Dashboard East Africa: Self Reliance Effective Allocation, Utilization and Monitoring of Financial Resources for Family Planning Programs

East Africa: Self-Reliance

Effective Allocation, Utilization and Monitoring of Financial Resources for Family Planning Programs

TCI team during the Mombasa County finance review meeting

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 workplans, 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 contracts mechanism in East Africa.

However, there are challenges during fund allocation due to underfunding, underutilization, weak capacity to manage 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 effectiveness and efficiencies in 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, the government and partners need to strengthen the public financial management process and increase accountability and compliance to the local government systems.

This is to ensure:

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 high-impact interventions (HIIs); and
Catalyzing the increased allocation and expenditure related to FP/AYSRH HIIs.

Why is Effective Utilization & Monitoring of Financial Resources Important for FP/AYSRH Programs?

Monitoring of expenditures against financial commitments ensures that governments are aware of any hitches or delays in spending as per costed workplans 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.

Evidence

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 HIIs.

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

Estimate the need for existing resources available 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 methods, CHVs/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.
Bring together all existing FP/AYSRH program implementers. Invite city program implementation teams, development partners and representatives from accredited private health facilities to share activities of the coming year as well as request for additional budget required for activities within the work plan, such as facility renovations, equipment and supplies, IEC materials, stipends for CHVs/VHTs, etc. Work with FP/AYSRH champions within the health system to support advocacy efforts, requesting additional resources. Review Resource Mobilization strategies.
Prepare the budget for submission. After deliberations with various stakeholders, prepare the budget for submission to relevant budgeting and planning oversight committees.
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 on a monthly basis when funds for the next round of activities will be disbursed to the Program Implementation Team.
Assess the progress. Conduct monthly review meetings to assess the implementation of program activities and financial progress. Make the information available during RAISE assessment meetings 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.
Share the review meeting findings with the Reproductive Health Coordinator and plan for next month’s activities. Participate in feedback meetings with local governments’ budget committees to share progress and impact from funds allocated. Be transparent and allow for verification of expenditure to encourage accountability.

TIP: 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. Here’s an example of a tool that lays out important dates in Kenya’s budget cycle at the national and county levels.

Roles and Responsibilities

There are different players within the city health structure that play complementing roles, from the political leadership, administrative and technical leadership to the implementation team.

The Project Implementation Team (PIT) is critical for the effective monitoring of financial resources for adequately financed, high-quality FP/AYSRH programs. The PIT serves as a management body that plans, coordinates and reviews program operations as well as financial management. The membership includes the reproductive health coordinators for the city, health records officers and the finance coordinator.

Roles	Responsibilities
City finance director/Administrator	Prepares the budget proposal to allocating the available resources to different departments including the health department
City political leadership	Makes decisions about allocation of resources to various departments within the city administrative set up e.g., health, agriculture etc. and creates a legal framework within which the funds are to be shared
City medical officer of health	Works within the department of health Gives the technical guidance and approves how the funds in the department of health are utilized
City level Project Implementation Team (PIT) led by the Reproductive Health Coordinator	Prepares cash requests for FP/AYSRH activities to be implemented at city level Provides financial management coaching to city implementers on an as needed basis Captures and reports city expenditure on a monthly basis Requests all the concerned officers in FP/AYSRH to provide information on all the activities which are to be continued in the new financial year, the activities which need to be discontinued, and any innovative activity that needs to be included Reviews the draft work plan and ensures that funds for FP services logistics, supplies and HR requirements are included in the budget Obtains approval for the finalized work plan/budget for activities and funds Informs all FP/AYSRH units about the approved budgets/activities Monitors the progress according to the approved work plan as well as utilization of funds Advocate for fund release for implementation of FP/AYSRH on a timely basis for activity implementation
Facility in-charge	Spends the money and reports back to the finance
Finance Coordinator/Accountant	Monitors activity costs for various interventions Prepares workplans and budgets for FP/AYSRH activities as per planning cycle Prepares quarterly reporting of the city expenditure on allocated funds to the Reproductive Health Coordinator Ensures compliance of activities as stipulated in work plans and budgets Coaching implementers at various levels on financial management including process flows Provides financial information during periodic review or activity audit

Key Outcomes

Increased in resource allocation and utilization at city level for FP/AYSRH program implementation
Cost-effective management of local government budgets to establish strong FP/AYSRH programs
Enhanced advocacy to unlock resources for impactful implementation of FP/AYSRH HIIs
Institutionalization of the allocations and spending for FP/AYSRH HIIs in city budgets
The operational bottlenecks experienced between the finance team and Program Implementation Team (PIT) within the cities are now solved promptly in the common forum, which is the PIT meeting.
The joint financial reviews by partners act to complement the government audit process.

Monitoring Processes

Pre-award reviews done with the local governments 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 PIT and finance teams
Quarterly finance reviews and verification of the reported expenditures by the cities
Documentation of areas of cost reductions due to program efficiencies developed over time

TIP: 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.

Cost

Coaching material and resources for learning
Budgeting for review meetings
Cost parameters for various FP/AYSRH HIIs

Sustainability

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 for both government and city funds and provide feedback and recommendations for corrective action