CHAI slide warehouse

Health Sector Resource Mapping Increasing Access to Information to Inform Decision Making 29 August 2013

Objectives

• Share with Parliamentarians, Civil Society, and the Media the context and benefits of a forward looking resource & activity mapping

• Discuss how the results of resource mapping exercises advocate for more funds directed towards women’s and children’s health

• Provide examples of how resource mapping

fits within the Ministry of Health’s work and expenditure analysis processes

• Share some of the work and experience on

Resource Mapping

Key Characteristics:

Simple approach that aims to rapidly capture both forward-looking budget data and high level past expenditures from government and external partners

Health sector wide and can be easily tailored to country’s particular context and needs with deep dives into programs that are significant drivers in a given country (i.e. RMNCH, Human Resources)

Annual exercise built into a country’s annual strategic planning structure

Timing aligned with a country’s fiscal year to integrate within and inform the annual financial planning and decision making processes

Key Features of Resource Mapping

Multi-lateral donors

Bilateral donors

Govt budgets

NGO donors

Budget and expenditure data is collected from across the health sector:

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• A planning tool to reduce duplication and improve coordination and allocation

• A resource mobilization tool to derive detailed gap analyses against costed national plans

• An advocacy tool to minimize multiple financial and programmatic data requests

• Increasing resource constraints

• Increasing attention on greater ‘value for money’ and ‘efficiency and effectiveness’

• Need for more transparency and accountability from all stakeholders

Multiple challenges… …can be addressed with a resource mapping tool

The Increasing Relevance of Resource Mapping

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Who is providing resources for health programs and who is implementing them?

What are available funds being spent on or budgeted?

Where are the resources being spent or budgeted?

• Source of funding • Financing agent • Implementing agent

• What activities are being funded? • Which strategies or programs do these activities fall under? • Which impact, outcome or output of the national plan do

these activities contribute to? • Which cost categories do these activities cover?

• How are funds allocated geographically? • How are funds allocated across different levels of the

health system?

Basic Information Captured in the Resource Mapping Tool

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How is the data collected?

Malawi Ministry of Health Resource Mapping Tool: Activity Input Worksheet

Section 1: Activity and Actors

FY Ending 2012

Row Complete? Row Number ( 2011 - December 2012)

ion 4: GeograSection 3: Categorization of Activity

CurrencyProgrammatic Sub - Function

National Strategic Plan

Please enter "NSP Not Applicable" if the activity is not

related to HIV

National Strategic Plan - Strategic Action

Section 2: Program/Systems Area and Details of Activity

Is there a sub-implementing agent?

(Activity conducted should be attributed to

the lowest level of implementer)

HSSP - Objective

Primary Implementing Agent (list only

one)

If OTHER please specifyFinancing AgentDescription of ActivityProject Name

Sub-Implementing Agent (list only

one)

Programmatic Function

Cent

ral

Com

mod

ity

Proc

urem

ent

HSSP - StrategyPrimary Cost Category

Duplicate Last Row

What? Who? What strategic plan objectives does it contribute to?

Where? With how much? When?

Resource Mapping Tool Snapshot

• The tool is a basic spreadsheet that is easy for data to be inputted by multiple stakeholders and then aggregated into a master data set

• All categories are pre-defined and standardized so to collect a standardized data set that is comparable across development partners, and government

• Web-based platform is possible, but should be considered on a case-by-case basis 6

Resource Mapping Fits within the Broader Financial System

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What resources are available to fund this plan? Projected Supply i.e. resource mapping

What is the gap between the $$ needed and the $$ available? Demand – Supply = Gaps

How much will the RMNCH plan cost to execute? Projected Demand i.e. costed plans

0100200300400

Mill

ions

0% 5% 10% 15% 20% 25%

Drugs, Commodities & ConsumablesSalaries

Technical AssistanceInfrastructure

Other - USG undeterminedOther

TrainingPBF financial support

Behavio(u)r Change CommunicationRunning costs - fuel, electricity, communication, office supplies

Mutuelle financial supportBudget Support

Medical EquipmentFood SuppliesCHW support

ResearchVehicles

Administrative Equipment (e.g. ICT)

Operational Investment

Impact and Outcomes (US$ million) 2009/2010 2010/2011 2011/2012 2012/2013 Total1. The incidence of HIV in the general population is reduced by half by 2012

1.1. Reduced sexual transmission of HIVResource Needs 46.3 49.5 53.1 58.1 207.0Resources Available 20.8 19.2 18.9 18.6 77.5Financing Gap 25.5 30.4 34.2 39.5 129.5 63%

1.2. Reduced mother to child transmission of HIV

Resource Needs 16.6 15.0 15.6 16.5 63.7Resources Available 8.3 7.0 6.6 6.1 27.9Financing Gap 8.3 8.0 9.0 10.4 35.7 56%

1.3. Maintenance of low levels of blood-borne transmission of HIVResource Needs 5.2 5.0 5.1 5.1 20.4Resources Available 1.2 1.2 1.2 1.2 4.9Financing Gap 4.0 3.8 3.9 3.9 15.5 76%

IMPACT 1 TOTAL GAP 37.7 42.1 47.1 53.8 180.7 62%2. Morbidity and Mortality among people living with HIV are reduced by 2012

2.1. People living with HIV systematically receive prophylaxis and treat. for OIs and other coinfectionsResource Needs 11.4 12.0 12.3 12.9 48.6Resources Available 10.0 8.3 7.8 7.3 33.3Financing Gap 1.4 3.7 4.5 5.6 15.3 31%

2.2. All people living with HIV eligible for ART receive itResource Needs 53.3 57.4 63.4 70.9 245.1Resources Available 41.2 39.3 39.1 38.9 158.5Financing Gap 12.1 18.1 24.3 32.1 86.6 35%

2.3. People living with HIV receive care and support according to needsResource Needs 6.4 7.7 9.0 10.7 33.8Resources Available 3.7 3.7 3.7 3.7 14.7Financing Gap 2.7 4.0 5.4 7.0 19.1 57%

IMPACT 2 TOTAL GAP 16.2 25.9 34.2 44.7 121.0 37%3. Persons infected and/or affected by HIV/AIDS have equal opportunities

3.1. People inf./aff. by HIV (incl. child headed households) have improved eco. Opp. and social protectionResource Needs 10.2 4.9 4.9 5.0 25.0Resources Available 2.2 2.2 2.2 2.2 8.9Financing Gap 8.0 2.7 2.7 2.8 16.1 65%

3.2. Social and economic protection are ensured for orphans and vulnerable childrenResource Needs 25.8 35.1 41.8 46.5 149.3Resources Available 16.7 16.4 16.3 16.2 65.5Financing Gap 9.1 18.8 25.6 30.4 83.8 56%

3.3. Reduction of stigma and discrimination of PLHIV and OVC in the communityResource Needs 1.1 1.0 1.1 1.0 4.0Resources Available 0.4 0.4 0.4 0.4 1.6Financing Gap 0.7 0.6 0.7 0.6 2.4 60%

IMPACT 3 TOTAL GAP 17.7 22.0 28.9 33.7 102.4 57%4. Strengthen the coordination institutions at central and decentralised level

Resource Needs 18.2 19.9 20.0 20.3 78.4Resources Available 17.9 16.2 15.8 15.3 65.2Financing Gap 0.3 3.8 4.2 5.0 13.3 17%

5. M&E, Data, and ResearchResource Needs 11.8 14.6 16.8 15.9 59.0Resources Available 9.1 8.8 8.7 8.6 35.1Financing Gap 2.7 5.8 8.1 7.3 23.9 40%

COORDINATION AND M&E TOTAL GAP 3.0 9.6 12.3 12.3 37.2 27%Unallocated resources from USG 4.1 4.1 4.1 4.1 16.6 -TOTAL GAP 70.5 95.4 118.4 140.5 424.7 45%

Relative total gap

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2

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These activities can enable countries to reallocate funds to critical areas where current resources are insufficient in reaching targets

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EXAMPLE 1: A robust gap analysis can uncover inefficiencies in spending that might potentially fill major gaps on other interventions

EXAMPLE 2: In a country facing significant funding shortfall through 2015, a gap analysis can quantify the need and advocate for fundraising to fill any gaps

0

50

100

150

200

250

ART (Universal Access) PMTCT (Switch to B+) Counseling and Testing

Mill

ions

Gap Overage Available Resources Total Need

HIV Antenatal care Deliveries

- 10 20 30 40 50 60 70 80 90

100

ART (Universal Access) Behavior ChangePrograms

Resource Mobilization

Mill

ions

Available Gap New Resources Total Need

Vaccines Antenatal care Resource Mobilization

Resource Mapping is Complementary to Other Expenditure Analysis Processes

Resource Mapping NHA

Government Expenditure Data*

Development Partner Expenditure Data*

Government Budget Data*

Development Partner Budget Data*

Government Expenditure Data (HIV/AIDS)

Development Partner Expenditure Data (HIV/AIDS)

Out of Pocket Expenditures (HIV/AIDS)

Private Expenditures (HIV/AIDS)

Non-Health Portion of HIV/AIDS Expenditures

Government Expenditure Data*

Development Partner Expenditure Data*

Out of Pocket Expenditures*

Private Expenditures*

NASA

* Health Sector Wide

RM can be complementary to NHA and NASA through two key ways: (1) Alignment of timelines , (2) Leveraging of data across the exercises

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Resource Mapping country example: Rwanda

Total Institutional Health Spending in Rwanda (in 2010 US dollars)

Example of District Analysis -- Top Implementers within the Burera District

In this current fiscal year, PIH expects to spend three times more than any other implementer in Burera.

Over time, analysis can cut across years, comparing budget and expenditures

Detailed information at sub-national level to facilitate

decentralization and implementation

Resource Mapping country example: Country geographical breakdowns

1 $- $20 $40 $60 $80

NtchisiDedza

MchinjiKasungu

DowaNtcheuSalima

MangochiMachinga

MzimbaLilongwe

ChikwawaZomba

BlantyreMulanje

BalakaPhalombe

KarongaNsanje

RumphiChitipaThyolo

MwanzaNkhata BayNkhotakotaChiradzulu

LikomaNeno

District30%

Other70%

Looking at on- and off-budget resources together provided a complete picture of what was happening in each district

> $30

$21-30

$11-20

< $11

FY 2012-13 Funding per capita

Per capita funding, FY 2012-13Of total $163 M allocated directly to districts

Map of per capita funding, FY 2012-13 Of total $163 M allocated directly to districts

Sources: 2008 Population and Housing Census, 2010 Demographic and Health Survey, and Resource Mapping

Allocation of funding

Supported by MSF

Mulanje and Salima had highest rates of maternal & child

mortality in 2010 DHS. Mulanjealso has high HIV prevalence

Per capita funding is highest in Neno, supported by Partners in Health. Levels of maternal & child mortality are lower than

in neighboring districts

Mzuzu

Lilongwe

Blantyre

Total Per Capita Expected Resources for Health by County FY 2012-13

Only $106M of the total $196M is allocated to specific counties. Per capita information here only incorporates resources identifiable by county.

Sinoe 73%

Bong83%

Nimba84%

River Gee 86%

$47

$29

$36

$16$34

$21

$17

$38

$29

$17

$37

Mary land $17

Montserrado$22

Margibi$18

$34

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County Per CapitaLofa $47.73 Sinoe $38.08 Nimba $37.10 Grand Cape Mount $36.13 Grand Kru $34.94 Bong $34.57 Gbarpolu $29.19 Grand Gedeh $29.14 Montserrado $22.50 Grand Bassa $21.38 Margibi $18.50 River Gee $17.94 Maryland $17.09 River Cess $17.00 Bomi $16.89

National Average $27.88

Source: MOHSW Resource Mapping

Rwanda

It appears as though Gasabo and Nyarugenge receive the greatest amount of funding

Per Capita Budget and Expenditure by District

Liberia

Malawi

Key Takeaways for Resource Mapping

• The results from the resource analysis empowers the government and stakeholders with information on how to use funds most efficiently

• Encourages stakeholders to better coordinate their work to reduce duplication and align their work with national strategic plans

• Maps financial resources for women’s and children’s health improves accountability and transparency