Asset Following for Budgetary Responsibility.


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Asset Tracking for Financial Accountability Nirmala Ravishankar Washington, DC January 25, 2010

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Outline Brief Introduction to National Health Accounts NHA as one of numerous Resource Tracking Tools Harmonizing Resource Tracking Tools to Improve Planning and Financial Accountability Ongoing Harmonization Efforts in Rwanda

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NHA: An Introduction

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National Health Accounts (NHA) Method for measuring complete use on wellbeing in a nation including open, private, and benefactor commitments Builds on OECD " s arrangement of wellbeing records Internationally acknowledged and tried (100+ nations) Application to need ranges has prompted advancement of NHA subaccounts HIV/AIDS subaccounts RH subaccount Malaria subaccount CH subaccount

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NHA tracks both the AMOUNT and FLOW of assets through the wellbeing framework MANAGERS of assets: Have power and control over how assets are utilized i.e., automatic duties: e.g. MOH, insurance agencies Financing Source $ Financing Agent End USERS of wellbeing assets: Entities that give/convey wellbeing administration . e.g., doctor\'s facilities, centers, wellbeing stations, drug stores Originators of wellbeing assets: e.g., MOF, families, contributors Actual USE of assets: Service and/or item conveyed. e.g. preventive projects, remedial care, administrator Health Provider $ Function $

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NHA understands a mind boggling arrangement of streams …

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To do that, it utilizes an assortment of sources Executed spending plan of the administration Institutional studies Donors and UN offices NGOs and other actualizing accomplices Employers Insurance suppliers Household study of wellbeing consumption Secondary information sources HMIS Facility information on use Others

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Total wellbeing use as percent of GDP in Namibia developed in first 50% of the decade

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International help represents greatest share of wellbeing assets in Rwanda 53% 1% 28% 42% half 33% 25% 52% 42% 19% 40% 30% 32% 25% 10% 18%

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NGOs and global organizations rise as greatest chiefs of wellbeing spending in Zambia Total: $133,918,260 Total: $164,810,839

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Reflecting on NHA in Africa: The requirement for regulation But NHA estimations keep on being expensive, tedious, and need impressive outside specialized support. No less than 25 nations are finishing or have done a NHA. Some – like Rwanda – have done different rounds. Egypt Mali Niger Burkina Faso Nigeria Ethiopia Liberia Uganda DRC Cote d\'Ivoire Kenya Ghana Rwanda Togo Tanzania Benin Malawi Zambia Mozambique Zimbabwe Mauritius Namibia Use of NHA should be upgraded. Madagascar Botswana South Africa

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Addressing obstructions to NHA standardization

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Demand for orchestrated asset following Harmonized assets following is a key part of the regulation motivation.

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Viewing NHA in Larger Context of Health Resource Tracking

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What is asset following for health?* Health asset following devices measure and examine the stream of monetary assets for enhancing wellbeing They track what amount is streaming, from whom, through whom, to whom, and for what reason *Sources: Powell-Jackson & Mills, A Review of Health Resource Tracking (2007); Berman, National wellbeing accounts in creating nations (1997), Schieber and Poullier, International medicinal services burning through (1986); Levine and Blumer, Gaps and Links: What do we think about asset streams in worldwide wellbeing (2004); Ravishankar et al., Financing Global Health (2009).

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Two levels of asset following International advancement help for wellbeing Resources for the wellbeing part inside a nation

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International asset following devices Track universal assets for enhancing wellbeing in creating nations Typically concentrate on duties, distributions, and in-kind administrations (restorative items, TA) Examples: OECD-DAC " s databases IHME " s improvement help for wellbeing database PLAID database

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National asset following apparatuses Some are centered around the wellbeing segment while others are not Track the stream of assets inside a solitary nation Many RT devices at the nation level have been institutionalized globally National Health Accounts (NHA) NHA subaccounts (HIV/AIDS, RH,etc.) National Aids Spending Accounts (NASA) Development Assistance Database (DAD) Public Expenditure Tracking Surveys (PETS) Countries have built up extra devices mirroring their needs E.g., Joint Annual Work Plan (Rwanda) Some are infection particular Some evaluate past uses while others concentrate on spending plans

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Distinguishing between various types of " instruments " being used in creating nations Multi-Sector Assessment e.g., PER Multi-Sector Planning e.g., MTEF Health Sector Planning e.g., Health segment arranges, national AIDS techniques Health Sector Assessment e.g., Health PER Costing e.g., MBB, HIV/AIDS costing devices Resource Tracking e.g., NHA, NASA, PETS, DAD

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Purpose of asset following To produce prove that can: Enhance coordination among benefactors at the worldwide level Feed into the arranging cycle and enhance asset portion at the national level Be utilized to prepare more assets for disregarded ranges and the wellbeing division all in all, both universally and broadly Be consolidated with measures of wellbeing framework yield and results to survey the execution of wellbeing frameworks Improve monetary responsibility by following stream of assets from budgetary source to the administration it was utilized to convey

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Harmonizing Resource Tracking Tools to Improve Policy Planning and Financial Accountability

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What does harmonization of asset following mean? (1) Rationalizing information accumulation frameworks to lessen the weight of information reporting and increment productivity NHA HIV/AIDS subaccount and NASA have extensive cover. Joining information gathering endeavors diminishes weight of reporting and spares both time and cash (Rwanda, Namibia, Ethiopia, DRC) Including wellbeing consumption addresses in progressing family reviews like the DHS, MICS, PLWHA overviews, and so on spares requirement for remain solitary studies (Rwanda, Namibia, DRC) Tracking office level uses as a component of a nation " s locale level HIS can create truly necessary data efficiently and on a normal premise (Rwanda, Liberia)

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What does harmonization of asset following mean? (2) Greater coordination amongst givers and government organizations Donors work with various government offices in the same nation. They each have diverse timetables and due dates, which should be synchronized (Rwanda) To be pertinent, RT data should be delivered at the perfect time in the Government " s arranging cycle (Kenya and Rwanda)

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What does harmonization of asset following mean? (3) Build linkages between RT frameworks to increment money related responsibility OECD-DAC tracks duties and distributions to the executing accomplice in a nation. NHA and PETS track what happens to the cash once it enters the nation and how it is spent. Joining these two will prompt finish monetary responsibility. In Rwanda, JAWP tracks arranged uses while NHA tracks real consumptions. Preferably, you might want to have the capacity to contrast arranged and genuine consumptions by various on-screen characters.

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Rwanda " s Resource Tracking Harmonization Initiative

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Rwanda is a pioneer in the asset following domain Rwanda has actualized numerous rounds of globally perceived asset following and asset portion examination apparatuses including National Health Account (NHA) and subaccounts for HIV/AIDS, intestinal sickness and RH National AIDS Spending Assessment (NASA) Development Assistance Database (DAD) It has created asset following frameworks of its own to suit the motivations behind GoR and its improvement accomplices Joint Annual Work Plan (JAWP)

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Despite these accomplishments, noteworthy difficulties endure While each of the exercises serves a significant capacity in its own right, they by and large place a substantial weight on all partners Harmonization of various asset following exercises is expected to: Reduce the weight of information reporting Build expository linkages between the diverse asset following activities Domestic limit for undertaking asset following is low

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Ongoing harmonization endeavors in Rwanda Undertake a precise survey of all RT exercises in the wellbeing area Design and execute a harmonization procedure throughout the following six months to make ONE asset following framework which Rationalizes institutional information gathering Synchronizes RT with the legislature " s arranging cycle Implement fit asset following with Rwanda School of Public Health, particularly: Train them to embrace RT practices upon demand from MOH Develop RT educational modules as a major aspect of general educational programs which they can use to prepare others Include family unit consumptions addresses in the up and coming DHS

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Harmonizing information accumulation stages: Reviewing inputs We require the Ministry\'s point by point arranged and executed spending plans . NHA Inputs MOH executed spending Donor and NGO overviews Employer review Insurance study Household consumption study NASA Inputs MOH executed spending Donor and NGO studies Provider study JAWP Inputs Donor and NGO studies MOH arranged spending plan If we don\'t facilitate information accumulation, we will approach accomplices 3 times!

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Harmonizing timing of information accumulation: Pending inquiries When is MOH\'s financial plan for up and coming FY finished ? July 2009 Government of Rwanda June 2010 When is MOH\'s executed spending plan for past FY settled ? Is it right to accept that on-spending backing will take after same arranging and execution cycle? At the point when can executing accomplices report their arranged uses for the following FY? Oct 2009 Sept 2010 USG and all its actualizing accomplices When can executing accomplices report consumptions

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