policy or legislation, and are key to the sustainability of programmes.

Participatory, transparent, accountable budget & expenditure systems indicate degree democracy in the country.

Monitoring of allocations & expenditure depends upon strong financial information systems!

Transparency & Accountability ~ Govt Allocation & Expenditure Processes

Challenges in Monitoring Allocations & Expenditure

Budget documents:Do not give detailNot actual expenditureNon-standardisedSome donor contributions

off-budgetLimited CS participation

in allocative decisionsAllocations not based on

need/ equityNot used as a planning

tool

Expenditure records:Not available/ accessible to

CSNot disaggregated (by

programme/ facility / district)

Donors do not provide actual expenditure by recipients (vs commitmts/ disbursmts)

NHA data impt but not detailed sufficiently (esp.public sources)

FOI laws in few countries or not used for accessing public expenditure records.

Data Required to Understand all Health Spending

Programme/ Activity

Programme/ Activity

Programme/ Activity

Programme/ Activity

Programme/ Activity

Programme/ Activity

Programme/ Activity

Programme/ Activity

Adjusted from UNAIDS NASA approach.

RecommendationsAll donor contributions to IHP+ must be indicated in the

National Budget documents, and their allocation clearly indicated according to programme and activity.

Govt must account for spending against the allocations and intended priorities, and explain discrepancies.

Governments must improve financial info & accounting systems: accurate expenditure records, accessible, transparent, detailed/ disaggregated.

Civil society must be engaged in the priority setting & allocative decisions for IHP+ funds, & m0nitoring of spending & outputs.

There remains need for direct donor funds for NGOs. These could still be ‘co-ordinated’ by govt (without managing them).

Diagonal funding necessary in the initial phases ~ aligned with national priorities, health plan and HIV NSP.

ConclusionsIHP+ could greatly enhance existing public financial

information & accounting systems. Or cripple them…IHP+ could lead to greater transparency &

accountability, with pressure & monitoring by CS. Or enable greater corruption & misappropriation.

IHP+ could increase health sector spending & development, improving systems which will enhance the response to HIV/AIDS & other diseases requiring specific responses.

Many lessons to be learnt from issues of financing for HIV/AIDS. Lets benefit from those.

Role of CS is critical in monitoring the allocation utilisation, accounting and efficiency of IHP+ funds.

But primary responsibility is the govt’s to account transparently on its expenditure, providing accessible data, establish strong info.systems, and routine explanation of expenditures/ discrepancies.

10

Thank You

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

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