Person:
Piatti-Fünfkirchen, Moritz
Author Name Variants
Fields of Specialization
Health Financing,
Public Financial Management,
Fiscal Policy
Degrees
External Links
Departments
Health, Nutrition, and Population, East and Southern Africa
Externally Hosted Work
Contact Information
Last updated
January 31, 2023
Biography
Moritz is a Senior Economist at the World Bank working at the nexus of public financial management and health. He is interested in how to balance fiscal control with service delivery needs and has written extensively on the use of financial management information systems. His work is currently focused on reforms in the Africa region where he leads various analytical programs including on how to deploy disruptive technology solutions. Prior to joining the World Bank, Moritz worked as an advisor in the Ministry of Health in Zanzibar/Tanzania, where he supported the government in budget management and the introduction of health finance reforms.
Publication Search Results
1 - 8 of 8
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Publication
Zambia Health Sector Public Expenditure Tracking and Quantitative Service Delivery Survey
(World Bank, Washington, DC, 2019-04)Zambia’s health sector has continued to evolve with the government undertaking several reforms aimed at improving the performance of the sector to achieve the Sustainable Development Goals (SDGs) and their precursor, the Millennium Development Goals (MDGs). Amid the ongoing reforms, the health sector has recorded a number of achievements, but some challenges remain. This Public Expenditure Tracking and Quantitative Service Delivery Survey (PET-QSDS) assesses the financing and delivery of health services, and whether the reform objectives have been made. This was achieved by reviewing the flow of financial and other resources in the public health sector from administrative units to service delivery points at the facility level. The data were collected from administrative units, health workers, and patients to gauge the various dimensions of the health system that include financial flows, management of infrastructure, human resources for health, and patient management. Specifically, the issues which were reviewed are: Availability, adequacy, and timeliness of resources for service delivery; implementation of some key policy reforms such as user fee removal and adherence to policy guidelines; donor resource coordination, ownership, and fragmentation at the district level; assessment of human resources management at the district and facility levels; and comparison of staff satisfaction, absenteeism, and service delivery in districts implementing the Results-based Financing (RBF) model and non-RBF districts. -
Publication
Zambia Health Sector Public Expenditure Review
(World Bank, Washington, DC, 2018-12)The Zambian government has outlined an ambitious rights-based approach to health care provision as outlined in its national health policy. Specifically, the government is determined to achieve universal health coverage (UHC) by providing all its citizens with access to free quality health care services through the public health system. To examine trends and patterns in health expenditures and to identify opportunities for achieving value for money and equity, the Zambian government, with technical and financial support from the World Bank and the U.K. Department for International Development (DFID), conducted a public expenditure review (PER) of the health sector. This review covers 2006−2016 and builds on the PER that was produced in 2009. This report shares the results of the PER and provides key policy recommendations on how to address the existing challenges. -
Publication
A Diagnostic Framework to Assess the Capacity of a Government's Financial Management Information System as a Budget Management Tool
(World Bank, Washington, DC, 2016-01-01)A government’s capacity to manage its public finances is central to its ability to deliver services. Well-functioning accounting and financial management systems are among the basics that facilitate this, and significant resources and time have been invested for the procurement and implementation of such systems across the world. Implementation is, however, often associated with disappointing results and attribution to higher-level public financial management (PFM) objectives difficult to establish. On the basis of five in-depth project-level evaluations of World Bank investments, this paper proposes a diagnostic framework that can be used to assess the utility of a Financial Management Information System (FMIS) as a budget management tool. The paper develops a total system strength score and weighs various dimensions according to importance. The total system strength score is mapped to corresponding Public Expenditure and Financial Accountability assessment dimensions to assess any correlation between the two, and extensive sensitivity analysis suggests a positive correlation. This is interpreted as an indication that the framework is robust. A preliminary application of the methodology to a sample set of countries finds that in many cases further reforms would be most effective if, at this stage, they pertained to expanding treasury single account and FMIS coverage (and its associated controls) rather than additional technological investments. -
Publication
Lessons from Reforming Financial Management Information Systems: A Review of the Evidence
(World Bank, Washington, DC, 2018-01)Financial management information systems are a sine qua non in public financial management and play a foundational role in the execution of the budget. Recognizing their potential contribution to fiscal discipline, the strategic allocation of resources, and operational efficiency, significant time and resources have been invested by the World Bank and other development institutions into such systems across the world. However, the reform of financial management information systems tends to be complex, and the evidence base of causal effects and mechanisms is thin. This study develops a framework that outlines the various steps involved in reform that illustrate how change is expected to happen. Three major dimensions were identified: (1) diagnostic phase, (2) systems development lifecycle, and (3) coverage and utilization. The paper argues that reaching the financial management information systems production frontier requires optimization across these dimensions, and that a programmatically coherent approach is required to realize fully the expected improvements in budget management. The study identifies a set of lessons on the various stages that are mapped against the framework by triangulating findings from a systematic review of the financial management information systems literature, field-based project-level evaluations and protocol based case studies, and a comprehensive desk review of the World Bank financial management information systems project documentation. -
Publication
Rwanda Nutrition Expenditure and Institutional Review 2020
(World Bank, Washington, DC, 2020-11-03)This report provides recommendations to further develop the methodology for nutrition expenditure analysis. This report carefully reviewed all available nutrition expenditure analyses available and drew methodological conclusions. Findings include a need for a standardized way of classifying nutrition-related spending to be applied, of which the 2013 Lancet Framework lends itself well. Government spending should be mapped against this framework to the extent possible. Government expenditure data as available from the FMIS should be used. Coding for nutrition should be done against activity descriptions in the budget. Merely looking at spending agencies or programs/subprograms is unlikely to be sufficiently precise to be helpful for an analysis and should only be used if the former not be available. Weighting nutrition spending tends to be subjective and should not be used for comparison. It is important to consider the adequacy of the institutional and public financial management environment. This can provide for actionable recommendations on how to improve the management of nutrition across governments, strengthen accountability, and help adjust spending toward high impact interventions. Optima can be used to inform allocative efficiency. It should however be interpreted with care if the unit cost estimates cannot be fully derived from Government and donor expenditure reports of all high impact interventions. -
Publication
Improving Effective Coverage in Health: Do Financial Incentives Work?
(Washington, DC: World Bank, 2022-05-11)In many low- and middle-income countries, health coverage has improved dramatically in the last two decades, but health outcomes have not. As such, effective coverage -- a measure of service delivery that meets a minimum standard of quality -- remains unacceptably low. This Policy Research Report examines one specific policy approach to improving effective coverage: financial incentives in the form of performance-based financing (PBF) or financial incentives to health workers on the front lines. The report draws on a rich set of rigorous studies and new analysis. When compared to business-as-usual, in low-income settings with centralized health systems PBF can result in substantial gains in effective coverage. However, the relative benefits of PBF are less clear when it is compared to two alternative approaches, decentralized facility financing which provides operating budget to frontline health services with facility autonomy on allocation, and demand-side financial support for health services (i.e., conditional cash transfers and vouchers). While PBF often results in improvements on the margins, closing the substantial gaps in effective health coverage is not yet within reach for many countries. Nonetheless, there are important lessons learned and experiences from the roll-out of PBF over the last decade which can guide health policies into the future. -
Publication
Public Spending In Health Sector in Malawi
(World Bank, Washington, DC, 2020-12)Malawi’s economic growth has been low and volatile for the past two decades, leading to stagnating high poverty levels. The Coronavirus (COVID-19) pandemic will negatively affected economic growth leading to lower government revenue. Despite low per capita growth, Malawi has made strong progress in many areas of human capital development since 2000. Notwithstanding the above, Malawi still faces considerable gaps in human capital, which will impede its ability to reduce poverty in the medium term. Malawi lags behind in some health and nutrition outcomes, including HIV and malaria prevalence. Strengthening human capital in Malawi will be critical to reduce poverty, increase inclusion in society, and create jobs. The World Bank launched a new Human capital index (HCI) in October 2018 as part of its broader Human capital project. One factor that contributes to low human capital outcomes is Malawi’s adolescent fertility rate, one of the highest rates of in the world, with 132 births per 1,000 women aged 15-19. The main underlying cause for the high adolescent fertility rate is the high rate of child marriage. The government is making efforts to strengthen human capital. To strengthen human capital in the face of limited fiscal space, Malawi needs to improve the efficiency and effectiveness of government and donor spending on human capital. To address this problem, there is need to integrate financial reporting systems at district and central government levels. This will enhance government’s ability to monitor and evaluate expenditure and program implementation across sectors. -
Publication
Tanzania Health Sector Public Expenditure Review 2020
(World Bank, Washington, DC, 2020-04)This Public Expenditure Review (PER) report provides an update on trends and patterns of health expenditures in the public sector. It assesses the availability of fiscal space, the role of user fees and pooled financing arrangements, and provides an overview of the fund flow and financial management processes. The report also explores equity and allocative efficiency considerations, access to care and technical efficiency.