IMPLICATIONS FOR VARIOUS STAKEHOLDERS

1. IMPLICATIONS FOR VARIOUS STAKEHOLDERS OUTLINE 1. FUNDING, BUDGETING AND EXPENDITURE FOR HIV/AIDS, BY GOVT DONORS CSOs and KNOWLEDGE MANAGEMENT INSTITUTIONS IN THAT ORDER 2. USE BOXES FOR ILLUSTRATIVE CASES DR FOLA OLOWU, INTELLFIT, LAGOS

2. GOVERNMENT- FUNDING Implement SWAPS and establish Common Fund for HIV/AIDS ( May need two funds like in Mozambique – Health Response in MOH and Multisector response in Aids Commission) DR FOLA OLOWU, INTELLFIT, LAGOS

3. GOVT FUNDING CONTD • Establish a reserve buffer from Aid funds ( what Maureen Lewis, Centre for Global Development calls “HIV/AIDS Stabilisation Fund “- Finance and Development, Dec 2005. • Build capacity of capital market ( bonds etc) • Prioritise establishment/reform of National Health Insurance Schemes so can improve health sector funding DR FOLA OLOWU, INTELLFIT, LAGOS

4. GOVT-BUDGETING AND EXPENDITURE • Improve on efficiency of budgeting and expenditure process to encourage all donors to put money in the basket as well as “on Budget” and “flow of Funds” • Common Fund mech will provide TA for this- Development of MOU’s etc DR FOLA OLOWU, INTELLFIT, LAGOS

5. BOX 1: TANZANIA • Tanzania could learn from itself and from Mozambique and attempt to unify “disbursement mechanisms” in spite of constraints of “fiscal space”. Global Fund where govt discretion put funds into govt budget, for World Bank little govt discretion- funds are off budget and ring fenced. Later is not ideal, but former which is ideal is not working…so govt must take lead in .. DR FOLA OLOWU, INTELLFIT, LAGOS

6. BOX 1 CONTD • ..temporary solutions to fix the problem (e.g send out letters, use mobile phones etc) but the donors must also be supportive of the longterm solution. This is tied to question of “composition of aid spending” and what was said yesterday about funding all the MDGs. • It is clear that Tanzania cannot solve this HIV/AIDS budgeting problem without significant investment in civil service reforms- personnel motivation (tied to improved wages) and upgrading public financial management systems ( computerised and real time) DR FOLA OLOWU, INTELLFIT, LAGOS

7. BOX 1 CONTD • But Tanzania does have a health common fund, so HIV/AIDS in Tanzania should learn from the health sector in Tanzania. • Common funds are no easy fixes, but they allow donors and govt to prioritise and fund an agreed sector plan over the medium term. • The challenge is linking this and the PRSPs with long term plans and long term donor commitments!!! – but remember there is the constraint that the term of office of governments is medium term !!!... So in reality making it difficult for bilateral aid (50% of aid) to be more guaranted beyond the medium term DR FOLA OLOWU, INTELLFIT, LAGOS

8. GOVT BUDGETING & EXP CONTD • Proactive in resolving bottle necks, for example establish central procurement unit for both MOH, NAC, as well as other projects thus better utilising scare manpower DR FOLA OLOWU, INTELLFIT, LAGOS

9. DONORS - FUNDING • Support development of Common Funds, which facilitate’s eventual transistion to budget support • Increase aid, and provide it for agreed duration for minimum of 5 year planning horizons and see if this could be increased to 10 years DR FOLA OLOWU, INTELLFIT, LAGOS

10. DONORS FUNDING CONTD • Explicitly link relevant political economic issues – terms of trade, revenue mobilisation and democracy/ legitimacy of governments. Govts not pursue some easy ways of increasing revenue cos afraid of legitimacy and accountability issues ( taxation and representation). So prioritise support for “fiscal reform” and “free elections” DR FOLA OLOWU, INTELLFIT, LAGOS

11. DONORS FUNDING CONTD • Make more investments in capacity building, particularly for senior policy makers (ministers and perm secs), training health economists as well as institutional development eg for Central Banks, MOF and Planning Ministries and be ready to compensate developing countries for “brain drain” • Pay more attention to donor coordination at country level ( common fund is a mechanism of achieving this) DR FOLA OLOWU, INTELLFIT, LAGOS

12. BOX 2- CAPACITY IN MINISTRIES OF HEALTH, FINANCE & PLANNING • In 1995 as a UNFPA Technical Adviser working at State level in Nigeria, the Planning Ministry sends out project appraisal and update forms to the MOH, while preparing the capital budget. It has funny terms like “NPV”, “IRR” etc. Folks in MOH do not understand it, so they either do not fill at all, or fill only portions they can understand, so MOF gives MOH very little capital votes… • in 2005, while leading development of Nigeria’s HIV/AIDS NSF, lack of capacity at NACA for health economics was clear, so having health economic capacity in MOH, MOF, Planning authorities and NAC is essential. DR FOLA OLOWU, INTELLFIT, LAGOS

13. BOX 2 CONTD • However how to get this done is not easy. Govt, donors and knowledge management institutions have all fallen short. In Africa only University of Capetown has dedicated “health economics masters programme”, the few health economists trained by donors are poached by the same donors, so while donors not done enough to build capacity in this field, govt itself has not recognised or prioritised the problem ! DR FOLA OLOWU, INTELLFIT, LAGOS

14. DONORS- BUDGETING • Be ready to deal with reality of putting funds “on budget’ and ‘on flow of funds”. This would improve Govts financial systems. • IMF- Evolve concensus on its role, conclude its reforms and do capacity building for IMF Mission Chiefs DR FOLA OLOWU, INTELLFIT, LAGOS

15. CSO FUNDING • Appreciate and better advocate for both govts and donors to prioritise “support for free and fair elections” and “fiscal reform” as these two have significant effects on the ability of govt to increase domestic revenue • Advcate for Donors to make longer time commitments by increasing HIV/AIDS aid time horizon to 5-10 years DR FOLA OLOWU, INTELLFIT, LAGOS

16. CSO FUNDING CONTD • Intensify advocacy to IMF, World Bank, Developed Countries, as well as recipient govts and their parliarments, for each of these various stakeholders to play their roles DR FOLA OLOWU, INTELLFIT, LAGOS

17. CSO BUDGETING AND EXP • Improve its capacity for oversight and accountability of both public and private HIV/AIDS expenditure by budget tracking and better liasion with and implement this in concert with legislatures DR FOLA OLOWU, INTELLFIT, LAGOS

18. KNOWLEDGE MANAGEMENT COMMUNITY - FUNDING • Universities, Research Institutes like IPC etc to prioritise implementation of research on effects of “dutch disease” and the various policy options for ameliorating it so that a concensus can emerge that will guide policy. • Note in absence of concensus, those with power like “IMF’ would decide or drive the decisions DR FOLA OLOWU, INTELLFIT, LAGOS

19. KNOWLEDGE MANAGEMENT COMMUNITY- BUDGETING & EXP • Provide capacity building in budget tracking ( conducting and interpreting of Public Expenditure Reviews, Gender Budgeting etc), Financing (mobilising, pooling & paying providers) and MDGs/PRSPs and HIV/AIDS for staff of CSOs and govt, particularly for the Senior Policy Makers in both sectors (Intellfit runs a 2-3 day course on MDGs/PRSPs & HIV/AIDS in Nigeria) DR FOLA OLOWU, INTELLFIT, LAGOS

20. Who’s in the driver’s seat? DR FOLA OLOWU, INTELLFIT, LAGOS

21. MY TAKE 1 • Ultimately developing countries must take responsibilty for keeping their house in order, ( Box 3- did you notice how Brazils Minister took the “driving seat” during the opening ceremony!) DR FOLA OLOWU, INTELLFIT, LAGOS

22. Will DP’s (donors) really let government drive? DR FOLA OLOWU, INTELLFIT, LAGOS

23. MY TAKE 2 • There is need for a more frank dialogue amongst developing countries in terms of addressing shortcomings that are within their control in order to improve HIV/AIDS funding, budgeting and expenditure e.g better use of NEPADs Peer Review Mechanisms for benchmarking, corrections and experience sharing DR FOLA OLOWU, INTELLFIT, LAGOS

24. FINITO THANKS FOR LISTENING DR FOLA OLOWU, INTELLFIT, LAGOS