What works in health budget accountability?

Earlier this month, Sarah Fox, E4A Health Financing Specialist, spent two days at the PHC Expenditure and Budget Advocacy Consultation convened by PAI in South Africa. Read about her key take aways here.

I was fortunate to attend the recent Primary Health Care (PHC) Expenditure and Budget Advocacy Consultation convened by PAI, where a range of experienced health budget advocates came together to share their experience and explore opportunities to strengthen their budget advocacy efforts around PHC.In one session, AHBN coordinator, Aminu Magashi Garba, interviewed three panellists about their budget advocacy approaches and successes: Itai Rusike Executive Director of Community Working Group on Health (CWGH) in Zimbabwe, Hugh Bagnall-Oakeley, Senior Policy Advisor, Save the Children who spoke about health budget advocacy in Malawi and Esther Agbon, Health Finance & Advocacy Advisor, E4A-MamaYe Nigeria.Here are some of the key points that I took away from the discussion:

Effectively synthesising evidence from the community level can help to open up space for civil society engagement

It’s important that advocates and government understand the key priorities of their constituents. CWGH conducts annual community reviews that it synthesises into position papers and shares with parliamentary committees on health. This process helps to sensitise parliamentarians on the key challenges in meeting the health needs of the citizens of Zimbabwe.

The media also has an important role to play in advocating for the community: “we need to bring journalists to the community level so that they have first-hand experience of the issues and how they are affecting communities.”CWGH also promotes the role of civil society to be given positions on key bodies that are mandated to advise the Ministry of Health. While previously in Zimbabwe the perception was that these positions should be reserved for professionals such as accountants or lawyers, there is now an acknowledgement of the important contribution to be made by civil society.

E4A-MamaYe has played a catalytic role holding the government of Nigeria accountable for its commitments. 

Esther and her colleagues have achieved this through analyses of the pre-approved budget, which is shared with various platforms such as the Health Sector Reform Coalition (HSRC).  These platforms can form a united voice to put pressure on the government.  In 2016, the budget line for Family Planning and the Midwives Services Scheme was initially omitted from the budget.  This was later restored following budget analysis and the advocacy efforts of the HSRC. Esther is hoping that this year, E4A-MamaYe will achieve similar success in holding the government accountable for its 1% contribution of the Consolidated Revenue Fund for basic health services.

Evidence generated from cross-sectoral budget analysis is increasingly being used by parliamentarians and the media.

Hugh Bagnall Oakeley spoke of the support Save the Children has provided to the Civil Society Organisation Nutrition Alliance (CSONA) in Malawi to advocate for increased public investment in nutrition through the analysis of budgets – specifically how they align with sectoral strategies, trends in allocation over time and budget breakdown at programme level. 

While in the beginning, there was little interest in this kind of analysis, now CSONA is regularly summoned by the parliamentary committee who see the value in using this evidence to inform their parliamentary discussions.  And MPs aren’t the only ones who are excited about this evidence; every time CSONA makes a presentation, they are seeing increasing numbers of press turning up to hear about the results. 

Hugh and his colleagues have already seen the benefits of their budget advocacy efforts.  When they started to undertake the analysis the allocation to Nutrition was about USD $50,000. As of 2016/17 the allocation has increased to USD $303,900.Hugh summed up what many of us working on health budget advocacy know to be true:“Some information can be politically explosive. Sharing this information opens the risk of destroying trusted relationships that have been established with the Government.”

Sometimes the line between influence and accountability can be a tricky one to tread. However, it’s good to always consider carefully the ramifications of information and the mechanisms by which it is shared. Though it’s not always easy, it’s important to know when to be an ally and when to push decision makers to live up to their commitments. 

Share this article