Background
PFM challenges affect health expenditure through often chronic bottlenecks at all steps of the budget cycle in the African Region – from budget formulation, to execution and reporting. To strengthen efficiency and accountability in the use of public resources, most African countries have initiated PFM related reforms since the late 1990s. However, progress varies across countries and, in many instances, fundamental PFM obstacles remain in the health sector. Most countries continue to struggle with unfinished transition and halfway implementation of both complex and basic reforms, leading to more intricate systems and complexity in resource management. There is a need to take stock, identify challenges and the possible ways forward in order to accelerate and tailor PFM reform implementation for better health spending.
Session objectives and outline
WHO’s Health Systems Governance and Financing Department held an Organized Session at the 5th African Health Economics Association Conference on PFM. The purpose of this session was to shed light on key PFM bottlenecks affecting health expenditure in African countries and to share key lessons learned from reform experience in the region. The session started with a presentation from WHO on key findings from a new flagship product on public finance for health in Africa.
The report “Leveraging PFM for better health in Africa” analyzes key PFM bottlenecks in the health sector and proposes an action framework for ministries of health to engage more effectively with budget authorities in the African Region. It calls for an acceleration of PFM reform implementation, as well as a process to revisit the focus and process which underpins these reforms. PFM reforms should be defined and implemented in a way that supports, not undermines, UHC.
This presentation was followed by two country presentations, from Burkina Faso and Ghana, highlighting lessons learned from the introduction of a program budget in health – a key PFM reform implemented across the region.
The reform implementation has raised questions in many contexts – from the elaboration of output-oriented budgetary programs, to the design of appropriate performance monitoring frameworks, to the actual change in expenditure management. Despite its potential merits, the reform is not a straightforward exercise in health. Building on lessons from countries that are at different stages of the reform institutionalization, participants were able to gather and discuss key challenges associated with this reform, as well as possible solutions to address them in a practical manner.