Introduction to Expenditure Tracking

1. Introduction to Expenditure Tracking CEGAA-OSI EE Partners Workshop March 2009 Teresa Guthrie Centre for Economic Governance and AIDS in Africa

2. Tracking Resources ~ What do we want to know? To describe the financial flows for health issues – because not easily found in budget documents: • who pays (sources)? • who manages the funds (financing agents)? • who provides the services (providers)? • what was provided (functions/ASC: prevention, treatment, social mitigation, other sector activities)? • which are the components (Objects of expenditure)? • who benefits (beneficiaries)?

3. Methods and Steps in Budget Monitoring and Expenditure Tracking • The initial planning stages are critical, during which time, understanding and agreement are reached on: • The focus/ topic of the project • The scope of the project: • Which phase/s of the budget are being considered (see next slide: preparation (need assessment, costing, resource allocation, processes), budgeted allocations analysis, expenditure analysis, output analysis, impact analysis) • Which years are to be covered • Which sources of funds (public and/or external and/or private) • Which providers of services – all, only district level, health facilities, schools, etc etc? • Use of the correct terminology – refer to next slide

4. Budget Monitoring, Expenditure Analysis and Resource Tracking Assessment of Resource Need – costing analysis Budget Monitoring Process Actual amounts Revenue & tax Sector analysis Budget Allocations – indication of intended PUBLIC expenditure Your use of the data will influence all these aspects Outcome analysis – long-term indicators. Impact assessment Public Private Donor Actual Expenditure – execution of budget. Can include all sources of funds and by all service providers Life years saved Quality of life Reduced prevalence rates Causal link Effectiveness (CEA/CBA/CUA) Expenditure Analysis Process/finance channels Actual amounts Output analysis – interim indicators comparing with objectives of expenditure Outputs Efficiency Effectiveness Quality

5. Resource Tracking: “Top down” & “Bottom up” ASC8 ASC1 ASC2 ASC3 ASC4 ASC5 ASC6 ASC7

6. Source Provider Functions A C B Target Groups Objects of Expenditure Flow of resources from origin to end users: reconstruction of transactions Agent

7. Sources of Data for ET • Top-down: from sources of funds eg donor reports, commitment reports, government budgets etc. • Bottom-up: service provides’ expenditure records, facility level records, governmental dept. expenditure accounts. • Missing data: costing techniques are used to estimate actual expenditure

8. Resource Tracking Process The broad steps in expenditure analysis: • Developing the project ToR ~ identification of potential advocacy issues, partners • Agree on Sample and get permissions • Planning and preparation • Data Collection • Data Processing • Data Analysis • Preliminary findings validation & identification of advocacy campaigns • Final Report & Dissemination • Advocacy campaign implementation

9. Step 1: Planning (1) • Establish core research team - including research agency, advocacy organisation, assoc. of the people affected • Establish a reference group – broader group with representation of all sectors eg. National AIDS Commission (if appropriate), Parliamentary Portfolio Committee • Conduct stakeholder meetings and workshops, secure support for and buy-in to process • Stakeholders should advise on data required and purpose of data collection

10. Step 1: Planning (2) • Collection of all background materialsepidemiological, socio-economic, demographics: • Description of the health sector, key programmes, and legislation • Description of the health financing mechanisms in the country, budget process • Collection of any costing studies in the health topic being examined

11. Health Issue in the country Magnitude, distribution, composition, trends National response Laws/policies NSP & programmes Organisation Services & Providers Groups covered Standard protocols Health expenditures Amounts Sources, agents, providers Flows Cost studies on AIDS/issue Date, coverage, source Information sources Access, quality Budgeted allocations Background Information to collect

12. Step 1: Planning (3) • Agreement on focus, scope and methodology - selection of the specific health programme (or beneficiary group) • Mapping the national response – ie. Identifying all sources, all agents, all providers, all functions, all service-providers – public, private and foreign (this can be done through questionnaires to stakeholders at initial meeting)

13. Step 1: Planning (4) • Prioritisation of key respondents from the list of all players – get contacts! • Development of the necessary sampling frames (e.g. of all NGOs providing health services for the selected programme/ beneficiary group), and selection of appropriate sampling technique • Planning the data collection steps – involves identification of key people within in each organisation/ institution, and setting up interview appointments.

14. Step 1: Planning (5) • Coding of the classifications and categories of functions (services provided), ensuring clear definitions and mutually exclusive categories • Note differences in terminology and standardise • Special projects, activities and services not specified in current classifications: include them in data collection forms • Data collection forms must reflect all the categories identified and coded

15. Step 1: Planning (6) Selecting data sources: • List all potential sources • Rank them by expected share of expenditures • Rank them by quality of records (complete, reliable, certified) • Rank them by accesibility • Prioritise data sources with a large share of the expenditures and better data quality

16. Step 1: Planning (7) • Define strategies & checklist for data collection (interviews, mailing forms, other) • Key informers are informed about the task at hand • Get appropriate permissions to access data, clinic records etc. • Development of data collection tools – different questionnaires for sources / agents and service providers

17. Step 2: Data Collection • Phone each respondent, explain project and use of data, and send appropriate data collection form asking them to gather the sources of required data to complete form • Thorough explanation of project, confidentiality and use of the data are essential • Make an appointment with each and together complete the form using the information they gathered • Collect data using appropriate form, thoroughly and accurately

18. Step 3: Data Processing • Completed forms must be checked for inaccuracies, missing data etc. • Data is captured into excel sheets and cleaned - checks data, identifies gaps, inconsistencies or double counting • If HIV/AIDS study – data can be exported to the NASA-RTS software (if available) • The data input reconstructs each transaction, Where estimates of expenditure have to be undertaken, all assumptions must be clearly explained

19. Step 4: Data Analysis • In this Phase the financing and expenditure flows are completed and cross checked • The indicators are calculated by relating them to other figures such as country population, PLWHA, national health expenditure and others. • Analyse and present the data in appropriate tables and graphs. • Conclusion are drawn.

20. Step 5: Final Report • The draft report is circulated to key stakeholders and government officials, to get their assistance in correcting any errors and filling any gaps. ‘Validation meeting’ suggested • The advocacy messages and strategies are agreed and the report is finalised • The report should point out the areas that need to be translate into action in the immediate future as well as in the mid and long term • The report should be disseminated widely to key audiences in appropriate formats • Awareness raising and advocacy campaigns

21. Classifying and Coding all the Actors and Actors In your issue of study

22. Your Classifications must be: • mutually exclusive and exhaustive. • standardized for internationalcomparisons and comparisons at country level in time trends. • Comprehensive: An inventory of all resources addressed to the issue • Internally consistent: Totals must add-up and be congruent across different variable dimensions and tables.

23. The Groups of Classifications • Financing Sources • Financing Agents • Providers • Production Factors • Spending Categories • Intended Beneficiary Populations FINANCING: PROVISION: USE: Or the Spending Activities in your Issue, ie. ALL the possible interventions/Services

24. Financing Sources: • Financing Sources are entities that provide resources to the Financing Agents to be pooled and distributed • Sources: Public (Ministry of Health, Social Security, etc), Private (Households, Corporations, NGOs, etc) and International (Multilateral, Bilateral, NGOs, Foundations, etc).

25. Financing Sources: • FS.1 Public Funds • FS.1.1 Territorial Government FundsFS.1.1.1 Central or Federal authorities • FS.1.1.1 Central Government Revenue • FS.1.1.2 State / Provincial Government Revenue • … • FS.2 Private Funds… • FS.3 International Funds…

26. Financing Agents: • The Financing Agents are entities that concentrate financing resources from different sources and transfer them to finance a program or as a payment to buy good and services, such as health treatment, prevention activities, etc. • This entities make programmatic decisions on the use of the resources they receive from the Financing Sources. • Financing Agent: Agent Purchaser

27. OVC NAP- OVC NGO Programmatic decisions: • What to buy? (selecting ASC) • For who? (selecting Beneficiary Populations) • Produced by whom? (selecting the Provider)

28. Financing Agents: • FA.1 Public Sector • FA.1.1 Territorial government • FA.1.1.1 Central or Federal authorities • FA.1.1.1.1 Ministry (or equivalent sector entity) of Health • FA.1.1.1.2 Ministry (or equivalent sector entity) of Education • … • FA.1.1.2 State / provincial / regional authorities • … • FA.1.1.3 Local / Municipal authorities • … • FA.1.2 Public Social Security • FA.1.3 Government employee insurance programs. • FA.1.4 Parastatal organizations • FA.2 Private Sector… • FA.3 International Purchasing Organizations…

29. Providers: • Entities that participate in the production of good and services for the response to HIV, or to your issue • To identify the provider, first identify the type of service and the final product (service/ intervention) • The provider is responsible for the delivery, provision and quality of the good and services. • The provider is responsible for the final product, but can either subcontract services or personal or the delivery of the product, or buy the inputs necessary for producing it itself.

30. Provider Example: Hospital Salaries • Opportunistic infections’ (OI) treatment BP.1 People living with HIV Drugs, Materials • Beneficiary Population • Antiretroviral therapy • Provider: Hospital Equipment, Capital • Specific HIV-related laboratory monitoring Energy • AIDS Spending Categories (Outputs) • Production Factors (Input)

31. Providers: • PS.1 Government Organizations • PS1.1 Public and Para-statal Providers • PS1.1.01 Hospitals • … • PS.2 Non-Governmental Organizations • PS.2.1 Non-Profit Providers • PS.2.1.1 Non-Profit Providers (except Faith Based Organizations) • PS.2.1.2 Faith Based Organizations non-profit • … • PS.2.2 For profit Private Providers (including for-profit FBO) • PS.3 Bilateral and Multilateral entities – in country offices • PS.4 Rest-of-the world providers

32. Spending Categories (interventions / services): • The SC reflect programmatic interventions. • From policy and programs to interventions:Condom use, for example, is an intervention that an individual can take to reduce risk from a range of diseases; condom distribution is a preventive program to encourage this intervention; thus, the level of expenditure in this programme reflects government decisions and public policies. • List ALL the possible interventions for your Issue

33. Beneficiary Populations OVC SW Targeted / Intended -Beneficiary Population: • -The Beneficiary Population represents resources allocated to a specific population as part of a programmatic intervention. The BP will be selected according the intention or target of the programmatic intervention…

34. Access to Information Challenges and others... Brainstorm

35. Access to Information Challenges • Annual Budgetary documentation is usually easily available (hard copies mostly, some electronic) • However, little disaggregation of allocations for a particular issue (eg palliative care) - maybe one line-item only • Recorded budget allocations are rarely the actual expenditure & audited expenditure figures not easily available • Previously centralised governments – access difficult & general lack of CSO participation • Varying budgetary, accounting & classification systems – undermines comparability between countries • Donor allocations often not indicated on-budget ~ donors reluctant to share their expenditure records • Lack of centralised database of donor funds coming into the country

36. Challenges/ Gaps cont. • Budget allocation analysis insufficient for issue – need access to expenditure records, and outputs – to assess impact of expenditure. • Increasing analysis of the services/ functions provided (but still limited on target groups). • Limited district level analysis – but necessary to see real impact of spending. • Access to donor spending data (eg PEPFAR, USAID, EU structural funds), IMF conditionalities & public participation in their decision-making processes • Not aware of any use of FOI litigation to access spending data ~ perhaps needing awareness of options

37. Possible Solutions.....?

38. Thank You For more information contact: • Teresa Guthrie • Centre for Economic Governance and AIDS in Africa • Email:teresa@cegaa.org • Teresa.cegaa@gmail.com • Tel: +27-82-872-4694 • Fax: +27-21-425-2852