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Challenges in Donor Funding in Zambia: the Example of HIV/AIDS Funding. Preliminary observations 27 May 2008. Outline of the Presentation . A) Health Care Financing: 1. Main Sources of Health Financing. 2. Health Financing Modalities. 3. Recent changes to the Funding Modalities.
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Challenges in Donor Funding in Zambia: the Example of HIV/AIDS Funding Preliminary observations 27 May 2008
Outline of the Presentation • A) Health Care Financing: • 1. Main Sources of Health Financing. • 2. Health Financing Modalities. • 3. Recent changes to the Funding Modalities. • 4. Donor funding to health. • B) Challenges of HIV/AIDS funding for the health sector: • 5. Overall • 6. Procurement • 7. Management information systems • HR: talked about elsewhere…???? [Sylvia, you may have to include a few slides on this during the workshop; you decide]
1. Main Sources of Health Financing • MOFNP – taxes (and small? medical levy) • Households – OOP, inc. user fees*; and (community) pre-payments. • External/donor funds – foreign taxes and other external funds (through GIs). • Other sources: • Medical saving scheme (mining companies); • private health insurance, • other e.g., fuel contribution by Total • potentially SHI, etc
2. Health Financing Modalities • SWAp = GBS through MOFNP. • SWAp = direct funding of expanded basket. • SWAp is strongly preferred by MOH. • Vertical funding GAVI, GF, etc. earmarked to specific interventions in health and is on-budget. • Parallel funding: e.g., PEPFAR, which is earmarked to specific interventions in health and is off-budget. • Facility and community level financing: • User fees (now in urban areas only). • Pre-payment schemes??? • Other income generating activitiesSylvia, maybe provide a few examples verbally during presentation (look in PETS report if you need ideas)
3. Changes to the Funding Modalities • Zambia Aids Policy (2005) & Joint Assistance Strategy for Zambia (JASZ) defining Wider Harmonization in Practice (WHIP). • WHIP has involved: • Movements from project to GBS. • Interim movements were observed: • Movement to GBS e.g., EU, DfID, etc. • Movement away from health to other sectors e.g., DANIDA initially moved to education. • Some stayed in Health e.g., Sida, DfID (replacement fund in 2005/06) but are intending to move.
4. Donor Funding: Average Shares of Total Health Expenditure in 2004 (Source: NHA) update with NHA 2007/08, if that is available…
B) Challenges of HIV/AIDS funding for the health sector: • Recall: • 5. Overall • Size of the funds • Planning difficulties • Emerging difficulties in implementation • 6. Procurement • New systems and implication • 7. Management information systems • New systems and implication • Add “8. Human resource” if you included some slides on HR
5. Overall Challenges of HIV/AIDS Funding (Size of the funds)
5. Overall Challenges of HIV/AIDS Funding – Cont’d • Implication of the size…: • National stewardship is potentially weakened. • Preferred SWAp (all the systems, processes, structures, tools, etc) is potentially undermined. • Reporting allegiances are potentially formed with funders. • Mutual accountability is potentially weakened. • Potential health systems distortions / destabilization…
5. Overall Challenges of HIV/AIDS Funding – Cont’d • Potential health systems distortions / destabilization: • Planning cycle mismatches make coordination difficult. • Unplanned HIV/AIDS spending that shows up in health facilities at district level make it hard for MOH to request for supplementary budgets from MOFNP. • HR and other resource deflections (time, attention, etc) goes to well funded programme HIV/AIDS • Specific health system effects • Procurement in health • Management information systems
6. Procurement in Health • New systems: HIV Procurement.xls, and • How involving is HIV procurement?
6. Procurement in Health – cont’d • Implication of new procurement systems and demands: • (+) More efficient HIV procurement systems, e.g., less stock-outs. • (-) Coordinator difficulties, e.g., with transportation/distribution schedules. • (-) Limited externalities LMU has limited spill-over to general health procurement (PSU). • (-) Further limitation of MOH stewardship (not adequately involved in HIV procurement planning).
7. Management Information Systems • HIS: HIV & Health Info Systems.xls, and • How is health information generated and collected?
7. Health information systems – cont’d • Implication of new HISs and demands: • (+) Much more information generated. Note: HMIS has had its own weaknesses, but with HIV… • (-) Disproportionately more information for HIV/AIDS is generated – resource deflection: • ARTIS is information heavy (combination of multiple systems that previous existed) extra burden for HWs; & it has been unable to integrate with HMIS. • SMARTCare was originally for overall patient records/HMIS, but to date ART, ANC-PMTCT & VCT are the only automated services. • (-) Limited feedback to lower levels, does not improve with HIV/AIDS focus info. systems.
Recommendation for Global Partners MOH point of view: • Increased commitment/support to national health systems and programmes; buy into SWAp (joint planning, joint procurements, integrated financing / accounting / information / reporting / etc. systems, etc.). • Improve information sharing about funding amounts and timings, towards improving predictability and fostering national planning/priority setting. • Full subscription by all partners to principle of mutual accountability.
Conclusion Point of view of the series of studies: • A lot has not been covered here (further research is required…) • From preliminary observations: • Government systems require attention. • Government is not sufficiently honouring Aduja declaration & may be sending negative signal. • Partners are not unified: in their willingness to lose some amount of identity; & in buying into government systems. • Long road ahead in building HS, which will require dialogue and like mindedness.
