1. It is proposed that OPM provide advisory support to the Health Sector Working Group/
MTEF/Budget Management Reform Committee and technical assistance to the Ministry of Health in operation of the public expenditure management process. The support and assistance will be managed within the Policy and Finance workstream of the DFID funded Primary Health Care programme.
2. The delivery of the advice and technical assistance to the MoLHSA will be co-ordinated with the Ministry of Finance MTEF Design and Implementation process and follow the annual calendar for PEM activities set by the Ministry of Finance in each year. (The MoF will prepare a detailed calendar in January 2005. The timings presented here for activities are therefore indicative). It is envisaged that the support and assistance will be delivered in a similar format
in each of the next three years. At the end of each year the activities and inputs from OPM for the next year should be approved by the Sector Working Group.
2004 2005
Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
MTEF Briefing
MTEF Briefing Paper for HSWG
Presentation of Briefing Paper to HSWG
International Consultants 1
Local Consultants 1
Review of Health Sector Budget Submission
Review of Health Sector Submission for 2005 Budget
Presentation of review recommendations to HSWG
International Consultants 2
Local Consultants 3
Detailed Workplanning for 2005
International Consultants 1
Local Consultants 1
Training for strategy and prioritisation
International Consultants 2
Local Consultants 2
Revise Health Sector Strategy
International Consultants 4
Local Consultants 4
Programme Identification
International Consultants 4
Local Consultants 2
Programme Costing
International Consultants 5
Local Consultants 3
Preparation of Sector Expenditure Framework
International Consultants 4
Local Consultants 4
Review 2006-08 MTEF Preparation Process
International Consultants 2
9.8.2 Activities in 2004
1. Prior to the start of the 2005 PEM process, OPM will provide two outputs in the fourth quarter of 2004.
2. The first of these would be to provide MoLHSA with a paper and briefing on the development of the MTEF in Georgia and the in the Health Sector.
3. The second will be a review of the process and results of the use of the 2005 Budget Guidelines and of the Budget Submission for health from the MoLHSA. The review will assess the strength of the linkages of the budget submission with the EDPRP, the National Health Policy, and the Health Strategy. It will provide recommendations for the updating of the policy and strategy in 2005 and for refinement of the 2006 budget preparation process.
4. The timing of the delivery of these outputs will depend on two factors: first, on the date of formation of the Sector Working Group; and second, on the timing of the Ministry of Finance review of the 2005 budget preparation process. Ideally, the review of the health budget preparation for the HSWG should be completed prior to the MoF review.
5. A tentative timing for these activities is mid November. OPM inputs for these activities and outputs will be: International Consultants 3 weeks; Local Consultants 3 weeks. Two meetings of the HSWG will be required.
9.8.3 Activities in 2005
1. OPM support in 2005 will be of a process nature and will follow the MTEF/Budget preparation calendar outlined in the Ministry of Finance’s MTEF Design and Implementation Plan. The plan envisages five sets of activities for 2005: Training for strategy and prioritisation; Revise (the Health) Strategy; programme identification; programme costing; and preparation of the Sector Expenditure Framework. The exact timing of these activities and of the Ministry of Finance’s contribution to them will be decided in early 2005. In addition to supporting these five sets of activities OPM will work with the HSWG in January to prepare a detailed work programme in January 2005. In addition OPM will provide the HSWG with a review of the experience of the 2005 process in the last quarter of the year. Proposed timing and inputs to these activities in 2005 are as follows.
2. Detailed Work Planning for 2005. When the Ministry of Finance has presented the MTEF work programme for 2005, OPM will work with the HSWG to prepare a detailed work programme for MoLHSA for MTEF preparation. This should take place in January. OPM inputs will be:
International Consultants 1 week; local consultant 1 week.
3. Training for Strategy and Prioritisation: This is the first activity identified in the MTEF Implementation Plan. OPM will provide support to this process in conjunction with MoF activities and work with staff of the MoLHSA. This is tentatively scheduled for February. OPM inputs will be: International Consultants 2 weeks; local consultant 2 weeks.
4. Revise the Health Sector Strategy. This activity will follow the training. The objective will be for a revision of the Health Sector Strategy based on the experience of budget implementation in 2004 and the preparation of the budget for 2005. The approach will be guided by consultation with the Ministry of Finance (and instructions and guidelines) and with the HSWG. The revision should result in a closer linkage of the sector strategy to the EDPRP and the National Health Policy and where necessary and desirable to make proposals for revision of these documents.
The result should be a more detailed specification of the strategy activities and targets that will facilitate the preparation of the Health Sector Expenditure Framework for 2006-2008. This activity is tentatively scheduled for March. OPM inputs will be: International Consultants 4 weeks (2x2); local consultant 4 weeks.
5. Programme Identification. When the strategy has been revised and updated, the next tasks will be programme identification including the setting of output targets against which performance in the implementation of the Health Sector Policies and Strategies can be measured. The means by which programmes will be identified will follow guidance given by the Ministry of Finance and the HSWG. This activity is tentatively scheduled for April. OPM inputs will be:
International Consultants 4 weeks (2x2); local consultant 2 weeks.
6. Programme Costing. Once programmes have been identified and output targets are set and agreed by the HSWG the costs of achieving programme outputs will be identified. Ideally this will need to be done in the context of preliminary MTEF ceilings. This activity will follow guidance from the Ministry of Finance. The HSWG should give guidance on which programmes should be costed in greatest detail. It is suggested that in 2005 attention is focused on primary health care programmes using the experience of other activities of the DFID PHC Programme.
This activity is tentatively scheduled for May. OPM inputs will be: International Consultants 5 weeks (1x2 and 1x3); local consultant 3 weeks.
7. Preparation of Sector Expenditure Framework. Work on the SEF is scheduled for July in each year. The SEF presents the three year expenditure plans for the sector using the planning ceilings set by the Government. This activity is tentatively scheduled for July. OPM inputs will be: International Consultants 4 weeks (2x2); local consultant 4 weeks.
Annex 9.1 Terms of reference
Background
The Primary Health Care Programme is intended to provide the government with evidence to assist it in making important strategic choices about primary health care services; and to support their implementation. This document proposes ways in which these objectives might be met, on the basis of the programme’s first six months’ operation.
The programme was formulated under the auspices of the previous government by Department for International Development (DFID) in partnership with the Ministry of Labour, Health and Social Affairs (MoLHSA) and its key donors, particularly the European Union and the World Bank. It began on 1 September 2003 and, after a six-moth inception period, is now poised to commence implementation. Its general directions were identified in consultation with national and international stakeholder partners during a consultation process led by the MoLHSA Primary Health Care Management Committee between November 2003 and January 2004.
The election of a new President at the end of 2003 and the appointment of a new executive has heralded a new era in Georgian politics, with renewed emphasis on economic and public sector reforms and on the reduction of corrupt practices. The programme has the flexibility to respond to these emerging policy directions.
Technical work of the programme
Technical work of the programme is divided into four workstreams: health services delivery, finance and policy, Health Management Information Systems and Information, Education and Communication. A central activity within the finance and policy workstream is assistance in improved budget management at the level of the MoLHSA and in the interface with the Ministry of Finance and other related bodies involved in financing the sector – principally the Social Insurance State Unified Fund (SUSIF).
Description of Technical Assistance / Job Description
A key component of the financing and policy workstream is to support the Ministry of Health in developing core budget management capabilities. This support has been delayed while the new Ministry of Health team was put in place. The Minister has now expressed his support to begin for this component of the workstream and four priority activities have been identified: MTEF, Budget cycle audit, geographic resource allocation and benefits package development (see annex 1).
Beginning work on the first two activities is a priority for this consultancy. The latter two activities will be covered through separate support.
The Ministry of Finance have a commitment with development partners to prepare an MTEF. Initial support to this process is being provided through consultancies financed by DFID. MTEF will initially be piloted in a small number of ministries including MoLHSA. The OPM programme will support this from the side of the MoLHSA. This is seen as a useful way of helping the Ministry to think through broader questions related to the budget process and output based approaches.
The purpose of this consultancy is as follows:
• Document the main steps in the budget cycle from initial development of budgets through to implementation. This should clearly identify the responsibility of the main actors for each stage of the process (Ministry of Finance, MoLHSA, SUSIF etc).
• Identify the main areas of strength and weakness in the budget management process.
• Outline possible support to the MoLHSA (and possibly SUSIF) to improve the process.
Where the issues lie with other agencies or ministries this should be stated. The consultant should become familiar with the likely changes to the budget management process proposed by the current government and take account of these when making recommendations.
• Identify links with the forthcoming MTEF process and identify the main steps and support required for the MoLHSA to develop the sector MTEF.
• With the workstream advisor (to ensure activities can be accommodated within the workstream budget), develop a workplan for support under the programme. Types of support, including training and technical assistance, should be identified.
Duration of Assignment
• An initial in-country visit of 14 days plus 5 days in the UK (or elsewhere) to finalise the report.
Outputs
• A report not exceeding 20 pages sent initially to the workstream advisor
• Plenary meeting with the Ministry of Health and PHC Committee at the end of the consultancy to discuss key findings and next steps.
Qualifications and Experience
• Post-graduate qualification in economics, business administration, finance or related discipline
• At least 10 years senior experience of public sector expenditure and budget management processes
• Understanding of the health system in transition countries
• Experience in supporting and developing budget management in low and middle income countries including MTEF
10 Health Sector Financing Indicators
Tim Ensor
June 2004
10.1 Introduction
Indicators are needed to monitor changes in the financing of the primary care-led health sector in Georgia. This briefing note suggests some indicators and explains why the proposed indicators may be useful.
The indicators cover four aspects of health sector financing:
- improving management of the health sector budget;
- improving technical efficiency;
- improving efficiency in the allocation of funding; and
- increasing access to health sector funding, particularly by the poor.
It should be noted that all indicators can be misinterpreted and none give an unambiguous assessment of the state of health sector financing. They will, therefore, need to be interpreted with care and in conjunction with other indicators, particularly those examining the volume and quality of services. It is necessary to collect baseline data and set target values.