Scoring Africa on Health Budget Transparency

It happened in the evening at a detached wooden restaurant inside the Indian Ocean in Daresslam, Tanzania during the CABRI Financing Healthcare in Africa Conference that took place at Double Tree by Hilton Hotel on 30^th November and 1^st December 2015. I made a presentation titled “what can budget transparency and participation do for health?” to a distinguished senior budget officials and international development partners that came to listen to a soft launch of the Africa Health Budget Network scorecard on Health Budget Transparency in Africa. The cool ocean atmosphere helped to make the African leaders relax even as I was sharing in some instances “red flags” on some indicators measured by the scorecard.

Yesterday Monday 7^th Dec is being marked as World Transparency Day which is being used to call on leaders to improve openness in the way they are administering their governments as openness and public participation have a direct bearing to good governance and improved quality services to the populace.

This article fits with the international call on transparency and it provides scores capable of catalysing action in the health sector.  The Collaborative Africa Budget Reform Initiative (CABRI), in conjunction with the United Republic of Tanzania, Organisation of Economic Cooperation and Development, World Health Organisation, and Global Fund hosted a conference on financing healthcare in Africa on 30 November and 1 December 2015. CABRI is a peer learning and exchange network of senior budget and public debt managers working in ministries of finance and planning across Africa in their efforts to build robust finance systems.

Coming back to my presentation “what can budget transparency and participation do for health?” I began by informing the audience that health spending does not always increase as fiscal space grows. A RESYST study in Kenya, South Africa and Nigeria has revealed some of the reasons as follows;

• Ministry of Health can lack macro-economic know-how or political influence to make a convincing case to Ministry of Finance.
• Ministry of Finance may not trust the health sector to deliver results or value for money
• Process for developing the budget can erode the final health sector allocation

I threw a rhetorical question “how can budget transparency and participation remedy this situation?”

Transparency helps to build Ministry of finance trust in health sector by linking public funds to results, empowering non-state actors to track whether value for money is delivered and if not, why and public participation in budget process helps Ministry of Health make its case to Ministry of finance by bringing additional expertise and bringing more voices to the table in support of health services.

Are there evidence supporting this argument? The answer is YES.

• Greater budget transparency is associated with a higher likelihood that the health budget is implemented as planned
• Countries that have improved budget transparency most have increased MDG spending more on average.

A senior budget official from Republic of Seychelles asked a direct question for me to provide example of how budget transparency has helped health sector in Africa. 2 example came to my mind. The case study of Treatment Action Campaign (TAC) in South Africa. In the late 1990s, the South African government was refusing to implement HIV/AIDS prevention and treatment programmes and TAC filed papers with the high court claiming that government’s position was unconstitutional and that services would save the $90,000. Government countered that a full roll-out would cost $33.3 Million. TAC, using publically available documents, showed that provincial departments of health underspent their budgets by about US$63.1 million and a high court ruled in favour of TAC.

The budget transparency scorecard that was presented in the meeting has the following indicators.

• Transparent allocation to health
• Transparent spending on health
• Spending linked to health outcomes
• Budget information clearly communicated to the public
• Public participation in the budget process

The data was sourced from 2015 Open Budget Index (IBP).

Key findings;

1. Transparent allocation to health. The top performers were Malawi, Namibia, Ssouth Africa and Uganda and bottom performers were Sudan, Equatorial Guinea and Chad
2. Transparent spending on health, top performers were Malawi, South Africa, Uganda, Sierra Leone, Botswana, Zambia and Sudan and many African countries fall under bbottom performers.
3. Spending linked to health outcomes; the top performers were Malawi, Namibia, Cameroon and Mozambique and bottom performers were Equatorial Guinea, Chad, Burkina Faso and Sudan
4. Budget information clearly communicated to the public; top performers were Mali and Tanzania and bottom performers were too many to list.
5. Public participation in the budget process; top performers were South Africa, Rwanda and Kenya and bottom performers were Equatorial Guinea, Sudan and

Written by  Dr Aminu Magashi Garba Coordinator Africa Health Budget Network &Publisher Health Reporters (healthweekly@yahoo.com)