Consultant Improving Efficiency of Public Health Spending in Anambra State through Public Finance Management Reforms

Objective

To achieve more health for the money through Public Finance Management reforms including Program Based Budgeting (PBB), thereby creating a replicable model of PFM reform in the health sector.

Rationale

Nigeria is currently not on track towards Universal Health Coverage (UHC). The sub-optimal performance of Nigeria’s health system can be attributed to the poor financing of the required investments for delivery and management of health services. With General Government Health Expenditure (GGHE) as a percentage of the General Government Expenditure (GGE) at 5.9% (Federal), 4.2% (States), and 3.8% (LGAs), Nigeria is still far from Abuja Declaration of 15% spending on health.

Available evidence suggest that favorable macro fiscal dynamics, reprioritization and efficiency savings are the most potent ways of expanding fiscal space for health in Low-and Middle-Income Countries (LMICs). Addressing inefficiency in health sector could prove very useful as competing priorities of government could make it difficult for the health sector to fully benefit from favorable macro fiscal dynamics and reprioritization.

Between 30-40% of health resources is wasted and common areas of inefficiency include, Human Resources for Health, commodity procurement and supply management and health system organization. Demand side strategic purchasing which ties spending to purchase of needed services that are most effective has been recognized as potent tool for enhancing efficiency of demand-side financing. However, the bulk of government spending in Nigeria is channel through supply-side as the health insurance penetration is still very low. Therefore, the need to prioritize supply-side strategic purchasing cannot be overemphasized.

Adjusting Public Financial Management (PFM) structure by migrating to Program Based Budgeting which allows linkages between health funding and health outcomes is a promising approach for allocating resources to program areas that will bring highest level of impact and provide opportunity for efficient budget execution and revolutionize budget tracking.

While World Bank and other partners have provided support that enables some states to develop administrative code as part of advancement towards International Public Sector Accounting Standard (IPSAS), states are yet to develop program code that will enable Program Based Budgeting and where program code exist it’s not used as the basis for budget, allocation, execution and monitoring.Another related PFM initiative in the horizon is Integrated Financial Management System (IFMS) which among other things, will ensure migration from paper based to fully automated financial accounting and reporting.

Scope of work

1. Design of scoping protocol
2. Desk review of available relevant documents on PFM processes and reforms at Anambra State level
3. Engage with relevant institutions in Anambra State namely the Ministry of Finance, Anambra State Ministry of Budget and Economic Planning, Accountant General of the State, Auditor General, State Ministry of Health and relevant development partners, etc.
4. Review of Budget allocation, execution and monitoring process in Anambra State;
5. Conduct a stakeholders’ workshop on PFM processes and introduction of PBB including electronic systems
6. Synthesis of evidence using health financing data (budget and expenditure) and health outcomes in Anambra State to develop a scorecard
7. Develop State Operational Guidelines for PFM Systems
8. Collaborate with the Consultant working on the PFM of National and Sokoto State
9. Report writing

Specific Deliverables

a.Scoping report protocol

b.Scoping Report detailing\:

• Analysis report of Anambra State PFM processes including allocation, execution and monitoring and identification of PFM challenges
• Analysis report of ongoing PFM interventions at national and sub national levels
• Mapping of institutions that play important role in PFM reforms at the national and sub national levels

c.Established mechanisms for PBB in Anambra State including coordination platforms and electronic systems

d.Report of evidence synthesis and scorecard using health financing data (budget and expenditure) and health outcomes in Anambra State

e.State Operational Guidelines for PFM Systems

f.Identification of intervention elements and opportunities for reforms

g.PowerPoint presentation on the products

h.A detailed consultancy report

Required Skills, Qualifications, and Experience

üEssential\: Advanced University degree in Health Financing/Economics, Public Health, or other related area.

üAt least 5 years’ experience and technical expertise in Public Health, Health Financing, Public Finance Management, costing, economic evaluations, health policy and strategy development, planning, monitoring and evaluating health systems

üDesirable\: At least 10 years’ experience and technical expertise in Public Health, Health Financing, Public Finance Management, costing, economic evaluations, health policy and strategy development, planning, monitoring and evaluating health systems

üExtensive Knowledge of Nigeria’s health system and health financing landscape

üPrevious experience in the design and implementation of Public Financial Management interventions in Nigeria will be an advantage

üPerformance of similar assignment with WHO will be an advantage

üDemonstrated ability to provide sound methodological and technical advice and guidance to multiple stakeholders and partners in Nigeria

üDemonstrated ability to analyze political contexts, interact, and negotiate effectively with multiple interests at the political level.

üDemonstrated ability to work effectively with the Ministry of Health, Ministry of Finance, Budget and Planning, and with a wide variety of stakeholders at the country, State, and LGA levels

üProven ability to interact effectively at the political level with multiple high level Stakeholders

üDemonstrated ability to innovate, integrate, synthesize and communicate complex concepts and ideas verbally and in writing.

üIT Proficiency is essential

Breakdown of the number of days for technical assistance

Financial Implication of the Agreement\:

The Contractor will be paid at the level of NOC Step 1 converted to daily rate of NGN64,301 for 20 days.