Tessa Tan-Torres Edejer

tantorrest@who.int WHO Health Systems Financing Department

Resource Tracking for RMNCH:

(reproductive, maternal, neonatal and child health)

Country Level Recommendations from Commission

4. By 2015, all 74 countries where 98% of maternal and child deaths take place are

tracking and reporting, at a minimum, two aggregate resource indicators: 1)

total health expenditure by financing source, per capita; and 2) total

reproductive, maternal, newborn and child health expenditure by financing

source, per capita.

5. By 2012, in order to facilitate resource tracking, “compacts” between country

governments and all major development partners are in place that require

reporting, based on a format to be agreed in each country, on externally

funded expenditures and predictable commitments.

6. By 2015, all governments have the capacity to regularly review health spending

(including spending on reproductive, maternal, newborn and child health) and

to relate spending to commitments, human rights, gender and other equity

goals and results.

8. By 2013, all stakeholders are publicly sharing information on commitments,

resources provided and results achieved annually, at both national and

international levels.

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Hold decision makers accountable to their commitments as

expressed in their national health strategic plans and also on

MDGs 4 and 5 (and/or other RMNCH goals), and MDG6.

– Assess the level and distribution of resources regarding alignment with

health sector priorities.

– Evaluate sustainability of financing over time

– Improve allocation of current spending, reduce waste of resources and

improve efficiency.

Why monitor expenditures on health and RMNCH?

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Country level Commitments to implement the Global Strategy Examples from WPRO

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THE BUDGET PROCESS

II- Operational

plan and budget

proposal

III- Budget

negotiation

IV- Budget

consolidation and

approval

V- Financial

tracking and

audit

Activity plan

Input

requirements

Input costs

Preliminary

budget

Internal revision

Negotiation with

Ministry of

Finance

Budget approval

by Ministry of

Finance

Distribution of the

budget by line

items

Monitoring of

financial

disbursements

by budgetary

line items

I- Strategic

plan

Timeline

Strategic

areas

Policies

Targets

Slide taken from a presentation by

Tania Dmytraczenko

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Reproductive and Maternal Health

Includes 5 priority areas identified in the Global

Reproductive Health Strategy

– Antenatal, delivery, post-partum and newborn care

– High-quality services for family planning, including infertility

services.

– Eliminating unsafe abortion.

– Combating STIs including HIV, reproductive tract infections,

reproductive health-related cancers, and other gynaecological

morbidities.

– Promoting sexual health.

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Child Health

Expenditures during a specified period of time on:

– goods, services and activities delivered

– to the child after birth or its caretaker

– whose primary purpose is to restore, improve and maintain the

health

– of children between zero and less than five years of age.

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Three levels of reporting

There are three main sources of funding for health and

RMNCH

– External resources (ODA), government and private (household)

Depending on current level of health expenditure

reporting:

– Minimum all countries, annual: RMNCH government

expenditure tracking tool; to include ODA outside of

government once compacts are developed

– If with periodic national health accounts, full distributional table,

including RMNCH

– If already with yearly NHA, full distributional table and

subaccounts (RMNCH)

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Examples of preliminary estimates presented by participants on 3rd day of workshop

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Cambodia

The Philippines

Example: government and external resource funding (annual)

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NHA Distributional Tables: Preferable to stand-alone subaccounts

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Reproductive Health subaccounts:

Egypt

Ethiopia

Georgia

Jordan

Karnataka State, India

Malawi

Increasing demand for child and reproductive health subaccounts at country level, but limited implementation to date

Child Health subaccounts:

Bangladesh

Ethiopia

Liberia

Malawi

Sri Lanka

Tanzania

• Mexico

• Morocco

• Rwanda

• Senegal

• Sri Lanka

• Tanzania

• Ukraine

www.who.int/nha/developments/en/

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Service utilisation data used to apportion % budget / expenditure to RMNCH

Direct estimates and/or a % share allocated to RMNCH

Direct estimates

Direct estimates

1. Shared Resources (e.g., Service delivery costs,

HRH, general care)

2. Commodities (e.g., vaccines, ITNs)

3. Programme-management

specific activities (i.e., national programme budget)

Type of RMNCH expenditure / budget data

4 components

4. Incentives

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Total amount: Government expenditure/budget Child Health

Maternal health

Reproductive health (+ Family Planning (as a subset of RH))

RMNCH share of Government health exp (%) Child Health

Maternal health

Reproductive health

Amount spent per beneficiary Government expenditures per capita on MH, RH, CH

Government expenditures on child health per child under five years old

Government expenditures on MH per live birth

Government expenditures on RH per woman of reproductive age

Indicators for RMNCH

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NATIONAL HEALTH ACCOUNTS (NHA) FRAMEWORK AND

GOVERNANCE

There is an officia l ly approved NHA framework bui l t upon

international guidel ines

There is a formal governance mechanism that speci fies

coordination, management, national indicators and

budget for implementing the NHA

COMPACT

There is a formal agreement (or compact) between

government and partners that requires reporting on

partner commitments and disbursements , and donor

funded expenditures on health, (including on RMNCH).

COORDINATION

There is an NHA steering committee that provides

technica l overs ight on data needs , methods of production

and data use

Key s takeholders are actively involved in the production

of NHA (including government s takeholders at national

and subnational level , CSOs , NGOS, partners , health

insurance companies )

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PRODUCTION

There is adequate human capacity at national and

subnational levels to produce NHA data and core

indicators .

Government expenditure data convers ion into NHA format

i s automated

There is a centra l database for automated production of

s tandard NHA tables , and methods and sources are wel l

documented and access ible

ANALYSIS

Analytica l summaries are produced annual ly including

time series , pol icy and equity analyses

NHA indicators and analyses are publicly accessible

DATA USE

NHA data including RMNCH data are an essentia l

element of annual reviews and are used in the

development of national pol icies , including RMNCH-

speci fic pol icies .