Meet Sowo Lebbie, Advocacy Advisor for MamaYe/Evidence for Action and institutional member of the budget advocacy working group in Sierra Leone. She tells us about what makes this group successful, what is special about budget advocacy, and how health budget advocacy has changed in the wake of the Ebola outbreak.What makes your budget coalition successful?The budget advocacy working group started in 2011 and has many members, including the Sierra Leone Budget Advocacy Network (BAN), Save the Children, World Vision, Health for All Coalition (HFAC), WASHNet, Health Alert, the Freetown WASH Consortium and my own organisation, MamaYe/Evidence4Action. We campaign mostly on health and water and sanitation financing issues.Our strength is that each of our members has specific expertise:
- BAN has technical people who can interpret the budget
- Others such as HFAC, Health Alert or WASHNet engage citizens and officials
- Save the Children and World Vision have a great community and district mobilisation strategy and a network of ambassadors (musicians)
- Freetown WASH consortium has experts with technical knowledge on water and sanitation,
- And we at MamaYe package the evidence and adapt messages to make them relevant to different audiences
Which is most important: budget allocation, revenue mobilisation, or spending?Despite our best efforts, allocations to health sector have fluctuated (7.4% in 2010, 11% in 2011, 7.4% in 2012, 10.5% in 2013 and 11.2% in 2014) over the past few years. The Governments usually allocates the budget based on revenue projections. Unfortunately, revenue is low and has been low for some time so the Ministry of Finance tells us there are no funds available. It would be easier if the revenue base were growing as this would mean they could increase the funding for health without taking money away from other sectors.The truth is that there is a huge problem around revenue collection. So this January, at the start of Sierra Leone’s fiscal year, we sat down to think about how we could influence the government budget, as we always do, but we also thought about how we could influence people and corporations to pay their taxes. Part of the problem is lack of trust – they don’t trust the government to spend their taxes properly. But there is also another problem around corporations, including mining companies, taking advantage of Sierra Leone’s natural resources. BAN published a report in December 2013 on how much Sierra Leone is losing from unpaid taxes. The budget advocacy working group will also continue reminding the government of Sierra Leone to fulfil its Abuja commitment of allocating 15% of its total annual budget to the health sector. There are still challenges with complete and timely disbursement of funds from the GoSL to the Ministry of Health and Sanitation, Ministry of Water Resources and councils. According to a report we launched last week on disbursement bottlenecks from GoSL to the councils and health and water sectors, none of the 8 councils assessed received timely funds for implementation from 2010 to 2013.Why do you think health budget advocacy is such a powerful tool for the health sector?When you do budget tracking you find out the true causes, you see the facts, you bring out the evidence about why the health system is not working. It is interesting because you see the whole picture of what is happening – it gives you answers to what people will want to know. Tracking budgets gets you to the root of the problem and also lets you see issues at different levels of the health system and how they connect to each other.Health facilities are not open, the District Health Management Team (DHMT) is not responding, drugs and staff are absent. Those are the problems at the surface. But when you do budget tracking, you realise one problem leads to the other. The DHMT or the council will tell you that the reason for no electricity in the hospital is that they did not receive the funds or that they received them late and so could not buy fuel for hospital generator. Also budgets are not based on need but on whatever money is available – so councils will tell you “budgets are whatever they give us, not based on needs or what we request. How can I execute my functions well?”How has the Ebola outbreak affected health financing and health budget advocacy in Sierra Leone?Much of the health funding has been diverted towards Ebola. The recent auditors report has found evidence of fraud, although investigations are on-going. It shows the need for greater budget transparency and accountability even in the middle of a crisis.Our latest research on inconsistent and incomplete disbursement of funding also has high relevance in the current context because funding bottlenecks cause weak health systems, and weak health systems are responsible for the scale of the outbreak.The budget advocacy working group members have joined various sub-groups of the Ebola Response Planning Group. Health budget and health financing issues come up all the time in these meetings, from the need to allocate more funds to health, to the negative effects of high out-of-pocket spending by patients. We will need to address all these issues in order to bring down Ebola cases to zero and ensure an outbreak like this never comes back.