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PUBLIC FINANCE LITERACY TRAINING
Training report for the Workshop held on the 22nd to the 25th July 2019 at the Boma Hotel, Nairobi
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Table of Contents DEFINITIONOFTERMS................................................................................................................................ii
INTRODUCTION...........................................................................................................................................1
Pre-TrainingsurveyReport.....................................................................................................................2
Modeoftrainingdelivery.......................................................................................................................5
SESSION1:DOMESTICREVENUEMOBILIZATION(DRM)...........................................................................5
ReactionsfromparticipantsonDRMsession.........................................................................................8
SESSION2:OVERVIEWOFBUDGETPROCESSINAFRICA...........................................................................9
Fourstagesofabudgetcycle................................................................................................................10
SESSION4:BUDGETTRANSPARENCY,PARTICIPATIONANDBUDGETOVERSIGHT................................15
SESSION5:HEALTHFINANCINGADVOCACY:WHATCOUNTS?...............................................................17
SESSION6:ENHANCINGBUDGETCREDIBILITY.........................................................................................18
Benefitsofbudgetcredibility...............................................................................................................18
SESSION7:UNDERSTANDINGGOVERNMENTBUDGETS.........................................................................21
Groupdiscussion...................................................................................................................................21
SESSION8:COMPONENTSOFAUDITREPORTS........................................................................................22
TypesofAudits......................................................................................................................................22
Groupdiscussion...................................................................................................................................23
EVALUATIONOFPARTICIPANTS’EXPECTATIONS.....................................................................................24
RECOMMENDATIONSANDWAYFORWARD............................................................................................26
LISTOFTABLES..........................................................................................................................................29
LISTOFFIGURES........................................................................................................................................29
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DEFINITIONOFTERMSBudget: It isadocumentthatcontainsanestimationofrevenueandexpensesoveraspecifiedfutureperiodnormallyayearandisutilizedbygovernments.
GDP:isthesumofthemarketvalues,orprices,ofallfinalgoodsandservicesproducedinaneconomyduringaperiod.
Out–of–pocketExpenditure:Thisreferstocoststhatindividualspayoutoftheirowncashsourcestomeethealthexpenditures.
Budget cycle: This refers to the ‘life’ of a budget from preparation to evaluation. It has four stages;formulation,approval,implementationandauditandoversight.
Formulationstage:Thisisthefirststageofthebudgetcycle.TheExecutivearmofgovernmentarethekeyplayerswhoprepareintegrateddevelopmentplanwhichshallincludebothlong-termandmedium-term.Theoverallbudgetestimatesarepreparedatthisstage.
Approval stage: at this stageparliamentbothnationalandsub-national levelsamendandapproveorapprovebudgetestimatesforappropriation.Parliamentcanonlychangethebudgettoacertaindegreedependingonindividualcountry.
Implementationstage:ThisistheexecutionstagewherebytheExecutiveimplementbudgetsapprovedbyparliament.Other keyplayers includeparliamentandcontrollerofbudget.Parliamentprovide theoversight role while the controller of budget authorize the withdrawal of funds from consolidatedaccountsandpreparequarterlyimplementationreports.
Auditstage:Thisisthelaststageofthebudgetcycle.Hereindependentofficessuchastheofficeoftheauditorgeneralprepareauditreports.Thesereportsshouldconfirmwhethergovernmentspentpublicresourcesprudently.
Budgetestimates: It’sanapproximationof thecostofanactivity,programorproject. Itprovidesanunderstandingof the scopeandexpenseofwhatneeds tobedone. It isalsoknownas theExecutivebudgetproposalorProgram-BasedBudget
Citizenbudget:Itreferstothesimplifiedversionpreparedfromthecomprehensivebudgetdocument;however, it should capture all the essential components of a budget. It’s meant for ease inunderstandingbycitizens
Enactedbudget:Thisreferstoabudgetthathasbeenapprovedbythelegislature.
Appropriationbill:it’saspendinglawthatgivesgovernmentpowerstoauthorizewithdrawalsfromtheconsolidatedfund
Appropriation-in-aidreferstorevenuegeneratedfromagovernmentdepartmentsuchasusercharge.This is normally included while budgeting, but the department is authorized not to surrender toconsolidated fund.
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INTRODUCTION
TheAfricanScorecardonHealthFinancingindicatethatthereexistssignificanthealthfinancing
gapspunctuatedwithhighoutofpocketexpenditures.Thedomesticfundsaretherefore
neededtomeetthesegapsinordertocurbthediseaseburdenwhichremainshighinAfrica.In
thatcontext,TheAfricanUnion(AU)FrameworkforGlobalSolidarityandSharedResponsibility
forAIDS,TBandMalaria,callsforincreaseddomesticfinancetowardsnationalhealth
developmentagendas,insteadofoverlyrelyingonOfficialDevelopmentAssistance(ODA).It
alsorecognizesthemultiplyingbenefitofsuchanapproachtoguaranteeincreased
accountabilityandcitizen’sparticipation,publicfinancialmanagement,efficiency,equity,and
themostdesiredbydevelopingcountries;higherdomesticpolicy.TheAfricanUnion
accountabilityreportonAfrica–G8partnershipcommitments,inassessingtheperformanceand
progressofmemberstatestomeettheAbujacommitmentofallocating15%ofpublicfinance
tohealth.Toachievethiscountrieswillneedtoensureatleast5%ofnationalgrossdomestic
productiscommittedtohealthexpenditure,turnhealthsectorallocationsintoinvestments
throughefficiencyandcostcontainment,scaleuppreventionandensureequitableaccessto
information,services,care,andtreatmentforeveryoneinneed,wherevertheyare.
Amongotherhealthpriorities,AfricanHeadsofStateshaveexplicitlycommittedtoendAIDS,
TBandmalariaby2030.Thisiscontainedinthe10-yearPlanofActionoftheAUAgenda2063
andtheGlobalGoalsforSustainableDevelopment.ThetargettoendAIDS,TBandmalariaby
2030wouldrequireboththatdonorsmaintainifnotincreasetheircontributionstotheGlobal
Fund,andthatAfricancountriesincreaseownershipoftheirdevelopmentagendathrough
significantdomesticcontributionforthethreediseases.
Therolethatthecivilsocietyplayinadvocatingforincreaseddomesticfinancingforhealthin
sub-SaharanAfricacannotbeover-emphasized.However,inplayingthisimportantrole,civil
society-ledadvocacyisdiscreditedduetoinadequacyincapacity,toolsandevidence.To
succeedinthisobjectivetowardincreaseddomesticresourcesforhealthaswellasbroader
healthfinancingobjectives,itiscriticaltoensurethatcivilsocietyorganizationshavetheright
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skills,toolsandevidenceforcredibleandeffectiveadvocacy.Itisagainstthisbackdropthat
WACIHealthinPartnershipwiththeInstituteofPublicFinanceKenya(IPFK)withsupportfrom
GlobalFundorganizeda3-dayworkshoponhealthfinancingliteracythemedUnlockingCivil
Society’sHealthFinancingAdvocacyCapacity.Participantswhoattendedtheworkshopwere
drawnfromtheGlobalFundAdvocatesNetwork(GFAN)from11countriesthatincludedKenya,
Tanzania,Rwanda,Zambia,Zimbabwe,SouthAfrica,Malawi,Ethiopia,Cameroon,Ghana,and
Nigeria.ThistrainingwasgracedbyofficersfromtheGlobalFundwhodeliveredthekey
messageontransitionplanforAfricanCountries.
Pre-TrainingSurveyReport
Pre-trainingquestionnaireswereadministeredinadvancetoinformagendaandcontent
decisions.Questionnairesweremeanttogaugeparticipants’understandingofthetopicsas
wellastheirexpectationsforthetraining.Apre-trainingsurveyquestionnairewassentto30
participantsinadvancepriortothetrainingday.14questionnaireswerefilledandsentback,
representingaresponserateof47%.Feedbackfrom16participantswerenotreceivedeven
afterfollowingup.Fromtheanalysis,10respondentswereFemalerepresenting(71%)while4
weremalerepresenting(29%)asindicatedonthepie-chartbelow
29%
71%
Gender
Male Female
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Majorityoftherespondentswereabove35yearsofage86%whilethosebetweentheageof
18-35years,thatisthosewhofallintheyouthbracketwereonly2representing14%.The
followingisapie-chartshowingapresentationofparticipantswhorespondedbyage;
MajorityofthosewhorespondedweredrawnfromCSOsinKenyaandSouthAfrica(4
participantseach)whilethosewiththeleastresponserateweredrawnfromGhana,Rwanda,
CameroonandMalawieachwith1participant.Thetablebelowgivesasummaryof
participants’
organizationsand
countryoforigin
14%
86%
Age
18-35Years Above35Years
No. Organization Country No.Responded
1. WACIHealth Kenya 12. KANCO Kenya 13. ZOOLOOhInternational SouthAfrica 14. HopeforFutureGenerations Ghana 15. IMRO Rwanda 16. UHAI-EASHRI Kenya 17. LwandleYouthConnect SouthAfrica 18. Women4Change SouthAfrica 19. GugulethuWoman'sMovement SouthAfrica 110. KETAM Kenya 111. 3rdSectorSupportAfrica Nigeria 112. JAAIDSNigeria Nigeria 113. ISA Cameroon 114. HREPMalawi Malawi 1
Total 14
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Ontheanalysisofthelevelofunderstandingofparticipants,IPFKusedaLikertscaleof1-4(1-
indicatingnounderstanding,while4indicatingthehighestlevelofunderstanding)togaugethe
understandingofparticipantsonthevarioustopicsthatwouldbediscussedduringthetraining.
ThetopicsonGlobalfundtransitionplananditsco-financingpolicyattractedthehighestlevel
ofunderstandingwhiletheroleofsupremeauditinstitutionsandatopiconbudgetcredibility
hadthelowestlevelofunderstandingfromparticipants.Thetablebelowgivesasummaryof
thelevelofunderstandingofvariousparticipantsondifferenttopics.
No. Statement Levelofunderstandin
g
Aggregatescore
1 2 3 4 1. GlobalFunds’overallapproachtosupporting
sustainability,includingencouragingincreaseddomesticfinancingandpreparingfortransition. 0 4 5 5 3
2. GlobalFunds’co-financingpolicythatsupportsoveralldomesticresourcemobilizationadvocacyefforts. 1 5 3 5 3
3. Leveragingnetworksinadvocatingforincreaseddomesticfinancingforhealth. 0 3 8 3 3
4. Relevantstakeholdersinhealthfinancingadvocacy. 0 8 2 4 35. ManagingnetworksforeffectiveadvocacyinDRM. 1 6 4 3 36. TheBudget cycle, key players andbudget discussions
ineachstageofthecycle. 1 5 6 2 37. Public participation andbudget transparency index in
yourcountry. 2 4 6 2 38. Budgetcredibility:Assessingthegapsbetweenbudget
allocation and expenditure and the legitimacy ofreasonsprovidedbythegovernment. 2 8 2 2 2
9. Analysis of pre-budget statement on citizen prioritiesandgovernmentfinancingplans. 1 8 4 1 2
10. Impactofexternalfinancingonhealthprograms. 1 3 7 3 311. Improving revenuemobilization for governments and
revenuemobilizationstrategies. 2 4 7 1 3
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12. Understanding government budgets and analysis ofExecutiveBudgetProposal/ApprovedBudgets. 2 7 4 1 2
13. Theroleofsupremeauditinstitutions. 3 8 2 1 2
1=None 2=Low 3=Moderate 4=High
Unfortunately,thisfeedbackwasnotavailedintimetoinformchangesinthetrainingprogram
agenda.
Modeoftrainingdelivery
The3-daytrainingonHealthtrainingliteracywasconductedbyIPFKstaffwithguidancefrom
theconvenerWACIhealthandsupportfromGlobalFund.Theopeningremarksweremadeby
GlobalFundwhiletheWACIHealthdidtheclosingremarksastheyguidedtheteamontheway
forward. Training was conducted by use of mix-methods; using PowerPoint presentations,
training cards, flow charts and group work discussions and presentations. In addition,
participantsweretaskedtoshareindividualcountryexperiencesonhealthfinancingadvocacy,
successstoriesandchallengesencounteredintheprocess.
SESSION1:DOMESTICREVENUEMOBILIZATION(DRM)
The facilitator started off by introducing Universal Health Coverage (UHC), a global health
priority embedded in the SustainableDevelopmentGoals. An ideal health system forUHC is
onethatiscomprehensive,integrated,rights-based,non-discriminativeandpeople-centered.It
wasnotedthatUHC’smomentumwasbuildingatcountry leveltowardsmeetingtheSDG3.8
Achieveuniversalhealthcoverage,includingfinancialriskprotection,accesstoqualityessential
health-care services and access to safe, effective, quality and affordable essentialmedicines
andvaccinesforall.Someoftheapproachesthatcountriesuseinclude;
o Expandedhealthinsuranceaccess
o Definedessentialhealthbenefitspackages
o Strategiestoensurequalityofcareandthatnooneisleftbehind.
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o Inaddition,thefirsteverUnitedNationsHigh-LevelMeetingtodiscussUHCwillbeheld
onthemarginsoftheUNGeneralAssemblymeetinginSeptember2019.
Data on an analysis of domestic government spending on health over a period of 7 years
beginning2010-2016waspresentedtoparticipantsbythefacilitator.AccordingtoCivilSociety
Engagement Mechanism of UHC 2030 (CSEM), it identified a minimum of 5% of GDP as
government health expenditure. Data fromWorld Bank on analysis of 11 countrieswas also
presented.Itwasobservedthatallthe11countrieshadlessthan5%domesticexpenditureon
healthwithSouthAfricaleadingwithanaggregateof4%whileCameroon,Ethiopia,Nigeriaand
Tanzaniahadtheleastat1%.Theresthadanaggregatemeanof2%.
Table1.1:DomesticGovernmentspendingonHealthas%ofGDP;2010–2016
No.
Country
DomesticGovernmentSpendingonHealthas%ofGDP
2010 2011 2012 2013 2014 2015 2016 Average
Spending
1. Cameroon 1 1 1 1 1 1 1 1
2. Ethiopia 1 0 1 1 1 1 1 1
3. Ghana 3 3 3 2 2 2 2 2
4. Kenya 2 2 2 2 2 2 2 2
5. Malawi 2 2 1 2 2 3 3 2
6. Nigeria 0 0 1 0 0 1 0 1
7. Rwanda 2 2 2 2 2 2 2 2
8. SouthAfrica 4 4 4 4 4 4 4 4
9. Tanzania 1 1 1 1 1 1 2 1
10. Zambia 1 1 1 1 2 2 2 2
11. Zimbabwe 3 2 2 2 3 4 4 3
AggregateMean 2 2 2 2 2 2 2 2
Source:http://apps.who.int/nha/database/Select/Indicators/en
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Afurtheranalysisoftheout-of-pocketexpenditure(OoPE)forthesameperiodsourcedfrom
WorldBankindicatedthat10countriesinSub-SaharanAfricahavemettheAbujadeclaration
committingtoallocate15%oftheirannualgovernmentspendingonprovisionofhealth.Out-
of-pocketpaymentshavebeendescribedascoststhatindividualspayoutoftheirowncash
sourcestomeethealthexpenditures.Thishasbeenpartlyattributedtolowallocationof
resourcestothehealthsectorandsuchcountriesarefarfromachievingUHC.Thissituationhas
pushedhouseholdsintopovertybyhavingtopayimpoverishingandcatastrophicout-of-pocket
paymentsforhealthcare.AccordingtoWHO’srecommendations,out-of-pocketpayments
shouldbenomorethan10-20%oftotalhealthexpenditure.Fromanalysisofdatapresentedby
thefacilitator,onaverage,NigeriahadthehighestOoPEat74%followedbyCameroonat68%,
Ethiopiaat41%andGhanaat38%.SouthAfricaandRwandahadtheleastOut-of-pocket
averagesat8%followedbyMalawi10%,Zambia16%,Kenyaat30%,andZimbabweat31%.
Table1.2:Out-of-pocketas%ofCurrentHealthExpenditure
No.
Country
Out-of-pocketas%ofCurrentHealthExpenditure
2010 2011 2012 2013 2014 2015 2016 Average
Spending
1. Cameroon 72 51 70 71 71 70 70 68
2. Ethiopia 42 47 42 42 38 38 37 41
3. Ghana 33 36 40 39 45 36 38 38
4. Kenya 30 31 32 32 30 29 28 30
5. Malawi 11 9 10 7 8 11 11 10
6. Nigeria 78 75 73 71 72 72 75 74
7. Rwanda 12 10 9 9 8 8 6 9
8. SouthAfrica 9 8 8 8 8 8 8 8
9. Tanzania 32 28 25 24 26 26 22 26
10. Zambia 24 22 17 11 14 12 12 16
11. Zimbabwe 36 40 35 30 25 26 21 31
AggregateMean 34 33 33 31 31 30 30 32
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Source:http://apps.who.int/nha/database/Select/Indicators/en
AnalyzeddataonexternalhealthExpenditureasapercentageoncurrenthealthexpenditure
was further presented to participants. This was data sourced fromworld bank covering the
same period for the 11 countries. Malawi led with an average of 62% External Health
Expenditure to current health expenditure followed by Rwanda at 50% while the least was
SouthAfricaandCameroonwith2%and8%respectively.
Table1.3:ExternalHealthExpenditure(EXT)as%ofCurrentHealthExpenditure(CHE)
No.
Country
ExternalHealthExpenditureas%ofCurrentHealthExpenditure
2010 2011 2012 2013 2014 2015 2016 Average
Spending
12. Cameroon 5 14 7 6 9 8 9 8
13. Ethiopia 35 38 28 23 23 16 15 25
14. Ghana 8 9 8 16 16 25 13 13
15. Kenya 29 26 24 23 22 21 19 24
16. Malawi 63 64 71 68 63 54 54 62
17. Nigeria 6 8 8 12 12 10 10 10
18. Rwanda 52 50 54 46 49 50 51 50
19. SouthAfrica 3 2 2 2 3 2 2 2
20. Tanzania 39 45 48 48 44 38 36 43
21. Zambia 46 37 44 55 33 36 42 42
22. Zimbabwe 29 23 20 27 32 23 25 26
AggregateMean 29 29 29 30 28 26 25 28
Source:http://apps.who.int/nha/database/Select/Indicators/en
ReactionsfromparticipantsonDRMsession
Thissessiontriggereddifferentreactionsfromparticipantsinspiredbytheperformanceoftheir
respective countries. Although this was viewed as good indicator for advocacy by the CSOs,
conflictingdata from theWorldBank (presentedby the facilitator) and thatofWorldHealth
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Organization (presentedbyparticipants) createdaheateddebateonwhosedata sourcewas
morecredible.Itwasagreedthatgoingforwardtheparticipantstogetherwithallstakeholders
needtoadvocateforuniformityindatapresentedbyworldBankandWHOoranyotherbody
thatcollectsdataonhealthmeanttoinfluencepolicies.Anothercritical issuethatarosefrom
thediscussionwashowCSOscanbeeffectiveinconductingadvocacyonDRM.Thefacilitator
notedthattherewasneedfortheCSOstopartnerwithrelevantgovernmentinstitutionsand
other networks, speak the language of government, have documented evidence and pursue
countrycommitmentsasfarasDRMisconcerned.
Participants also stressed on the need to go to the ground and assess the situation vis-a vis
whatthefiguresontheindicatorsanalyzedindicated.Itwasresolvedthatthisistheonlysure
way to conducteffectiveadvocacy,as it isnotenough toensure resourcesareallocatedbut
equallytoevaluatethelegitimacyofgovernmentplans,byassessingwhatisimplementedand
theimpactithasonservicedelivery.
ThestrategiesforachievingUHCincludinghealthfinancingwerealsodiscussedatlength.The
facilitator brought to attention of participants the upcoming UN general Assembly in
September2019thatwilldiscussUHCandtheprogressmadeso far. However, itwasnoted
that therewasneedtounpackwhat iscontained inEssentialBenefitsPackage (EBP)ofUHC.
The CSOswere asked to champion forUHCs slogan of “leaving no one behind” in their own
countries.
SESSION2:OVERVIEWOFBUDGETPROCESSINAFRICA
The facilitator began by appreciating that budget process differs between countries but
stressed that the budget documents prepared are similar in principle. Nevertheless, budget
advocacyshouldbetimelytosupportmeaningfulengagementwiththedecisionmakers. The
facilitatormapped the budget cycle and the key documents to expect in every stage of the
cycle, the facilitator asked the participants to mention any of the key stages of the budget
processtoassesstheextenttowhichthissessionwouldstretchinenhancingtheirclarityand
understanding on the topic. The facilitator thenmapped out the four budget stages in the
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budgetcycleintheplenary;Formulation,Approval,ImplementationandAudit.Theparticipants
wereissuedwiththebudgetcardscontainingthenamesofallthekeybudgetdocumentsand
weretaskedtoplaceeachcardinitsappropriatestageinthebudgetcyclesomewereplaced
accuratelywhileothersweremisplaced.Inaddition,budgetcalendarforthe11countrieswere
discussedatlengthwiththeguideofthefacilitatorasfollows:
1. Kenya:July-June
2. Rwanda: July-June
3. Tanzania July-June
4. Malawi: July-June
5. Ethiopia: July-June
6. SouthAfrica:April-March
7. Cameroon: January-December
8. Ghana: January-December
9. Nigeria: January-December
10. Zambia: January–December
11. Zimbabwe:January–December
Thefacilitatordiscussedeachofthefourstagesofthebudgetcycleindetailandmappedthe
keybudgetdocumentsundereachstage.
FourstagesofabudgetcycleFormulationstage:Thisisthefirststageofthebudgetcycle.TheExecutivearmofgovernment
are thekeyplayerswhoprepare integrateddevelopmentplanwhich shall includeboth long-
termandmedium-term.Theoverallbudgetestimatesarepreparedatthisstage.
Keydocuments
1. Pre-budgetstatement
2. ExecutiveBudgetProposal
3. EnactedBudget
4. CitizenBudget
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Approval stage: at this stage parliament both national and sub-national levels amend and
approveorapprovebudgetestimatesforappropriation.Parliamentcanonlychangethebudget
toacertaindegreedependingonindividualcountry.
Keydocuments
1. EnactedBudget
2. AppropriationBill
3. BudgetCommitteeReports
Implementationstage:This istheexecutionstagewherebytheExecutive implementbudgets
approved by parliament. Other key players include parliament and controller of budget.
Parliamentprovidetheoversightrolewhilethecontrollerofbudgetauthorizethewithdrawal
offundsfromconsolidatedaccountsandpreparequarterlyimplementationreports.
Keydocuments
1. In-yearreports
2. Mid-yearreviewreports
3. Year-endreport
Audit stage:This is the last stage of the budget cycle.Here independent offices such as the
office of the auditor general prepare audit reports. These reports should confirm whether
government spent public resources prudently. Key players are the accounting officers and
controllerofbudget
Keydocuments
1. Budgetreviewreports
2. Annualauditreports
Participantswereeagertoknowwhetherthereareopportunitiesforengagementandatwhat
stage they are supposed to conduct budget advocacy based on the countries’ contexts. The
facilitatorexplainedthatopportunitiesforthecitizenstoengageineachofthefourstagesof
the budget cycle exist but, equally appreciated that there are challenges such as the
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supplementary budgets which in most cases are not subjected to Public Participation. In
addition,itwasobservedthattheAuditreportsarereleasedwaytoolateaftertheprocesshas
been concluded and their recommendations are rarely taken into consideration. The other
challenge that was shared was the extent at which parliament can change the budget.
Althoughit’scontextual,inmostcasesitfavorstheinterestsofparliamentandtheconsistency
in parliament adjustments is most cases seeks to advance political profile than address the
needsofthepublic.AcaseofZimbabwewassharedwherebyinameetingorganizedbyCSOs
toconductbudgetanalysis;aresolutionwasmadebytheparliamentrepresentativespresent
thattheyweregoingtolobbytheircounterpartsnottoapprovethebudgetunlesstheCabinet
Secretaryreviewedthehealthbudgetupwards.Fromthis,itwasagreedtheorganizedinterest
groupsplaya critical role inbudgetprocessand they shouldmakeallieswithgovernment in
ordertogainmuchinformationaspossibleasgovernmentstendtoconcealcriticalinformation,
moresoonbudgets.Inconclusionofthissession,itwasrecommendedthattheCSOsshould
advocateforbudgetsthataretransparentandcomprehensivetoprovideasmuchdetailstothe
publicformeaningfulparticipationintheprocess.TheCSOswereaskedtobekeenandensure
government align budgets to policies at formulation stage putting into consideration citizen
prioritiesasamechanismtoensurethattheiragendawillbefactoredinduringthebudgeting
stage. Other concerns that participants wanted clarity on included who is responsible for
budgetformulation,whetherdonorfunding is factored induringbudgetingandtheextentto
which parliament can influence a budget. In addition, participantswanted to knowwhether
political leadersespeciallythoseintherulingregimesinfluencebudgetprocesses.Discussions
on these concerns ensued; while countries differ contextually, public finance management
standardsareconsistentacrossboardwithpublicparticipationbeingthebackboneofbudget
decisions. The facilitator explained that the Executive arm of government is responsible in
formulationofthebudget,butthisshouldbedoneinconsultationwiththecitizens.Likewise,
while parliament is approving the budget citizens should also be engaged to legitimize any
adjustment that parliamentmakes on the budget and to confirm that what is submitted to
thembytheExecutiveisinlinewithcitizenpriorities.Inpracticehowever,itwasobservedthat
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in most cases public consultation is done to meet legal dictates but not much to influence
budgetdecisions.
From the pictorial presentation and flow charts showing the budget cycle, one participant
wantedtoknowwhetherthebudgetcycleforcountrieswithsub-nationalgovernmentsarelike
thenationalone.Theparticipantnotedthat insuchacase,budgetsrunsconcurrentlyand in
countries such as KenyawhereRevenue is shared among the two levels of government, the
subnationalgovernmentspreparebudgetsbasedontheirshareofrevenue.
SESSION3:PUBLICFINANCINGOFNON-STATEACTORS
ThissessionwassteeredbyMattMGreenallaglobalfundconsultanttobringintoperspective
theconceptof“socialcontracting”foreaseinunderstandingbyparticipants.Theglobalfund
consultantbeganbyaskingparticipantstobrainstormonwhatisspecialinthewayGFmoney
getsspentasopposedtotheonebyMOH.Themajordistinctiononthetwosourcesoffunding
identifiedwasthehighleveloftransparencyandaccountabilityassociatedwithGFfunding.The
otherwasthatGFfundingisonlyusedtofinance3healthconditionsofHIVandAids,Malaria
andTB.
He introducedtheconceptofsocialcontracting;Theprocessbywhichgovernmentresources
areusedtofundentitieswhicharenotpartofgovernment(non-stateactors(NSAs)toprovide
servicesinordertoassurethehealthofitscitizenry.Thisisviewedasthebestwaytomaintain
effectiveservicedeliveryinpost-GFcontexts.Socialcontractingmayhavedifferentnamesand
slightlydifferentmechanismsindifferentcountries.Regardlessoftheterminologyused,social
contractingmechanismsmust; includea legallybindingagreement, inwhich,thegovernment
agreestopayaCSOforservicesrendered,and,theCSOagreestoprovidecertaindeliverables
inexchange,eitherasservices providedorashealthoutcomesreached.
Furthera justificationastowhygovernmentshouldfundCSOwerediscussedwhich included
thefollowing;
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o CSOsareheavilyinvolvedinserviceprovision
o Theuniquenessofservicetobedelivered
o Specificpopulationshaveuniqueneedsorfaceuniquebarriersand
o Sometimesit’stheonlywaytogetitdone
It’sbecauseoftheabovereasonswhymuchemphasisisplacedonthevulnerableandthekey
populations because they are most affected by the three diseases and less likely to access
servicesformultiplereasons,includingstigmaanddiscrimination.Forexample,keypopulations
groupsoftenfacemorebarriersthanothersinaccessingHIVtestingandtreatmentand,once
startedonART,toretentionincareandadherencetotreatment.Thisisoftencompoundedby
stigmaanddiscriminationandotherformsofexclusion.
Participantswereabletoidentifysomeofthebarrierstopublicfinancingofnon-stateactorsas;
Trust issues, Unhealthy competition-conflict of interest, Disintegration of CSO, highly
fragmentation, Tendency by government to pick sycophants and Bureaucracy in disbursing
governmentmoney.
Fromthispresentation,thekeytakesawaymessageswere;
o CSOsareoftenaveryimportantpartofimplementation,particularlyifwedon’twantto
leaveanyonebehind.
o But CSOs are not always or inherently the best or most efficient route for
implementation.
o There are barriers to government funding non state actors and mechanisms are
required.
o Anycontractedorganization(profitornon-profit)mustbeaccountable.
o It may be suitable for funding service delivery but probably not for funding
accountability,advocacy,oractivism.
Finally, the CSOs were challenged to think beyond HIV, TB and malaria and how such
mechanismswouldcontributetohealthreform,efficiencyandUHCinoverall.However,CSOs
shouldbearinmindthatgovernmentscannotfundadvocacyinitiatives.
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SESSION4:BUDGETTRANSPARENCY,PARTICIPATIONANDBUDGETOVERSIGHT
The facilitator began the presentation on posing rhetoric question to participants on how
governmentsmakebudget informationavailable. The facilitator furtherelaboratedonOpen
Budget Survey (OBS) a bi-annual study done by International Budget Partnership which
publishes and summarizes individual country findings and individual recommendations on
Budgettransparency,PublicParticipationandOversight.TheOBSassesswhethergovernments
in115countriesproduceanddisseminatecomprehensiveandtimelyinformationtothepublic
in8keybudgetdocumentsasrecommendedbyinternationalgoodpracticesasfollows.
Pre-Budget Statement: discloses the broad parameters of fiscal policies in advance of the
Executive’s Budget Proposal; outlines the government’s economic forecast, anticipated
revenue,expenditures,anddebt.
Executive’sBudgetProposal:submittedbytheExecutivetothelegislatureforapproval;details
the sources of revenue, the allocations to ministries, proposed policy changes, and other
informationimportantforunderstandingthecountry’sfiscalsituation.
EnactedBudget:thebudgetthathasbeenapprovedbythelegislature.
CitizensBudget: a simpler and less technical versionof thegovernment’s Executive’sBudget
ProposalorEnactedBudget,designedtoconveykeyinformationtothepublic.
In-YearReports: include informationonactualrevenuescollected,actualexpendituresmade,
anddebtincurredatdifferentintervals;issuedquarterlyormonthly.
Year-EndReport:describesthesituationofthegovernment’saccountsattheendofthefiscal
year and, ideally, an evaluation of the progress made toward achieving the budget’s policy
goals.
AuditReport:issuedbythesupremeauditinstitution,thisdocumentexaminesthesoundness
andcompletenessofthegovernment’syear-endaccounts.
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The threeparametersused inOBS includebudget transparencywhich is theextentandease
with which citizens can access information and provide feedback on government revenues
allocations and expenditures. The other parameter is public participation which refers to
opportunities for citizens and non-state actors to participate directly in the design and
implementation of fiscal policies. Finally, budget oversight which refers to budget
implementationanditsimpact.Theseassessmentsshouldbeconductedbyindependentbodies
thatshouldhaveadequatecapacitytoperformthesetasks.
Thefacilitatorpresentedacomparativeanalysisofperformanceofeachofthe10countriesfor
thetwoyears2015and2017foreachoftheOBSparameters.Finally,thefacilitatorgavea
comparativeanalysisforthethreeparametersfortheyear2017forthe10countries.
However,dataforEthiopiawasnotavailableasitdoesnotsubscribetotheOBS.Fromthe
analyzeddatapresentedCameroonwastheleastinperformanceintermsofTransparency,
publicparticipationandoversightparameterswhileSouthAfricawasthebestinaverage
thoughtheirPublicParticipationparameterwaswaybelowtheaveragemarkof50%.
Table4.1:OBScomparativeanalysisfor2017
7
50 46
2617 22
89
10 8
23
7
2215 15 13 13
2415 15
922
4350 55 56 59
85
4148 44
0102030405060708090100
OBS2017COMPARATIVE
Transparency Publicparncipanon Budgetoversight
17
Presentations made for individual countries excited the participants as they anticipated to
knowhow their respective countries performedonbudget transparency, public participation
andoversight.Itelicitedemotionsasparticipantscelebratedwheretheydeemedtohavedone
well and seemingly registered disappointments,where the country’s performancewas poor.
Recommendations given for each country was a basis for the participants to advocate to
improvetheindicesdiscussed.Theparticipantshighlightedwhiletheyhavetakenpartinpublic
participation what curtailed their participation mostly was inadequacy and limited
understandingonabudgetdiscourseandthegovernmentwasnotdoingenoughtohelpthis.In
addition,heapplaudedtheorganizersoftheworkshop,sincetheplatformhadprovidedmore
breadthandinsightongovernmentbudgeting.
SESSION5:HEALTHFINANCINGADVOCACY:WHATCOUNTS?
The facilitator gave a pictorial presentation of a network and asked participants to interpret
what they saw.He asked participants to give their own interpretation ofwhat a network is.
Participants suggested that most of them were already in networks working in the health
sector.Increasedsynergytoconductadvocacywassuggestedasonemajoradvantageofbeing
inanetwork.
A representative fromCSOsbased inRwandagavea success storyofbeing inanetwork.He
mentioned that through coalition building and mobilizing other CSOs in his country they
managedtopullresourcestogethertheywroteaproposalandthat ishowtheysucceededin
gettingtheirfirstgrantfromGlobalFund.
Missingoutonbudgetnetworkswasnotedasamajor impediment to theirbudgetadvocacy
work.Thesituationvaryingbetweencountries,someworsethanothers.Insomecountriesthe
CSOscouldnotidentifyasingleorganizationthatworksinthepublicfinancespace.Eventhose
whowereableto identify,veryfewhadexistingpartnerships. Movingforwarditwasagreed
thatIPFKwouldsharecontactsoforganizationsinthosecountries.Thelistwassharedonthe
lastdayofthetraining.
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SESSION6:ENHANCINGBUDGETCREDIBILITY
Thefacilitatorbeganthesessionbyastorylineonloveandhowitrelatedwellwiththosewho
work in thepublic financespace.Sheoutlined that sometimesyoumust suspenddisbelief in
order to reconcile realitywithexpectation.Budgetcredibility is theabilityofgovernments to
accurately and consistentlymeet their expenditure and revenue targets. At its core, budget
credibility is about upholding government commitments and seeks to understand why
governmentsdeviatefromthesecommitments.Thekeyplayerinbudgetcredibilityistheoffice
ofcontrollerofbudget.
Benefitsofbudgetcredibility.
o Budgetcredibilityisimportantbothfortheattainmentofmacroeconomicgoalsandthe
effectivedeliveryofpublicservices.
o It promotes social acceptance of taxation and spending and contributes to a general
strengtheningofthepowerofformalinstitutionstoshapethebehaviorofindividuals.
o Budgets are the key policy tool that governments have at their disposal to translate
theirpoliciesandplansintospecificprogramsandactivities.Theyhavebeendefinedby
someasa“socialcontract”betweengovernmentsandcitizens,wherecitizenspaytaxes
inexchange for thedeliveryofa specified setofgoodsandservices (Wildavsky1984;
Schick2011)
Itwasdiscussedthatsomeoftheconsequencesthatthreatenedcredibilityofbudgetsinclude
external economic shocks and indicative of smart managerial decisions to address
unanticipatedevents.Thesoundnessbudgetsystemscanbejudgedbythefollowingprinciples;
Comprehensiveness
o Isthecoverageofgovernmentoperationscomplete?
o Areestimatesgross(inclusiveofAppropriationinAid)ordoesnettingtakeplace?
Transparency
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o How useful is the budget classification? Are there separate economic and functional
classificationsthatmeetinternationalstandards?
o Isiteasytoconnectpoliciesandexpendituresthroughaprogramstructure?
Realism
o Isthebudgetbasedonarealisticmacroeconomicframework?
o Areestimatesbasedonreasonablerevenueprojections?Howarethesemade,andby
whom?
o Arethefinancingprovisionsrealistic?
o Is there a realistic costing of policies and programs and hence expenditures (e.g.,
assumptionsaboutinflation,exchangerates,etc.)?
o Howarefuturecostimplicationsconsidered?
o Isthereaclearseparationbetweenpresentandnewpolicies?
o Howfararespendingprioritiesdeterminedandagreedunderthebudgetprocess
The consequences of having non-credible budgets may have different kinds of impacts. For
example,non-credibilityofthebudgetintermsofoverallrevenueandexpenditurewillhavean
impact on a country’s fiscal balance, with associated macroeconomic implications. Non-
credibility of allocations to high-level voteswithin the budgetmay not havemacroeconomic
implicationsifoverallexpenditurelevelsareadheredto,butitmightunderminelegitimacyand
trust ingovernment if itappears that thegovernment isdisregarding theallocativedecisions
presentedbyitselfandapprovedbyParliament.
Inconclusion,itwasnotedthatthereisneedfortheCSOstoconsiderbudgetcredibilityaspart
of budget advocacy. CSOs should move beyond championing for allocation to specific
interventionsinthebudgetandfollowuponactualimplementationofbudgetwhichismorea
credibility issue.Thiswillhelp inrestoringpublictrust ingovernmentson implementingwhat
wasagreedduringbudgetformulation.
20
In breakout sessions, the facilitator grouped participants in 3 groups and gave each group a
budget implementation reports from three different countries; Kenya, Tanzania and Nigeria.
Thefacilitatorthengavethefollowinglistofquestionstoguidethegroupdiscussion;
1. Doesthecountryhaveaproblemofunderspending?
2. Whichsector/departmenthasthemostshareofdeviationandwhy?
3. Whatistheimpactofthis?
4. Whatimpact,ifany,doesrevenueperformancehaveonunderspending?
5. Howisthebudgetimplementationpresenteddoesitcontainreasonsandjustifications
forthedeviation?
Each group had 30minutes to look through the documents presented to them andmake a
presentationbasedontheabovequestions.Fromthegrouppresentations,theteamthatwas
tacklingNigeria2012budget implementationreportcouldnot interpretterminology“amount
cashbacked”whichwasacomponentintheirbudgetdocumentandyetnoexplanationofthe
termwasgiven.
Fromthisgroupwork,participantswantedtoknowwhythereisnostandardizationinbudget
analysisandwhyearmarkingofbudgetsisnotencouraged.Thefacilitatorindicatedthatthere
wasnostandardwayofbudgetanalysisasdifferentstakeholdershavedifferentinterestwhile
conductingbudgetanalysis.Earmarkingofbudgetsontheotherhandisdiscouragedbecauseit
restrictsgovernmentdevelopmentplansasrevenuesarealwayslimitedandthusbudgetingisa
negotiationprocess.Earmarkingisonlyencouragedwhengovernmentisimplementing“special
projects”.
Reactions fromparticipants indicated they relatedwellwith thegroupworkdiscussionsas it
gave them a practical example onwhere to look out forwhile conducting budget credibility
advocacyintheirindividualcountries.Herearethesentimentsfromoneoftheparticipants
“Iwanttoappreciatetheexercisebecauseitopenedmymind,whateveryoudidalldaywhile
presentingbecamecleartome”.
21
SESSION7:UNDERSTANDINGGOVERNMENTBUDGETS
The facilitatorbeganbyaskingparticipants todefineabudget. Itwasdefinedasadocument
thatcontainsanestimationofrevenueandexpensesoveraspecifiedfutureperiodnormallya
year and is utilized by governments. The factors that determine howmuch a sector should
receiveincludethefollowing;
o Previousceilings/historicalallocations/ongoingprojects
o Prioritiesandchangingprioritiesovertime
o Governmentproposal
o Emergingissues
o Sourceoffunding
ThefacilitatorfurthergaveasampleaKenyanbudgetillustratingallocationtodifferentsectors
over a period with emphasis on the health budget. He illustrated health programmes and
programmeobjectiveswithinthebudgetandindicatorsforspecificprogrammesthatmakeup
the health sector. He further explained to participants how to determine priorities and
changingpriorities.Thefacilitatorsaidonewayoflookingatprioritiesandchangingpriorityis
tofocusonthepercentagesrelativetothechangeinthebudgetinsteadoflookingatchanges
inabsolutefigures.Heemphasizedthatthecostofrunningservices isdifferent invarieswith
thesectors.Givinganexamplewithhealthandwatersectors, itwasarguedthat itwouldbe
moreexpensivetopurchaseatheaterequipmentforthehealthsectorthantodrillaborehole
orinstallwaterpipesinthecaseofwatersector.
Acaseofprocuringsuppliesanddrugsinthehealthsectorwasusedtoillustrateopportunities
for engagement by the CSOs. The critical asks that CSOswould pursue are;whatwas the
processlike?Wasitopen?Howdidbeneficiaries’benefit?
Group discussion
Participants were put in three groups to discuss and analyze the Executive Budget Proposal
(BudgetEstimates)documentsforKenya,ZimbabweandRwanda.Thesessionsweremeantto
22
giveparticipantsapracticalknowledgeonwhattolookforandespeciallyonthehealthbudgets
the area of interest when analyzing budgets. The facilitator then gave guiding questions to
groupsforthemtointeractandinterrogatethedocumentfully.
Aretheresomeobservationsyoucouldhighlightforthissession?
The takeaway messages during this exercise were for participants to know the amount of
resourcesallocatedfordevelopmenti.eafterrecurrentexpenditureisdeducted.Theotherkey
messagewashowtoknowifasector isapriorityornot.Fromtheexerciseitwasnotedthat
theCSOsneedmorecapacitybuildinginbudgettrackingandanalysisandthatthereisneedto
linktheCSOswithorganizationsworkingaroundPFMinindividualcountries.
SESSION8:COMPONENTSOFAUDITREPORTS
The objective of this session was; enhancing understanding of the audit process and the
contentofauditreports.Thefacilitatorbeganbyintroducingsupremeauditinstitutions(SAIs).
SAIs are independent and professional that acts as an important actor in a country’s
accountabilitychain.Theyareagovernmententitywhoseexternalauditroleisestablishedby
theconstitutionorsupremelaw-makingbody.SAIsaretraditionallyknownfortheiroversight
ofpublicexpenditure,whichremainsacorepartoftheauditportfolio.
The key player in the audit process is the audit office. In some countries the audit office is
referredtoastheOfficeoftheAuditorGeneral(OAG)whichisaconstitutionalofficemandated
to confirmwhether publicmoney has been applied lawfully (following budgets and financial
proceduresforprocurementandspending)andinaneffectiveway.
Types of Audits
1. Financial audit: It looks at whether an entity’s financial information is accurate (free
from errors) and presented in accordancewith the applicable financial reporting and
regulatoryframework.Financialauditdoesnotonitsownestablishcorruptioninmost
23
cases, as it only shows that procedures were not followed, but not what ultimately
happenedtothefunds.
2. Performanceaudits: It examine theeconomy,efficiencyandeffectivenesswithwhich
publicmoneyisspent.Thisappliestotheoverallcountryandspecificcountryprojects
evaluatingwhethercitizensgotvaluefortheirmoney.
3. Forensicaudits:Theseestablishfraud,corruptionorotherfinancialimproprieties.
4. Procurementaudits: Examine thepublicprocurementandassetdisposalprocessof a
stateorganorapublicentitywithaviewtoconfirmastowhetherprocurementswere
donelawfullyandinaneffectiveway.
5. Compliance audits that look at the extent to which the relevant regulations and
procedureshavebeenfollowed.
Thetypesofauditqueriesthatariseduringauditingprocessinclude,unsupportedexpenditure,
excess expenditure, pending bills andmanagement of imprests by government officials who
traveltoattendmeetingswhichneedtobeaccountedfor.
Groupdiscussion
Participantswereputin3groupsandgiventhefollowingreportsfromtheofficesoftheauditor
generalfromthefollowingcountries.
o Ghanaforthefinancialyearended31December2014
o Rwandafortheyearended30June2015
o ZimbabwefinancialyearendedDecember31,2014
Thefacilitatorthenaskedparticipantstohavealookattheirrespectivedocumentandnavigate
theentiredocumenttohavealookatthefollowing;
1. Asummaryof findingsandkey recommendationsandreportonone thing thatstands
out
2. AuditopinionsgivenbytheAuditorGeneralandforwhichdepartmentsmentionatleast
two(withabiasinhealth).
24
3. What are the practical opportunities for advocacy that can be pursued in the issues
observed?
Itwasobservedfromgroupworkthatparticipantswereabletointeractwiththeauditreports
from the three countries and were able to point most of the audit queries. Unsupported
expenditure was the most outstanding query across the three documents and was
consequently identified as one opportunity for the CSOs to conduct advocacy on in their
individualcountries.
One issue that was observed by all the groups in the three documents had unsupported
expenditure. Thiswas identified as one opportunity for the CSOs to conduct advocacy on in
theirindividualcountries.
EVALUATIONOFPARTICIPANTS’EXPECTATIONS
Attheendofthetraining,participantsweregivenanopportunitytoevaluatepresentationsby
facilitators based on their expectations. Below is a summary of expectations, scores and
recommendations,givenbyparticipants.Thescoreswereinascaleof1-5with1beingtheleast
and5beingthehighestscore.
Figure1.1:Participants’Expectations
Themes Expectations Score Recommendations
25
Budgetprocess
! Tolearnbasicbudgetanalysis
! Todemystifybudgets! Tounderstandthe
budgetcycle! Clearunderstandingof
financialbudgetingprocess
! Whereandwhentoinfluenceonthebudgetcycleforadvocacy
! Toclearlyunderstandgovernmentrevenuedistribution
545324
- NeedformoreinformationonwhereCSOsneedtoinfluence
- WhatshouldtheCSOspushforinrevenuedistribution
DRMandAdvocacy
! Toclearlyunderstand
theroleofCSOsinDRMatnational,regionalandgloballevel
! TolearnmoreonhowtobestpushgovernmentstocommittoDRM
! TogainthenecessaryskillstoforeffectiveadvocacyinDRM
! Tomakeacleardistinctionbetween5%allocationtohealthintheGDPand15%allocationforAbujadeclaration
! Tounderstandwellissuesrelatedtohealthfinancing
! Tounderstandbetterwhatworksinhealthfinancingadvocacyfromdifferentcountries’context-successstories
2.53434
3.5
Globalfundtransition
! Tounderstand
replenishmentprocess
4
-FurtherdiscussionsonKeyandVulnerable
26
andtransition! Understandglobalfund
strategiesfortransition! Toidentifyareasof
focusespeciallytheKeyandvulnerablepopulationsduringtransition
43
populationsontransition-Presentationsviaskypeposedatechnologicalchallengeanditshouldbelookedatnexttime
RECOMMENDATIONSANDWAYFORWARD
At the end of the 3-day training, participants who represented various CSO from different
countries were tasked to commit to championed for domestic resource mobilization.
Participants from the 11 countries outlined activities they will undertake going forward. In
addition, the CSOwere asked tomention organizations thatwork in the PFM space in their
respective countrieswhom they have partneredwith or potential partners theywouldwork
with.
The tablebelowoutlines the summaryof all theCSOs, their commitments andorganizations
working inPFMspaceinthe10countries.Ethiopia isnot includedbecausetherewasnoCSO
fromthereexceptWACIhealthwhichwastheconvenerofthismeeting.
Figure1.2:CSOsCommitments
Country CSOs CSOCommitments OrganizationsworkinginPFM
Rwanda RwandaNGO’sforumonHIV/AIDS&Healthpromotion
-IMRO
• TakepartinupcomingICASAworkshoptobeheldinRwandaasessiononHealthFinancing
Notknown
Tanzania TanzaniaNetworkof
• TrackresourcesforadolescentgirlsandYoungwomen
27
womenLivingwithHIV/AIDS(TNW+)
• CapacitybuildCSOsand• Engagewithmembersofthe
NationalAssemblytotrackbudgets
Sikika
Malawi HREP-Malawi • OrientCSOsonbudgetwiththeuseofAccountabilitytoolwithintheir3yearprojectwithHP+.
• TheywillcollaboratewithCHAI,Options,CentreforsocialresearchandNationalassemblyonaccountability
-CentreforsocialResearch
-Options
-Chai
SouthAfrica
TreatmentActionCampaign(TAC)
-ZOOLOOhinternational
-LwandleYouthConnect
-Women4Change
-GugulethuWoman’sMovement
• WorkcloselywithMOHtofollowuptheircommitmentsonthebudget
-PublicServiceAccountabilityMonitor
-CEGA
Zambia CommunityInitiativeforTB,HIV/AIDSandMalaria(CITAM+)
• Planneda3-dayBudgettrackingtrainingforTB&Nutritionbudgetswithapproximately20CSOsinOctober2019
NotKnown
Nigeria JournalistAgainstAids(JAAIDS)and3rdSectorsupport
-3rdSector
• PlannedaCSOpeerreviewforumtotrainCSOsonbudgetanalysisandtrackinginNovemberinpartnershipwithBUGIT
• Plannedasessionforsustainabilityco-financing
-BUGIT
FollowtheMoney
-HP+
28
Support -PRF
-BudgetTransparencyNetwork
Ghana HealthforFutureGenerations(HFFG)
• MeetwithSUNandseetheplanstheyhaveandhowtoengage
• MobilizeCSOstobebudgetadvocatesbyDecember2019
-SendGhana
-Isodec
Zimbabwe CommunityWorkingGrouponHealth(CWGH)
• OrganizecapacitybuildingformembersofparliamentinAugust.ApositionpaperwillbedrawninOctoberonpre-budget
-Budgetcoalition
-HP+Cameroon CS4M • WorkwithCSOstodoapetition
askinggovernmentstostep-upco-financing
• WillleadthesameworkshoponfinancialliteracyforCSOsforFrancophonecountriesthefollowingweek
-Notknown
Someoftherecommendationsthatcameoutofthistrainingwere;
i. Takeadvantageoftechnologye.g.webinarsforfeedbackandfollow-upstosustain
discussiononDomesticResourceMobilization.
ii. CSOstobepreciseoncommitmentstheyhavefortheircountries,stateresourcesthat
theyhaveandwhattheyneeded.
iii. ConnectCSOswithorganizationswhoareinpublicfinancespacetosupportCSOsin
thosecountries.
iv. Maptheneedsofparticipantsinfuturetrainingsforbetterresults.
v. LeverageoncountryownershipandpridebymembersoftheGFANtoadvocatefor
betterperformanceintheircountries’fiscalpolicies
29
vi. Haveasummaryoftakeawaymessages-keyissuesthatcameoutofthetraining.
LISTOFTABLESTable1.1:DomesticGovernmentspendingonHealthas%ofGDP;2010–2016.....................................6Table1.2:Out-of-pocketas%ofCurrentHealthExpenditure...................................................................7Table1.3:ExternalHealthExpenditure(EXT)as%ofCurrentHealthExpenditure(CHE)..........................8
LISTOFFIGURESFigure1.1:Participants’Expectations.......................................................................................................24Figure1.2:CSOsCommitments................................................................................................................26
30