Tracking investments on nutrition Workshop on Costing and Financial Tracking of Nutrition Investments Nairobi, 12 th to 14 th of November 2013 Clara Picanyol, Oxford Policy Management
Table of Content What is resource tracking Tracking aid resources at global level Tracking resources at the country level Budget analysis Public Expenditure Review (PER) Health Accounts CHAI Resource Mapping tool Public Expenditure Tracking Survey (PETS) Tracking system assessment framework Way forward Tracking Investments on Nutrition 2
What is resource tracking? Tracking Investments on Nutrition 3
What is resource tracking? Main challenges Limits in the legal and regulatory framework tracking or financial control might not be covered in every country s budget laws or may lack sufficient clarity not legally binding and therefore depends on the commitment (or lack of) of individual officers Limits in organisational structures and control processes Responsibility spread across several institutions without clear delineation of tasks or coordination Data not generated or not done timely Resource tracking will depend to a large extend to the existing data collection and financial accounting in country Limited capacity to collect data Different interests by different audiences multiple reporting formats Tracking Investments on Nutrition 4
Tracking aid resources at global level (1) Limited literature on tracking resources on nutrition The OECD/DAC Credit Reporting System (CRS) online database is the most extensive and reliable tool reporting regularly on donor aid It is organised in 3 main layers Main sector categories (26) Purpose codes (1 to 18 per category) Activity It contains a purpose code named basic nutrition (12240) Limitations: there are classification errors and it is incomplete Three recent studies using the CRS data The ACF International study (Mutuma et al, 2012) The Development Initiatives study (Di Ciommo et al, 2013) The Donor Network study (AidData, 2013, forthcoming) Tracking Investments on Nutrition 5
Tracking aid resources at global level (2) Main challenges Consensus building on definitions Old-date data Arbitrary attribution (particularly in the case of nutrition sensitive) Under-estimated investments Main lessons Importance of defining the scope Defining the domain of nutrition (specific and sensitive) Working with limited information Making assumptions with attribution Are these similar to countries experiences? Tracking Investments on Nutrition 6
Tracking resources at country level Tool Nutrition expenditures covered (excluded) Frequency of data collection Budget Analysis Expenditures from the national budget classified by ministry, department or agency. Annual PER Health Accounts Typically public expenditure only (not private or investment from external sources). Public and private nutrition expenditures within the health sector, including from external sources. It uses actual expenditure (not budget or commitments). Usually designed as a one-off study Typically every 3-5 years in LMICs CHAI Res Mapping Tool Designed to cover health expenditures from the national budget and from donor resources, with the possibility to import private expenditures. It includes budget as well as actual expenditure. Designed to be carried out regularly PETS It covers public (and non-public in the case of contracting out) units involved in service delivery. Usually designed as a one-off study. Tracking Investments on Nutrition 7
Budget analysis What? Tabulating relevant budget data across different dimensions, e.g. economic or functional classification, and compare expenditure across years and sectors Breadth and depth? Breath defined by the study but depth limited by the level of detail of budget data. E.g. in some countries, it might be limited to main economic classification per department (salaries, overheads or capital) within each department; some countries might provide info by program Isolating nutrition? Potentially where countries adopt a so-called nutrition budget line (has an administrative or a functional code in the CoA). Limitations In terms of coverage, it only covers on-budget expenditure Budgets do not necessarily respond to plans and often cover only a small part of a national costed plan Limited level of detail in the budget compared to a costed plan Salaries and overheads most likely to be reported at an aggregate level Does not assess allocations against a set of desired outputs or objectives E.g. Tanzania Budget Analysis 2009; Namibia budget estimates 2011/12 Tracking Investments on Nutrition 8
Public Expenditure Review (PER) What? Assessment of and recommendations on the level and composition of actual public expenditures over the last 3-5 years, against a predetermined set of policy goals and outputs in national plan Breath and depth? Breath defined by the study but relies on existing reporting and data monitoring systems, including budgets, health accounts or OECD/DAC CRS database which will determine depth Isolating nutrition? Yes, as it can cut across MDAs and will be possible to filter expenditures to the extent that data is available on budgets and programs (e.g. Social Protection PERs) Limitations In terms of coverage, a PER usually covers only domestic expenditure or on-budget aid funded expenditure Usually designed as a one-off study, i.e., it only provides a static picture The size and cost means it is carried out only every 3 to 5 years, but quicker and easier to undertake than National Health Accounts (NHA) If policy objectives are unclear, it can be left as a simple budget analysis E.g. Moldova Social Protection PER 2006-08 Tracking Investments on Nutrition 9
Health Accounts What? Global standardise methodology to measure and categorise health spending resulting in a standard set of tables presenting health expenditure Breath and depth? It covers all health actual expenditures (public, private, external), but limited to health sector. Classifies expenditure by health care function, providers and financing scheme. System of Health Accounts (SHA) 2011 includes reporting by diseases/conditions Isolating nutrition? Where SHA 2011 are used, nutrition could potentially be isolated. Lie et al, 2011 matched a list of 25 nutrition related interventions to Health Accounts codes Limitations In terms of coverage, non-health related expenditures cannot be tracked The diseases/conditions classification is relatively new and not yet institutionalised in countries Attempting to isolate nutrition expenditure would probably mean additional data collection to include memorandum items in the production of NHA In low and middle income countries, it is typically done every 3 to 5 years. E.g. Botswana National Health Accounts 2007/08-09/10 Tracking Investments on Nutrition 10
CHAI Resource Mapping Tool What? data collection tool measuring resources available for the health sector, resulting in a basic spreadsheet where data is inputted and then aggregated into a master data set Breath and depth? Does not cover out of pocket and private expenditure. Classifies expenditure by source, function and location, both budget and actual amounts. Isolating nutrition? Boundaries set more loosely than in NHAs so would need to be designed for this purpose and delineated. As it uses secondary sources, it will depend on the level of detail of those sources Limitations In terms of coverage, with the current categorisation of the tool, non-health related expenditures cannot be tracked Critics argue that boundaries are set loose and what is included and what is not can vary within a country over time and across countries Relatively new tool with experience from a few countries (about 5) Sample template: CHAI Resource Mapping Tool Tracking Investments on Nutrition 11
Public Expenditure Tracking Survey (PETS) What? detailed analysis of the financial flows between public (and nonpublic in the case of contracting out) units involved in service delivery Breath and depth? Based on a sample defined by the study and collect primary data via surveys at all administrative levels. It could in theory be specified to nutrition and to the level of detail required, bearing in mind it relies heavily on administrative and accounting records Isolating nutrition? To the extent that these are identifiable within administrative and accounting records, and can be clearly defined in household and clinic surveys. Limitations It is probably the largest and most costly exercise of them all, Designed as a one-off exercise providing a static picture It is based on a sample and not aimed to provide a comprehensive picture It focuses on leakages and governance issues (including corruption), and not aimed at analysing the allocation or composition of expenditures E.g. South Africa Early Childhood Development (ECD) PETS limited to one programme: the ECD per child subsidy, an earmarked grant. Tracking Investments on Nutrition 12
Tracking System Assessment Framework What makes a system good or bad? Does it allow us to review policy? Does it allow us to plan better? Does it provide us with information to refine our costed plans? Does it allow us to monitor our plans? Does it allow us to close the cycle? Tracking Investments on Nutrition 13
Tracking System Assessment Framework Some ideas of desired features (assessment criteria) may include: Comprehensive? Should it cover both health and non-health nutrition expenditures? Should it cover both nutrition specific as well as nutrition sensitive? What is the link with costed plans/budgets? Timely? Does it need to allow us to track resources annually? Would once every 5 years be enough? User friendly? Can it be easily institutionalised and adapted to different users? (e.g. those inputting information, those having to use it) Alignment and harmonisation? How to integrate with existing systems? Does it require different reporting by agent? (e.g. government, donors) Ownership Does it require buy-in by donors? And by those responsible to use it? How many ministries does this imply? Incentives Should an incentive scheme be designed along with it? Tracking Investments on Nutrition 14
Way forward and debate The initial identified desired features lead us to some considerations for the audience: Do we need a standard tracking mechanism? What do we want to track? based on inputs or outputs, economic classification vs functional, etc. (E.g. the CRS classifies by purpose code, i.e., by output, but does not say anything about composition of exp.) Should the tracking system stay within the boundaries of the national costed plans? If not, What do we want to cover? (within and outside health, nutrition specific and nutrition sensitive, etc.) Who should track what? Which regularity is feasible? How does your existing PFM system limit your resource tracking efforts? Can you work around these limitations?? Alternative or additional desired features? Tracking Investments on Nutrition 15