Resource Tracking for RMNCH:

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1 Resource Tracking for RMNCH: (reproductive, maternal, neonatal and child health) Presenter: Cornelis van Mosseveld, PhD Baktygul Akkazieva, MSc. Contact Coordinator: Tessa Tan Torres Edejer

2 Country Level Recommendations from Commission 4. By 2015, all 74 countries where 98% of maternal and child deaths take place are tracking and reporting, at a minimum, two aggregate resource indicators: 1) total health expenditure by financing source, per capita; and 2) total reproductive, maternal, newborn and child health expenditure by financing source, per capita. 5. By 2012, in order to facilitate resource tracking, compacts between country governments and all major development partners are in place that require reporting, based on a format to be agreed in each country, on externally funded expenditures and predictable commitments. 6. By 2015, all governments have the capacity to regularly review health spending (including spending on reproductive, maternal, newborn and child health) and to relate spending to commitments, human rights, gender and other equity goals and results. 8. By 2013, all stakeholders are publicly sharing information on commitments, resources provided and results achieved annually, at both national and international levels.

3 Country level Commitments to implement the Global Strategy Example Ethiopia: Ethiopia will increase the number of midwives from 2050 to 8635; increase the proportion of births attended by a skilled professional from 18% to 60%; and provide emergency obstetric care to all women at all health centres and hospitals. Ethiopia will also increase the proportion of children immunized against measles to 90%, and provide access to prevention, care and support and treatment for HIV/AIDS for all those who need it, by As a result, the government expects a decrease in the maternal mortality ratio from 590 to 267, and under-five morality from 101 to 68 (per 100,000) by Tracking RMNCH expenditures

4 Why monitor expenditures on health and RMNCH? Hold decision makers accountable to their commitments as expressed in their national health strategic plans and also on MDGs 4 and 5 (and/or other RMNCH goals). Assess the level and distribution of resources regarding alignment with health sector priorities. Evaluate sustainability of financing over time Improve allocation of current spending, reduce waste of resources and improve efficiency. 4 Tracking RMNCH expenditures

5 Rational of the HA measurement To define what is to be measured, to identify the associated resource flows and the records documenting them Data compilation and classification, to collect, organize, summarize and present data in relevant indicators Basic accounting rules To include all resources used during the accounting period, for resident population, avoiding double counting and omissions All resources are included regardless the place of consumption and the origin of the financing (hospital, clinic, medical office, pharmacy, internet, domestic/external, etc.) 5 Tracking RMNCH expenditures

6 System Confusion?! SHA PG LMIC Toolbox NHA Data 6 Tracking RMNCH expenditures

7 System Confusion ---- Clarity? SHA SNA NHA Data NA 7 Tracking RMNCH expenditures

8 Confusion ---- Clarity? SHA SNA System; Methodology NHA NA Implementation; Data 8 Tracking RMNCH expenditures

9 Confusion ---- Clarity SHA SNA System; Methodology HA NA Implementation; Data 9 Tracking RMNCH expenditures

10 HA present aggregates Detailed analyses require additional data The aim is a full and simultaneous distribution of expenditure among all disease groups Main advantages of a full distribution is to ensure the appropriate consolidation and triangulation When data is needed for a specific topic, a detailed account can be performed: Information at intervention level to inform on main program components If developed simultaneous to a full SHA, the risk of overvaluation is reduced Specific accounts allow for easier and greater quality over full distribution Information in both health and non health components (below the line) Boundaries and accounting rules are standard in all cases 10 Tracking RMNCH expenditures

11 Scope: Reproductive, Maternal & Child Health Includes expenditure on 5 priority areas on reproductive and maternal health Antenatal, delivery, post-partum and newborn care High-quality services for family planning, Eliminating unsafe abortion. Combating STIs including HIV, reproductive tract infections, and morbidities. Promoting sexual health. Expenditures on child health during a specified period: Goods & services & activities delivered to the child after birth or its caretaker, whose primary purpose is to restore, improve and maintain the health of children between zero and less than five years of age. 11 Tracking RMNCH expenditures

12 The HA strategy towards RMNCH SHA 2011 framework - Financing Dimension - Provision Dimension COIA indicators - THE by source and per capita by source - RMNCH by source and per capita by source - Consumption Dimension Revenues of financing schemes Beneficiary characteristics Selected items for RMNCH Spending by: Spending by: - Government - Age and gender - Corporations - Disease groups - Age and gender (0-5 years) - Etc. - Geographical - Disease groups (FP & maternal) - Socioeconomic status 12 Tracking RMNCH expenditures

13 RMNCH Reporting levels Main financing sources for health and RMNCH: Government, external resources, and private (household) Reporting based on maturity of health expenditure data: Starting point is the government expenditure (e.g. GET) + external resources outside of government When periodic health accounts exist, a proportion of OOPS can be estimated A table with RMNCH details can be generated, considering preferably: Triangulation and validation not to overstate spending, Constructing it within a HA process Including two classes: RMNCH and the non RMNCH components to get a full oversight of resources used (RMNCH + non RMNCH = HA Totals) When a mature use of the statistical system is feasible, a full distributional table, including RMNCH could be generated Government expenditure is a beginning, but not enough to assess any financing strategy 13 Tracking RMNCH expenditures

14 RMNCH Government Expenditure Tracking Tool -minimum: can be generated annually 14 Tracking RMNCH expenditures

15 NHA Distributional Table: Shows allocation to one relative to others 15 Tracking RMNCH expenditures

16 Subaccount: More in-depth view 16 Tracking RMNCH expenditures

17 Indicators for RMNCH "More policy relevant" indicators: Total amount: Government expenditure/budget Child Health Maternal health Reproductive health (+ Family Planning (as a subset of RH)) RMNCH share of Government health exp (%) Child Health Maternal health Reproductive health "Official" COIA indicators: THE by source & per capita RMNCH by source & per capita Amount spent per beneficiary Government expenditures per capita on MH, RH, CH Government expenditures on child health per child under five years old Government expenditures on MH per live birth Government expenditures on RH per woman of reproductive age 17 Tracking RMNCH expenditures

18 Plan of action of HA (& specific RMNCH accounts) 1. Ensure demand and commitment: RMNCH partners informed, Demand help to address problems and constraints 2. Finding a stable "home" for HA: part of HA and in RMNCH area 3. Drafting a work plan and assess its costs: use the guides for CH and RH accounts. Adjust RH to concise maternal boundaries & FP 4. Setting up a technical team and a steering committee: HA, RMNCH, statistical experts, users of RMNCH data 5. Assessing information availability & needs: sound search of all data sources: expenditure, utilization, costs. 6. Reassess the plan, costs and needs: try to avoid ad hoc surveys, piggyback on others when possible. 7. Institutionalization, a full cycle: HA planning and budgeting processes, demand for data by country leaders, production and dissemination of HA data, the use and application of HA in policy decisions 18 Tracking RMNCH expenditures

19 19 Tracking RMNCH expenditures NHA in Eurasia region

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