CEGAA’s contribution in open economic governance in South Africa: A district level budget monitoring

effort on health, HIV/AIDS & TB in South Africa

Presentation to: The Power of Open: A Global Discussion

Teresa Guthrie, CEGAA

The concerning global situation • Shrinking financial resources for social spending – domestic &

global – Increased dependency on foreign aid – Yet contributions to Global Fund decreasing

• Committed ‘aid’ or public allocations often do not materialize to transferred funds or remain unspent or mismanaged

• Inadequate or weak health information systems • Inefficiencies in relation to optimal and effective use of existing

scarce resources • Lack of sound public finance management system • Insufficient financial & project management capacity & skills

• impacting on transparency and accountability, as well as forward planning and reporting

• Weak M&E systems, even weaker financial information systems

2

The problem in many African countries • Communities and civil society organizations (CSOs) have not adequately

participated in budget making processes affecting health, HIV/AIDS and TB service issues.

• There are insufficient monitoring processes at community level for social accountability.

– Resulting in poor identification of community needs required in planning and budgeting for the response to HIV/AIDs and TB

• South Africa is rated highly on the international Open Budget Index but insufficient budget openness at sub-national levels, especially at local government and health facility level.

• Real citizen participation is required at community level where public services should be delivered in line with community needs and available resources.

– Thus communities need to be capacitated at local level to track expenditures and their outcomes on health and development

for their ongoing empowerment in holding different levels of government, including local authorities, accountable.

Thus, strategic interventions are needed to strengthen financial management and M&E systems, and facilitation of, and capacity building for CSO participation and effective oversight by relevant bodies, such as parliaments, to have a greater impact on scarce resource allocation and utilisation for health service provision

4

CEGAA’s Response to that Need

• Established in 2006

• As an African regional NGO committed to achieving efficient, effective, equitable and developmental economic governance responses to HIV/AIDS and TB in Africa through capacity building, research, information dissemination and advocacy with relevant stakeholders

5

The impact we are working towards

Improved African government’s response to HIV and AIDS as a development issue: – Implies need to work directly with African governments

– Implies building the capacity of civil society to hold governments accountable

– Implies building capacity of oversight bodies like parliament to ensure accountability

HIV and AIDS often spoken of as a developmental issue yet financial response continues to be in silos, mainly located within the health budget

6

CEGAA’s Overall Aims

• Civil society is actively engaged in holding governments accountable for effective resourcing of the response to HIV/AIDS and TB

• Financial resources are increased and effectively used by African governments to strengthen their response to HIV/AIDS and TB

7

CEGAA’s Strategic Result Areas 1. Increased civil society influence in HIV/AIDS & TB

budgeting and expenditure processes 2. Increased transparency and accountability of

governments and other stakeholders for HIV/AIDS & TB spending

3. Improved use of evidence for effective and efficient allocations and spending on HIV/AIDS, TB & related health systems

4. Increased & improved spending for a multi-sectoral developmental response to HIV/AIDS & TB

5. Enhanced influence through strategic global, regional and national opportunities for increased access to financial resources for the response to HIV/AIDS & TB in Africa

6. Enhanced organisational functioning of CEGAA

8

Results we have achieved to date

• Increased capacity by civil society organizations in the SADC region to do BMET for effective advocacy, at national and local levels

• Strengthened financial management skills by government officials

• Improved skills to undertake NASAs in several SADC and East & West African countries

• Improved generation and utilisation of evidence to inform budget policy discussions and decision making

• Enhanced health budget and expenditure dialogue between governments and civil society in our BMETA countries

9

Some of our interventions… • National AIDS Spending Assessments in almost all SADC countries & some

East & West African countries

– Provided data on all sources of funding for HIV/AIDS activities

– Advising on improved financial information systems

– Informed national HIV/AIDS strategic plans & allocative decisions

• Budget Monitoring by CSOs in South Africa, Mozambique, Zimbabwe, Zambia, Uganda, Nigeria

– strengthened their advocacy regarding HIV treatment, sexual reproductive health, achievement of the MDGs, improving quality of water & sanitation services etc

• Technical support provision to other partners, including International Budget Partnership (IBP) partners. E.g. Great Lakes University of Kisumu (Kenya), Amanitare, BEMF (SA), TALC (Zambia)

• Costing of the SA response to HIV/AIDS to 2031 – assisted govt and donors to strategise regarding funding

• Planned intervention involving capacity building for parliamentarians

10

Tools we support partners to use • Budget analysis & expenditure tracking tools

• Citizen Report Card

• Citizen Satisfaction Survey

• Public hearing and accountability forums with citizens and public officials

• HIV/AIDS expenditure tracking software (UNAIDS: Resource Tracking Software)

• Excel - presentation of impactful findings

• Training for public officials in costing, budgeting, financial management, improving financial information systems

Successfully implementing a comprehensive approach in Southern African countries…

Strengthening TAC & BEMF Advocacy

Efforts with Evidence

Improved Evidence to

Inform Policy Choices, Improve

Spending & Service Delivery

Community Monitoring of HIV

Spending & Quality of Services

at District Level

Tracking of all HIV/AIDS Spending

at all Levels (external, domestic

& private)

Costing of the SA HIV/AIDS Response to Inform Policy &

Allocative Decisions

12

Strengthening Oversight Bodies (eg. Parliament,

NACs)

NANGO and members of the Zimbabwean Budget Coalition are trained in analysing their government’s

budget

The Zimbabwe Budget Coalition work on developing community monitoring tools of

various services

In Zimbabwe, members of the Community Working Group on Health engage the Ministry of

Health on issues of access to health services

Zimbabweans demand their right to health.

Case Study - South African CSO Project OVERALL AIM:

To increase the delivery, accessibility, affordability and quality of

treatment for people living with HIV/AIDS and TB, thus ensuring that

ARVs and TB treatment are available as lifesaving and prevention

mechanisms.

OBJECTIVES:

• Enhanced community empowerment and participation in district budget planning processes

• Better skilled district public servants, so as to improve their management of their budgets

• More effective and efficient use of scarce resources to ensure their greatest impact

• Improved health services for persons affected by HIV/AIDS and TB, leading to their improved quality of life

• Strengthened health care systems, through improved health

care spending and outputs.

Interim SA Project Results • Strengthened local level capacity to influence budget planning and to

enhance social and financial accountability

• Formation of a strong coalition of governmental and non-governmental organisations monitoring the implementation of health and HIV/AIDS and TB budgets at district level

• Satisfaction surveys indicated that more people needing treatment are accessing it and that most people are happy with the quality of service they receive, whilst

• Most health workers are not happy with the quality of health care services they provide due to a numbers of reasons:, such as serious shortages of specialist staff such as doctors, pharmacists & dieticians, staff burnout, lack of basic admin necessities etc

• Ongoing community monitoring provides necessary information for lobbying and local level planning

• Enhanced social accountability – through ongoing interactive engagements between health officials, health workers and citizens

In South Africa, the ART patients reported long queues for their drugs

TAC & CEGAA present the evidence at public hearings in SA

Public Hearing in SA – officials listen to the people

CEGAA’s research to improve public financing systems

• Costing

• Budget allocation monitoring

• Expenditure tracking

• Financial gap analysis

• Financial systems improvements

In forward projecting the impact & costs of an expanded response to

HIV/AIDS in South Africa, CEGAA found a potential funding shortfall – data

which should mobilise govt & donors & business sector to collaborate more

transparently in their future he development of their new Strategic

Plan and resource mobilisation

Projecting the impact of expanded spending on HIV incidence in SA

SA Adult (15+yrs) HIV Prevalence

27

Estimated Costs for 3 scenarios for response to HIV/AIDS in SA

Projecting the costs of an expanded response to HIV in SA

Estimated Cost by Programme

CEGAA’s assessment of total spending on HIV/AIDS and TB in SADC countries

CEGAA’s assessment of the per capita HIV/AIDS spending by region/ area can identify issues of equity

and efficiency in delivery

CEGAA’s comparison of regional HIV prevention spending – assists countries determine if they

are targeting effective prevention interventions

CEGAA examined the cost drivers and efficiency of the delivery of ART by region -variations showing need for

improved efficiency

Estimating the Funding Gap – Mobilising Resources

Requirements for Civil Society engagement • Online access to timely budgetary and expenditure data,

linked to performance indicators. Eg. South Africa OBI rating & People’s Budget

• All development partners giving funds to Africa should declare and align their intentions, spending & longer-term commitments with the national priorities.

• District level budget/ development committees, involving citizens and public officials – to determine their district’s needs, set priorities, budget for these, and monitor spending on them.

• HIV/AIDS multisectoral coordinating structures with political power & commitment, to which all actors

must report regularly -activities and spending.

Enhanced Budget Monitoring and Expenditure Tracking

• Empowers citizens to understand what their governments are doing with public funds

• Helps them identify the key challenges with the financial information systems, which are limiting sound economic governance

• So as to demand increases in efficient spending

• Also to call for improved financial data systems that will enhance transparency and accountability

• It is not enough for citizens to be empowered with these tools –government officials responsible for priority setting, costing, budgeting, and spending according to plan require skills and enhanced financial information systems, esp. at local levels

• All partners need to be transparent and accountable for their activities and spending, especially development partners

Lessons Learnt/Observations Made • Provincial and district health plans indicate increased efforts to

strengthen the fight against the epidemic – ongoing monitoring required

to monitor sustainability

• Budget and expenditure analyses indicate increased resources for

HIV/AIDS&TB – costing required to address adequacy issues

• Massive growth in ART beneficiaries – balance with prevention?

• Remarkable improvement on absorptive capacity, in line with increased

government and donor funds for ARVs

• Need for continuous oversight through Provincial Offices of the Premiers

that also serve as secretariats for Provincial AIDS Councils

• Need for improved information & financial management systems

undermining efforts for open governance & accountability

Contact Details Teresa Guthrie

Director

Centre for Economic Governance and AIDS in Africa

teresa@cegaa.org

Tel: +27 21 425 2852

Mobile: +27 82 872 4694

Website: www.cegaa.org