Publication: Following the Government Playbook? Channeling Development Assistance for Health through Country Systems
Loading...
Published
2021-10-21
ISSN
Date
2021-11-09
Editor(s)
Abstract
Development partners (DPs) contribute to a significant share of total health financing, especially in low-income countries, and support the achievement of universal health coverage (UHC). However, if DP support is not well aligned with government systems, it can lead to inefficiencies, such as poor prioritization, fragmentation, and duplication of activities, and inhibit the government’s ability to maintain effective stewardship over sector activities. This note develops a comprehensive interpretation of the term ‘country systems’ in a public financial management (PFM) environment along with a checklist across the budget cycle that can be used to assess whether DPs in a given country are aligned to various PFM aspects. Undertaking an assessment is expected to have the following benefits: to provide a better understanding of the DP financial architecture and contribute to the literature of DP alignment and aid effectiveness; to articulate a clear baseline of DP financing modalities to allow for establishing a logical framework that will help articulate a reform program and strengthen mutual accountability. to foster learning across countries and DPs.
Link to Data Set
Citation
“Piatti-Funfkirchen, Moritz; Hashim, Ali; Alkenbrack, Sarah; Gurazada, Srinivas. 2021. Following the Government Playbook? Channeling Development Assistance for Health through Country Systems. © World Bank. http://hdl.handle.net/10986/36525 License: CC BY 3.0 IGO.”
Digital Object Identifier
Associated URLs
Associated content
Other publications in this report series
Journal
Journal Volume
Journal Issue
Collections
Related items
Showing items related by metadata.
Publication The Use of Data Analytics Techniques to Assess the Functioning of a Government's Financial Management Information System(World Bank, Washington, DC, 2019-01)Public financial management enables government to implement policy. Financial management information systems are a central element of PFM in that they facilitate government financial transactions and subject them to rigorous budgetary controls. Therefore, the adequate use of FMIS systems supports the implementation of fiscal rules and provides the basis for holding the executive accountable for implementing the budget. Yet, the integrity of expenditure transactions and effectiveness of budget controls is rarely assessed. This paper explores the meaning of adequate use of FMIS systems and points to data analytics techniques that can shed light on how the use FMIS systems affects expenditure data integrity and effectiveness of budget controls. This methodology is applied to Pakistan and Cambodia, which reveals two very different problems. In Pakistan the analysis of the transactions profile suggests that a large share of the budget is not subjected to FMIS internal controls. In Cambodia the majority of the budget is channeled through the system, but the method exposes very large advances to commercial bank accounts that are subsequently drawn upon but outside the system. Both of these raise concerns about the effectiveness of the FMIS system. Deploying data analytics techniques can help assess whether FMIS systems serve form or function. Judging a system by its use is informative about governments' revealed preferences in expenditure management. This paper puts the spotlight on the foundation of expenditure data and advocates for a transparent, methodical and evidenced based approach to FMIS deployment and expenditure management reform.Publication Budget Execution in Health(World Bank, Washington, DC, 2021-11-04)Most countries are committed to the provision of quality health services to all, without risk of financial hardship. Adequate budget provisions are an important, yet insufficient requirement in this pursuit. The budget also needs to be implemented in full and with regard to efficiency and accountability. While this is widely acknowledged, there is no systematic evidence on how well the health budget is implemented and literature remains thin on how budget execution practices relate to health financing functions and service delivery. This report is the first in a series of publications on the topic following an active World Health Organization and World Bank collaboration. It aims to define concepts, characteristics and trends in health sector budget execution. The report first calls for clarity in use of terminology. It helps to differentiate between ‘budget execution rates’ and ‘budget execution practices’. The former refers to the share of the budget being executed. The latter to processes on how well the budget is executed. Both aspects are equally important. Not implementing the budget in full is a lost opportunity, efficiency and accountability concern and undermines the health sector’s ability to deliver services. It also undermines prospects for increased fiscal space going forward. To identify trends and patterns in over and underspending, the report draws on previously unexplored PEFA annex and World Bank BOOST data. This reveals the following: Health budget execution rates are inversely related to levels of income and maturity of PFM systems. Health budget under-execution is particularly pervasive in LMICs where the budget is executed at around 85-90 percent. Some countries have chronic budget execution problems where the budget is executed at a rate below 85 percent across consecutive years. In LMICs, the health budget is systematically implemented at a lower rate than the general government budget. This means, that governments are effectively deprioritizing health during budget implementation. For Sub-Saharan Africa countries in the sample, the average health budget was 6.7 percent of the general government budget. Health spending as a share of general government spending was half a percentage point less at 6.2 percent. In some countries this is much more pronounced, where health is deprioritized by 2-3 percentage points of general government spending during implementation. The health budget was also implemented at a lower rate than the education budget in most countries at an average rate of 4 percentage points. Underspending in some categories often occurs concurrently with overspending on other expenditure items. While the wage and salary budget tend to be implemented in full, this is less so for goods and services or the capital budget. This can leave health workers without the necessary supplies or support infrastructure to provide quality services and invariably lead to inefficiencies.Publication Lessons from Reforming Financial Management Information Systems(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 Tanzania Health Policy Note(World Bank, Washington, DC, 2021-01-12)This is the second in a series of health policy notes that address critical health finance related questions in Tanzania. They are issued as part of a larger public expenditure review exercise. The audience is government, civil society and the development partner community with the aim to initiate a dialogue around key health finance issues and present recommendations to government. This policy note raises budget execution in health as a problem and discusses reasons behind low rates and the consequences for service delivery.Publication From Stumbling Block to Enabler(Taylor and Francis, 2018-11-06)The way governments manage resources through the budget cycle has important implications for health policy and whether governments achieve societal objectives such as efficiency, equity, quality, and accountability. Studies found a positive association between health service delivery outcomes and good governance of public finance; however, the mechanisms through which public financial management affects service delivery remain underexplored. This article maps the three stages of the budget cycle to common performance criteria used in health service delivery. It applies this approach to experiences in Tanzania and Zambia. The findings point to a number of stumbling blocks, including the lack of flexibility to provide additional resources for unexpected demand for care, misalignment between budgeting and planning, fragmented funding sources, rigid internal controls, insufficient budget provision leading to arrears, and a budget evaluation system that is excessively compliance driven and gives inadequate attention to issues of equity, quality, and efficiency in service delivery.
Users also downloaded
Showing related downloaded files
Publication Digital Africa(Washington, DC: World Bank, 2023-03-13)All African countries need better and more jobs for their growing populations. "Digital Africa: Technological Transformation for Jobs" shows that broader use of productivity-enhancing, digital technologies by enterprises and households is imperative to generate such jobs, including for lower-skilled people. At the same time, it can support not only countries’ short-term objective of postpandemic economic recovery but also their vision of economic transformation with more inclusive growth. These outcomes are not automatic, however. Mobile internet availability has increased throughout the continent in recent years, but Africa’s uptake gap is the highest in the world. Areas with at least 3G mobile internet service now cover 84 percent of Africa’s population, but only 22 percent uses such services. And the average African business lags in the use of smartphones and computers as well as more sophisticated digital technologies that catalyze further productivity gains. Two issues explain the usage gap: affordability of these new technologies and willingness to use them. For the 40 percent of Africans below the extreme poverty line, mobile data plans alone would cost one-third of their incomes—in addition to the price of access devices, apps, and electricity. Data plans for small- and medium-size businesses are also more expensive than in other regions. Moreover, shortcomings in the quality of internet services—and in the supply of attractive, skills-appropriate apps that promote entrepreneurship and raise earnings—dampen people’s willingness to use them. For those countries already using these technologies, the development payoffs are significant. New empirical studies for this report add to the rapidly growing evidence that mobile internet availability directly raises enterprise productivity, increases jobs, and reduces poverty throughout Africa. To realize these and other benefits more widely, Africa’s countries must implement complementary and mutually reinforcing policies to strengthen both consumers’ ability to pay and willingness to use digital technologies. These interventions must prioritize productive use to generate large numbers of inclusive jobs in a region poised to benefit from a massive, youthful workforce—one projected to become the world’s largest by the end of this century.Publication World Development Report 2018(Washington, DC: World Bank, 2018)Every year, the World Bank's World Development Report takes on a topic of central importance to global development. The 2018 Report, Learning to Realize Education's Promise, is the first ever devoted entirely to education. Now is an excellent time for it: education has long been critical for human welfare, but is even more so in a time of rapid economic change. The Report explores four main themes. First, education's promise: Education is a powerful instrument for eradicating poverty and promoting shared prosperity, but fulfilling its potential requires better policies - both within and outside the education system. Second, the learning crisis: Despite gains in education access, recent learning assessments show that many young people around the world, especially from poor families, are leaving school unequipped with even the most foundational skills they need for life. At the same time, internationally comparable learning assessments show that skills in many middle-income countries lag far behind what those countries aspire to. Third, promising interventions to improve learning: Research from areas such as brain science, pedagogical innovations, or school management have identified interventions that promote learning by ensuring that learners are prepared, that teachers are skilled as well as motivated, and that other inputs support the teacher-learner relationship. Fourth, learning at scale: Achieving learning throughout an education system will require more than just scaling up effective interventions. Change requires overcoming technical and political barriers by deploying salient metrics for mobilizing actors and tracking progress, building coalitions for learning, and being adaptive when implementing programs.Publication Better Jobs and Brighter Futures(World Bank, Washington, DC, 2020-12)In this paper, the authors present the evidence on why childcare matters for building human capital, look at the current status of childcare provision worldwide, including an estimate of the global gaps in access, and present specific actions countries can take to expand access to quality, affordable childcare for all families that need it, especially the most vulnerable. This paper was originally drafted prior to the Coronavirus 2019 (COVID-19) pandemic and has been updated to include new content, taking into account the unique challenges that the COVID-19 pandemic poses for families, children, governments, and the childcare industry, as well as the importance of investing in childcare to drive countries’ economic recovery. In section one the authors make the case for why childcare matters for building human capital and how it relates to a web of diverse issues that include women’s employment, family welfare, child development, business productivity, and the overall economy. In section two, the authors present the scope of the challenge worldwide, with projections of the unmet need for quality childcare and, ultimately, the size of the market opportunity. In section three the authors suggest five policy goals that all governments should work toward to ensure affordable, quality childcare for those families that need it. In section four, the authors lay out an agenda to better leverage existing resources and cross-sectoral opportunities, support country-level processes, and expand the research agenda. Detailed annexes are included at the end of the paper, which include additional research, guidance for countries, and specific policy and country examples that may be helpful in policy dialogue. These annexes can be used as standalone resources to go into more depth on specific topics.Publication Choosing Our Future(Washington, DC: World Bank, 2024-09-04)Education can propel faster and better climate action in two crucial ways. First, education can galvanize behavior change at scale - not just for tomorrow, but also for today. Second, education can unlock skills and innovation to shift economies onto greener trajectories for growth. At the same time, education needs to be protected from climate change. Extreme climate events and temperatures are already eroding hard-won progress on schooling and learning. Climate change is causing school closures, learning losses, and dropouts. These will turn into long-run inter-generational earnings losses putting into jeopardy education’s powerful potential for spurring poverty alleviation and economic growth. Governments can act now to adapt schools for climate change in cost-effective ways. This report outlines new data, evidence, and examples on how countries can harness education to propel climate action. It provides an actionable policy agenda to meet development, education, and climate goals together, recognizing that tackling climate change requires changes to individual beliefs, behaviors, and skills – changes that education is uniquely positioned to catalyze.Publication Quality Early Learning(Washington, DC: World Bank, 2022-05-11)In this volume, leading researchers and implementation experts from an array of disciplines provide evidence-based, cost-effective, and actionable strategies for delivering quality early childhood education (ECE) at scale in low- and middle-income countries (LMICS).Over the past decade, neuroscientists, developmental and cognitive psychologists, economists, and education researchers have amassed evidence to inform ECE program design. Yet much of this evidence has not been readily accessible to policymakers and practitioners, and potential synergies from cross-disciplinary considerations have not been realized.Quality Early Learning: Nurturing Children’s Potential synthesizes the evidence across disciplines and charts a forward course for quality ECE. The volume includes Overview, From Evidence to Effective Policies: How to Invest in Early Childhood Education to Nurture Children’s Potential, by Magdalena Bendini, Amanda E. Devercelli, Elaine Ding, Melissa Kelly, and Adelle Pushparatnam Chapter 1, Learning in the Early Years, by Elizabeth Spelke and Kristin Shutts Chapter 2, Pedagogy and Curricula Content: Building Foundational Skills and Knowledge, by David Whitebread and Yasmin Sitabkhan Chapter 3, Building an Effective Early Childhood Education Workforce, by Nirmala Rao, Emma Pearson, Benjamin Piper, and Carrie Lau Chapter 4, Creating Early Childhood Education Environments That Promote Early Learning, by Cynthia Adlerstein and Alejandra Cortázar Chapter 5, The Role of Management, Leadership, and Monitoring in Producing Quality Learning Outcomes in Early Childhood Education, by Iram Siraj, Violeta Arancibia, and Juan Barón Chapter 6, Toward Quality Early Learning: Systems for Success, by Sharon Lynn Kagan and Caitlin M. Dermody In the volume, the authors provide the latest evidence on how young children learn most effectively and how ECE programs can foster children’s natural ability and motivation to learn. It offers guidance for policy makers on policy design and implementation including what elements of ECE to prioritize in resource- and capacity-constrained settings in LMICs.