Training Completion Report
Training on Planning, Budgeting, Controls, Cash Flow and
Government Financial Rules for Government Health Staff
Nay Pyi Taw, November 2016
1. Introduction
The Global Fund (GFATM) supports National response to HIV/AIDS, TB and Malaria in all 330 townships of the country. Following Additional Safe Guard Policy (ASP) of GF, there was a need to set up a managed cash flow system in the country for GF funds flow.. Provision of such trainings on Planning, Budgeting, Controls, Cash Flow and Government Financial Rules is not only helpful in grant implementation but is very helpful in strengthening health systems and management capacities and to enhance financial management capacities of officers in National Health System.
Thus, mid-level manager trainings on Planning and Budgeting, Controls, Cash Flow and Government Financial Rules were organized by UNOPS under the leadership of MOHS in Nay Pyi Taw, Myanmar– a long event of 6 sessions with 12 batches and more than 900 participants – It was conducted from 15 Nov to 29 November 2016 and every session was opened by one of the DD(G) Health. This was the third of the series of similar trainings in the last 3 years.
2. General objective
The aim of the workshop is to promote management capacities of National Health staff through understanding the principles of a management structure and hierarchy of implementation management, including budgeting, work planning, activity implementation, budget management and reporting through the Managed Cash Flow.
3. Arrangements for training
Detailed planning for this training initiated 2 months in advance with the leadership and guidance of Disease Control Division of DoPH. UNOPS took the responsibility for logistics of trainings, including the provision of accommodation, travel costs and applicable Daily Subsistence Allowances (DSA) of trainees. The training took place at the Hotel Royal ACE, Nay Pyi Taw. In each batch, in order to have good space and to promote maximal participation, 2 sessions were separated and conducted in 2 halls simultaneously by 2 groups of facilitators.
4. Preparation of training materials
Agenda: Disease Control Division of the DoPH – Director (Disease Control), 3 National Programme Managers and focal persons led in the development of training agenda based on the previous year experience (agenda is attached).
Training materials: DoPH reviewed training materials of previous year’s training and
provided inputs and PR-UNOPS prepared for the updates. Before conducting this training, the Standard Operating Procedures of Managed Cash Flow (MCF SOPs) was revised by conducting a formal meeting in Yangon among DoPH- 3 National Programmes, Department of Medical Services (District and Township level implementers) and PR-UNOPS on 20 October 2016. Consultations with National Health Laboratory were also carried out by NAP and NTP to get updated costs for laboratory investigations. Most of the training materials were prepared based on the updated MCF SOPs.
Government financial regulations: Director (Budget Division) of DoPH provided training hand-outs and presentations for ‘government financial regulations’ session.
5. Trainees and attendance rates
A total of 6 sessions and 12 batches of trainings were held in Nay Pyi Taw. Disease Control Division of the Department of Public Health invited government health staff of different levels from all over the country who are responsible for Health care service management, financial management and accounting. Participants included State/ Regional Public Health Directors who had not attended similar training before, District Public Health Officers or Deputy District Public Health Officers (Disease Control), Township Public Health Officers or Township Medical Care Officers, Deputy Township PHO (Disease Control), Assistant Directors and Team Leaders (AIDS, TB, Malaria), AD or Medical Officers from other sections/ divisions of DoPH. Moreover, one financial focal point from all townships – Bench Clerk, Finance Clerk or Accountants were also invited to the training.
Attendance rates were observed as follows:
Batch No. Dates No. of invited
participants No. attended
% of attendance 1 15-16 Nov 133 122 91.7% 2 17-18 Nov 141 137 97.2% 3 20-21 Nov 144 133 92.4% 4 22-23 Nov 148 139 93.9% 5 25-26 Nov 145 132 91.0% 6 28-29 Nov 145 118 81.4% All - 856 781 91.2%
Note: If facilitators and central level staff will be counted, it was nearly an average of 96% attendance rate.
Moreover, interested participants from ADB-JPF grant (HIV/AIDS), colleagues from UNICEF and WHO also participated in respective batches of training as observers.
6. Opening speeches
Training batches 1-4 were opened by Dr. Yin Thandar Lwin, Deputy Director General (Public Health), batch 5 by Daw Aye Aye Sein Deputy Director General (Finance and Administration) and batch 6 by Dr. Than Win Deputy Director General (Disease Control). Opening speeches emphasized the importance of achieving health care results, economic safety and customer satisfaction through realization of Universal Health Coverage by 2030,
improvements not only in numbers but also in quality with 9 strategic areas. Out of Pocket Expenditures (OOP) has been reduced in 2015 up to 60% from 80% in 2011. Health staff must carry out programme management, procurement and supply chain management, financial management and information management according to international standards. Although more ODA and government contribution in health budgets, the rules and regulations of foreign assistance are not consistent with departmental budget management, there are funding mechanisms through UN agencies and INGOs or through reimbursement systems, those intermediary organizations must operate according to MOU or contract terms. DoPH will try to have one costed plan, one integrated management system so that it will serve as a fundamental mechanism to implement programmes supported by any funding source. As this is a third time provision of training, township level staff should discuss based on their own experiences.
Deputy Director Generals instructed participants to use funds properly and follow the SOPs strictly. All claims should also be kept properly and examined (audited) any time. Regular coordination meetings should be held at the township level with implementing partners (IPs), reports should be gathered timely and it’s necessary to make sure that IPs must report to IRD and relevant State/Regional and Township Public Health Departments. Their coverage and gap should be known.
Implementation must not only be transparent and accountable but also be effective and efficient, so that we will achieve UHC in 2030 and Sustainable Development Goals. As donors would be measuring results based on performance based indicators, being assessed through agreed targets, everyone should be collaborating within disciplined frameworks.
7. Pre- and Post-Test
To assess background knowledge of trainees, pre-tests was carried out on Day-1 before starting MCF sessions. 6 questions on MCF, 2 questions on PSM and 1 question on M&E were assessed. On Day-2 after all training sessions, post-test was conducted using the same questions. Responses from each trainee were entered into excel file; correct responses of all trainees were analyzed and summarized by calculating the percentages of correctness against total responses- below graph.
78% 77% 79% 70% 79% 75% 72% 74% 76% 75% 77% 79% 80% 97% 98% 81% 93% 84% 83% 86% 86% 81% 84% 91% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 1A 1B 2A 2B 3A 3B 4A 4B 5A 5B 6A 6B Batch
Pre/Post Test Results - Summary
Pre Post
8. Discussion of participants during training
Discussion Points Responses from DoPH and PR-UNOPS
Programme and work plan related discussion
Bottom-up planning is not really happening at the township level
(Many townships discussed this issue)
Basically, it has been rolled out and started but it should be strengthened further. Some state and region hold regular coordination meeting and discussed about needs and demands there.
Township level officers get work plans from central level with long delays
(Many townships discussed this issue)
DoPH- ATM programmes usually take the responsibility of sending/ sharing verified (finalized) quarterly work plans to all levels timely. Some delays may be due to communication gap.
There are role conflicts between Team Leaders (who are relatively younger but have direct responsibilities and authority in ATM implementation) and TPHO, TMSO (who are older and more experienced).
(Maubin township)
MOHS and local S/R health authorities will work closely with its staff to ensure that such conflicts do not arise.
MOHS operational arrangements of split between DoPH and DMS causes difficulties in programme implementation – e.g., invitation for training, meetings, laboratory services, etc.
(Magway and many townships)
It is unfortunate and township level staff should coordinate with respective units/ departments of DoPH and DMS to conduct township level activities timely.
Township level focal persons of ATM should also be included in MCF training.
(Many townships)
DoPH/DC will consider this for similar training in the future.
More group works (practical sessions) should be included in future MCF training.
(Many townships)
Yes, this strong recommendation will be considered carefully for similar training in the future.
For year-end claims, shall it be allowed beyond 31 Dec 2016?
(Hmawbi Township)
It is being instructed by DoPH to claim all payment requests by 31 Dec 2016; UNOPS MCFU has requested to allow late claims up to 31 March 2017 in bi-monthly review meetings conducted on 7 Oct 2016and again on 12th December 16
The (GF) should allow some “incentives” to township level “finance staff” like a practice of cash flow mechanism of WB money.
GFATM is very sensitive to provide ‘incentives’ for government health staff. Even very small amount of cash for volunteers and BHS has been justified in budgets as “transport subsidies” but not as “incentives”.
After receiving LFA visit at the township, one TMSO wanted to get findings and feedbacks of LFA visit reports and RDQA reports (feedback mechanism).
(Kun-chan-gone Township)
LFA and PR-UNOPS always share such reports and findings to 3 National Programmes (NAP, NTP and NMCP). And it is discussed to inform NPs to share relevant LFA visit reports and RDQA reports to township level staff.
Procurement and Supplies related discussion
Tax on the goods and commodities Commercial tax is exempted for UN organizations. But, due to the nature of country, seller or supplier shall have to pay for commercial tax. Hence the total price of goods shall be all in price, no additional tax or VAT shall be charged by supplier. MOHS decides requirement of tax in accordance with the government rules and regulations.
Brand Name was restricted in SOP. Kindly clarify how to get the better quality product?
National Programmes can mention the requirement of quality certification, warranty and technical
requirements in solicitation document. In case of Air-Con procurement, will it be
acceptable if the process of Air-Con and installation carry out separately?
For the procurement of products which need installation service for functioning purpose, the estimated total amount will be the product cost + installation service charges. Most of the Air-Con suppliers could provide the product along with installation service. If a process will be carried out separately, a prior approval from PR would be required with proper justification.
As per the work plan, the same items need to be procured in different townships with an available budget of less than MMK 500,000. However, the product was not available and it had to be procured in nearby township. In that case, are separate procurements required?
Yes, if the available budget was under different townships with different DOA, separate process was applicable. Name of township (for the item) to be delivered, date and buyer name need to be mentioned on invoice.
If the procurement process received only 2 or single quotations, should the process be canceled or preceded?
In the budget threshold of MMK 500,000 to MMK 1,000,000, if a buyer did not received 3 quotations, National Programme needs to submit all the documents to PR-UNOPS for review before issuing an award. For a threshold of MMK 1,000,000 to MMK 49,999,000, all the documents need to be submitted to PR for review along with proper justification in ‘evaluation report’. The process can be continued only after getting PR approval.
How to make payment for BOQ and drawing charges for engineer in renovation process? From which budget line will it be charged?
Engineer service charges for preparation of BOQ and drawing can be charged through single receipt if the charge is less than MMK 500,000. Payment can be paid from ‘renovation budget line’ but it must be included in quarterly work plan.
Which information/ facts need to be provided in the comparison sheet?
All the quotations received shall be compared and evaluated as per criteria mentioned in solicitation document. In ‘technical comparison sheet’, technical specifications of offered products need to be compared with a requirement. In ‘financial comparison sheet’, an offered price of suppliers whose offered product was compliant with a requirement must be mentioned.
Managed Cash Flow related discussion
Payments especially “Modified Reimbursement” claims were received lately at the township level
(Many townships)
One of the main reasons is “increase in no. of activities of 3 NPs” in 2016 due to “reprogramming exercise”, unspent budget (savings) are being re-budgeted in this year.
One FFA can hold only 500 lakhs MMK in a particular time and which may not be enough for that particular area for 3 NPs.
A good solution is to start Advance money mechanism. .
To avoid payment delays, a specific time frame to process ‘modified reimbursement’ should be mentioned in MCF SOPs.
(Insein township)
For MRs more than 2,500 USD, UNOPS usually process within 6 week time. But it has no defined specific timeframe for MRs less than 2,500 USD. However, if all claims, vouchers, forms and attachments are complete with DOA Officers’ signatures, FFA usually pay the cash ASAP.
Township level staff (TPHO, TMSO) should be granted an “authority” to initiate “advance money”, rather than retaining the authority in the hands of PMs only.
(Many townships)
DoPH/DC would review this, and if it’s feasible, it will be revised in the nearest revision of MCF SOPs.
In a township, training was planned to conduct with (for example) 20 participants. However, when training was conducted, 30 participants attended the training and they shared the DSA among 30 participants. So each participant received less DSA than expected.
It is suggested to change their work plan with new expected no. of participants before conducting training as per MCF SOPs. Besides, according to the revised MCF SOPs, ‘budget flexibility’ has been increased from 10% to 20% and thus, township staff will be able to host some more participants, as long as the total approved budget in work plan is not changed.
For activities conducted in Magway township, health staff from Minbu township get ‘non-resident’ DSA rate although they traveled only few miles while some health centre staff from Magway township get ‘resident’ DSA rate even they travelled for 30-40 miles. Such cases happen in other states and regions and it should be re-considered.
(Magway Township; similar discussion from many townships)
Yes, for such case, ‘distance travelled’ should be considered. DoPH/DC should review this, and if it’s feasible, it will be revised in the nearest revision of MCF SOPs.
9. Feedback of participants
Trainees were asked to provide feedback of the whole training and their suggestions were collected and recorded. Training evaluation was also done using structured questionnaires and responses of participants were recorded. Those responses are compiled in annex-1 (see attached document).
10. Conclusion
Most of training participants saw this training as a useful one for their daily works. They left positive comments regarding contents, structure, timing and logistic arrangements of training. However, there were many things to be improved and those deficiencies will be corrected in future training.
Date of report: 13 Dec 2016
Annexes
1. Feedbacks of participants: a separate doc (Myanmar language) has been attached.
2. Pre- and Post-Test questions
