East Africa: Self-Reliance
Effective Allocation, Utilization and Monitoring of Financial Resources for Family Planning Programs
Financial management is an integral part of overall health program management. Financial management involves routine financial operations, such as negotiating contracts, making cash available for activity expenses and maintaining a cash flow for unexpected costs. Effective financial management also requires providing members of the leadership team with information to make decisions and plan strategically for the future.
Within East Africa, health care is financed through three primary sources: out of pocket/household, national/local government revenue and donors. Through the annual budgeting process, the government allocates funds for health care services based on work plans, priorities and budget. Often, the funds approved by the national and local governments are inadequate to fully support a well-functioning health system and requires supplemental funding from donors. Broadly, donor funds represent more than 25% of the total expenditure for health care, including family planning, in East Africa. TCI’s Challenge Fund, which falls under the donor financing category, is availed to collaborating local governments through a performance contracting mechanism in East Africa.
However, there are challenges during fund allocation due to underfunding, underutilization, weak management capacity in terms of government planning and financial management systems, lack of political leadership and commitment and competing priorities. These have often resulted in allocated FP funds being redirected to other competing areas and, in some cases, the funds are returned to the national treasury at the end of the financial year due to underutilization. As a result, it is imperative that availed finances are properly managed to ensure effective and efficient health care service delivery.
Why Focus on Effective Allocation, Utilization and Management of Financial Resources?
With the focus of nongovernmental partners and donors on self-reliance, government and partners need to strengthen the public financial management processes and increase accountability and compliance to the local government systems. This will ensure:
- Greater openness, accountability and public participation in financial matters.
- Resources and public borrowing are shared equitably.
- Health care funds are used in a prudent and responsible manner within a clear reporting structure.
- Adaptation to institutional dynamics with a view towards building domestic ownership.
- Constant capacity strengthening of public health officials in relation to effective financial management.
- Regular advocacy to political leadership at all levels of governance to ensure that once a budget has been allocated to a sector, it is not diverted for other use.
TCI has created a platform that leverages on the existing government structures to achieve the following two objectives:
- City-led leadership and implementation of FP/AYSRH high-impact practices (HIPs); and
- Catalyzing the increased allocation and expenditure related to implementation of them.
Why is Effective Utilization & Monitoring of Financial Resources Important for FP/AYSRH Programs?
Monitoring of expenditures against financial allocation ensures that governments are aware of any hitches or delays in spending as per costed work plans and remain on track to meet health program objectives.
Financial monitoring also offers insight for action on implementing more cost-effective and efficient programs.
A clear understanding of the linkages between resource allocation for FP/AYSRH programs, processes of funds mobilization, effective and efficient consumption mechanisms and proper documentation creates an opportunity that can be utilized for smart advocacy for increased program resource allocation.
TCI has witnessed increased allocation and expenditure of FP/AYSRH funds by local governments as they move towards graduation, while it simultaneously has been reducing its own financial support via The Challenge Fund. This demonstrates the capacity of the local governments’ financial system to capture and track both allocations and expenditures related to financing FP/AYSRH HIPs.
An example comes from Kigamboni Municipal in Tanzania, Kilifi County in Kenya, and Iganga district in Uganda where TCI’s participation in city-level budgeting and advocacy resulted in significant increases in funding allocated and utilized for FP/AYSRH across four years.
Guidance on How to Effectively Monitor Financial Resources for FP/AYSRH Programs
- Identify and prioritize resource gaps in the geography. During monitoring visits and reviewing data from facilities, estimate the need for existing resourcesavailable for implementation of FP/AYSRH programs at the start of the planning and budgeting period. Based on the number of facilities in need of FP/AYSRH services, calculate the required human resources, including available trained health providers on FP/contraception, CHVs/CHWs/VHTs, supplies and operating funds, which are presently available, as well as additional requirements to be included in the city budget and annual work plan, including costs associated with private health facilities that provide FP/AYSRH.
- Identify and orient key FP program implementers (e.g., County Executive Committee member (CEC), District Medical Officer, etc.)
- Conduct an orientation on FP program management with the health management team (HMT), including other development partners and representatives from accredited private health facilities to share planned activities and request for any additional financial resources as required for activities within the work plan. Workwithin the health system to support advocacy efforts, requesting additional resources. Review Resource Mobilization strategies and leverage FP/AYSRH champions within the health system to support advocacy efforts, requesting additional resources.
- Prepare the budget for submission. After deliberations with various stakeholders, prepare the budget for submission to relevant budgeting and planning oversight committees. Ensure the champions participate in the budget planning and allocation.
- Operationalize the budget. Once funds are availed from the local government, disseminate to budget holders at city level to ensure that funds are allocated according to the planned activities and the expected milestones are reached as stipulated in the budget. Ensure information on approved budgets is also shared with various stakeholders and partners.
- Develop a plan for fund disbursements based on FP/AYSRH activities to be implemented. To avoid delays in release and disbursements, schedule a date monthly when funds for the next round of activities will be disbursed to the HTM.
- Monitor to ensure utilization of funds to assess progress. Conduct monthly review meetings to assess the implementation of program activities and financial progress. Make the information available during RAISE assessments to implementers to enable them to verify expenditure. This may include activities that were approved in the previous months’ program implementation meeting as well as action plans from quality checks.
- Conduct a review to share feedback with local government (LG) leadership on funds release and utilized. Participate in feedback meetings with local governments’ budget committees to share progress and impact from funds allocated. Be transparent and allow for verification of expenditures to encourage accountability.
- Make sure that all relevant stakeholders are familiar with the budget process, ensuring that they are aware of the processes as well as key dates for submissions and review as it ensures that public expenditure is well planned, executed and accounted for.
- Work with government agencies such as the National Council for Population and Development (NCPD), National Population Council (NPC) for linkages with key decision makers.
- Ensure gender intentionality in identification and selection of HMT for orientation.
- Quarterly financial reviews are an integral part of program management, this offers an opportunity to evaluate the financial investments, emphasize on the strengths and give feedback on the areas for growth.
- Prioritization of FP interventions within the LG
- 100% implementation of activities
- 80% utilization of committed funds
- Implementation of FP interventions within the agreed scope on time and within budget
- Increased allocation for FP by at least 10% annually
- 75% expenditure of allocated funds
- Pre-award reviews done with the LG to assess the adequacy of the financial controls using a pre-award financial and management capacity assessment tool.
- Monthly reporting of city expenditures by the HMT and finance teams.
- Quarterly financial review meetings and verification of the reported expenditures by city.
- Documentation of areas of cost reduction due to program efficiencies developed over time.
- Refreshment/Teas and snacks
- Facilitation fee
- Incorporate the tracking of city funds within performance review processes.
- Integrate the tracking of funds within government systems.
- Plan for activities in line with local government systems.
- Quarterly financial review meetings for both government and city funds and provide feedback and recommendations for corrective action.
- Engage civil society organizations for community accountability to ensure the promises made by the LG leadership are honored.
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