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