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Public Financial Management

Reinvigorating Health Services: An Agenda for Public Finance Management

Matthew Jowett's picture



At the recent “New Directions in Governance” meeting it was suggested that future meetings should bring governance advisors together with sector-specific colleagues. The different language we use in our respective disciplines is a serious barrier to taking forward an agenda of real importance and  hence this message seemed particularly pertinent. I came to the meeting with a number of thoughts on how public finance management (PFM) rules often hinder health system performance, some of which I outline below.

Over the past three decades a major focus in low- and middle-income countries has been to seek new revenue sources for health services to overcome strict controls over the use of budget funds which were seen as inefficient but difficult to address. Community-based health insurance schemes have been widely introduced, as were patient user charges and payroll tax-funded social health insurance schemes. These various developments reflected a belief that governments were unlikely to increase funding to health, or to introduce the flexibility in budget funds required to incentivize improvements in service delivery.

A Matter of Trust: Governance and Service Delivery in the Time of Ebola

Hana Brixi's picture
WHO team are preparing to remove dead bodies of people who died from Ebola.
"WHO logistician Jose and team are preparing to remove dead bodies of people who died from Ebola." Source: WHO

Why do people  sick with the Ebola virus in West Africa avoid public hospitals?  Or, why do children not learn basic skills in schools despite significant public investment in education? 

In response to such situations, development specialists typically call for sector-wide reforms. And the design of such reforms draws on sector policy analysis and on the assessment of service delivery arrangements and capacity. Increasingly, since the 2004 World Development Report, sector reforms also seek to make teachers, health professionals and other service providers accountable to citizens and communities.

Do governments report on where the money goes?

Cem Dener's picture

The discussions on budget transparency and open data have been gaining momentum over recent years. Not only is it important that governments publish budget data on web sites, but also that they disclose meaningful data and full picture of financial activities to the public. The question is, how much of the disclosed information and documents are reliable? What is the scope of disclosed information? Is there any reliable information about other important aspects of fiscal discipline and transparency?

A number of fiscal transparency instruments and guidelines have been developed by civil society groups and international organizations to evaluate the existence, regularity, and contents of certain key budget documents published in the public domain and whether the information comply with international standards. However, current instruments do not concentrate on the source and reliability of published information, as well as the integrity of underlying systems and databases from which governments extract data.

Public Participation in the Budget Process in the Republic of Korea

Young Kyu Kang's picture

A recently released Open Budget Survey conducted by the International Budget Partnership (IBP) ranked the Republic of Korea as the top performer in public participation in the budget process. With a score of 92, Korea rose to the top as the only country “that provides extensive opportunities for public participation” (IBP 2012). Of 100 countries surveyed, the average score for public participation in the budget process was 19 out of 100. IBP found that in many countries there are limited, if any, opportunities provided to the public for engagement in the budget process. So what is it about Korea that makes it an exception?

Financial Management Reforms and the Realities of Politics

Sina Odugbemi's picture

There is probably no area of 'governance reform' work that is as technocratic and as ubiquitous as public financial management reform. It is where experts of different kinds - economists, accountants, auditors or all the above - work on improving the plumbing of governments, how revenues are collected and managed with efficiency and a minimum of leakage. Because the technical skills involved are deep and carefully honed over years of specialist training it is also an area where experts often seek to work in a politics- free zone by trying to ignore taking on the realities of each political context and just work on the plumbing. There is no doubt that a lot of good work is going on here, but there is also no doubt that a lot of the work is less effective than it might have been because interventions don't seek to work the politics of the initiative.

No Public Will, No Accountability

Anne-Katrin Arnold's picture

Last week and this, the Institute for Democracy in Africa (IDASA) piloted the new World Bank Institute's (WBI) new Core Learning Program "Introduction to Social Accountability" near Johannesburg, South Africa. CommGAP was invited to present a module on "Communication and Strategies for Constructive Engagement" - introducing our core concepts and messages on mobilizing public opinion to create genuine demand for social accountability. Here's a comment from the evaluations of our module: "The mobilization of public opinion is vital for social accountability. I have to admit that I was not aware of the importance of public opinion for social accountability before this course!"