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Assessing Fiscal Space For Health: Rwanda Case Study

Assessing Fiscal Space For Health: Rwanda Case Study. Presenter: Chris Lane World Bank, HD learning week November 13, 2008. Acknowledgements.

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Assessing Fiscal Space For Health: Rwanda Case Study

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  1. Assessing Fiscal Space For Health: Rwanda Case Study Presenter: Chris Lane World Bank, HD learning week November 13, 2008

  2. Acknowledgements • Fiscal space paper drafted with Pablo Gottret, June 2008. Contributions from Agnes Soucat, Banefsheh Siadat, Laurence Lannes, Annika Kjellgren (all World Bank) and Sabine Furure (UNICEF). • With special thanks to officials at the Rwanda Ministry of Health.

  3. Outline of presentation • Context • Scale up health financing and improving health status • MBB costings (marginal budgeting for bottlenecks) • Fiscal space scenarios • Risks and policy implications

  4. Why is fiscal space for health needed? • 2005 health outcomes are similar to sub-Saharan Africa average. However: fertility rate is above average; HIV prevalence rate among adults is lower than average. • Malaria is the principal cause of morbidity and mortality. • Life expectancy and U5 mortality are in line with income per head. • Economic growth and aid per head are above SSA average • Rwanda aims to continue improving health status through 2015.

  5. Health financing expansion donors households government Source: Rwanda, National Health Accounts 2003, 2006

  6. Indications of progress to the health MDGs I Sources: Rwanda Ministry of Health, Rwanda Economic Devt and Poverty Reduction Strategy

  7. Progress to the MDGs II Sources: Rwanda Ministry of Health, Rwanda Economic Devt and Poverty Reduction Strategy

  8. Simulation of health MDG costs using MBB Sources: Rwanda Ministry of Health/ Unicef/ World Bank MBB simulations May 2008.

  9. ..

  10. Prospective fiscal space for health Assuming external finance remains At $250 million per year from 2008 Source: Rwanda NHAs, 2008 Budget, 2008 health donor tracking, author’s assumptions.

  11. Much depends on the US: Source of 50 percent aid for health

  12. Health share of budget - macroframework 15 percent of recurrent spending by 2015 Some technical factors Constant 8.3 percent of recurrent spending after 2010 Source: Rwanda, MoH; EDPRS, MTEF and author’s assumptions

  13. Financing gaps from 2011… Fiscal space for health High case Low case MBB costings Source: MBB costings, authors estimates based on Budgetary framework, MTEF, EDPRS.

  14. Policy implications • Large increases in health financing have put health MDGs within reach. Expansion of fiscal space for health likely to slow or reverse as aid tops out. • Aid dependency of health sector will remain for the foreseeable future (now 80 percent, 67 percent by 2020 in financing scenario). • Long-term aid commitments are needed. • Achieving the Abuja target also important. • Efficiency gains will be needed to cover financing gaps from 2011.

  15. How to realize efficiency gains • Some mismatch between govt. health priorities and allocation of donor funds: despite aid surge (much of which focussed on HIV/AIDs • MoH reports in 2008 financing shortfalls in support for CH workers, human resources for health; rural health services; family planning and reproductive health. • Mechanism needed to improve donor alignment. • Government-Donor health compact could address the coordination problems.

  16. Thanks for listening …..

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