Tracking Resources for Global Health

1
Tracking Resources for Global Health Progress
toward a policy-responsive system Ruth Levine
Presentation to the High-Level Forum on the
Health MDGs Abuja, Nigeria December 2004
2
Presentation Overview

• Sad stories
• Policy needs for information
• Whats out there now
• Gaps and missing links
• Working on a plan for progress

3
Sad stories

• Immunization finance
• Budget support vs. project support
• Measuring the value of drug donations
• Conversations in capital cities
• Are we closing the gap?

4
Policy needs for information

• Resource mobilization
• Commitments and recent budget execution for
  health priorities
• Donor and government
• Along with estimates of resource requirements
• Resource allocation
• Commitments and recent budget execution for
  health priorities
• Donor and governments
• Along with information about BOD, C/E, government
  role
• Fiscal planning and donor coordination
• Commitments for health priorities
• Donor and governments
• Estimating input-output relationships
• Expenditures by type and level of service
• Donor, governments, private sector
• Along with information about outputs
• Developing better financing strategies
• Expenditures by type and level of service
• Donor, governments, private sector

• - Many uses
• Needs for complementary data
• (HMN)

5
The resource supply chain
Legislative authorization
Developing country
Donor country
Legislative appropriation
Legislative authorization
Allocation by executive
Legislative appropriation
Commitment to contractors/implementers
On-budget
Allocation by executive
Commitment to contractors/implementers
Off-budget
Use of resources to deliver services
6
Whats out there now?

• Government
• Commitments - Special exercises
• Spending - National Health Accounts analyses of
  reported expenditures from budget authorities
• Donor
• Commitments - OECD/DAC CRS
• Spending - Estimates based on past trends
  special exercises
• Private
• Foundations - ?
• Pharma - ?
• Out-of-pocket - Household survey data massaged
  into NHAs

7
Gaps and missing links

• Gaps
• Commitments and disbursements
• Detail by program, intervention, MDG
• Donor coverage
• Country coverage
• Missing links
• Donor-to-country
• NHA-to-budgets
• Inputs-to-outputs
• Health-to-other sectors

8
Working on a plan for progress

• Working Group on Global Health Resource Tracking
• Composed of agency representatives experts
  about NHA, budget tracking, expenditure analysis
• Co-chair with Gustavo Nigenda (FUNSALUD), Brian
  Hammond (OECD/DAC)
• Developing recommendations for a sequence of
  actions that would lead to systematic
  improvements in resource tracking at donor and
  country levels
• Making the case for improved information
• Identifying how to do it and what it would cost
• Setting out the institutional and financing
  options
• Seeking endorsement and action
• Present to High-Level Forum for the Health MDGs
  in December
• Background analyses on-going
• Report out by June 2005

9
Global Health Resource Tracking Working Group

• Members
• Daniel Lopez Acuna, PAHO
• Sono Aibe, David and Lucile Packard Foundation
• Negar Akhavi, Bill Melinda Gates Foundation
• Joseph Annan, UNDP
• Mark Bura, Commonwealth Regional Health
  CommunitySecretariat for East, Central and
  Southern Africa
• Lisa Carty, Bill Melinda Gates Foundation
• Andrew Cassels, WHO
• Karen Cavanaugh, USAID
• Thea Christiansen, Royal Danish Ministry of
  Foreign Affairs
• Don Creighton, Pfizer, Inc
• Paul De Lay, UNAIDS
• Jacqueline Eckhardt-Gerritsen, NIDI
• Francois Farah, UNFPA
• Tamara Fox, William and Flora Hewlett Foundation
• Charu Garg, WHO
• Pablo Gottret, World Bank
• Prea Gulati, GHC

Co-chairs Brian Hammond, OECD/DAC Ruth Levine,
CGD Gustavo Nigenda, FUNSALUD
Project support Katherine Blumer, Project
Manager Eric Lief, Technical Consultant
Additional input Background analyses prepared by
technical experts Civil society
consultation Outreach to stakeholders
Financial support from The Bill Melinda Gates
Foundation
10
Our evolving thinking

• Simultaneous support to donor- and country-level
  tracking
• Need to build on existing systems
• But with recognition that policy needs imply
  changes
• Need to build flexibility to respond to future
  questions
• Realism
• Sequenced, based on starting conditions
• Selective not comprehensive approach
• surveillance metaphor

11
Are we heading in the right direction?

• Feedback
• Participation in background analyses (financing
  agencies)
• Invitation to report back