|Parallel session PS10, Tuesday, May 27 2008, 11:00-12:30, Room 3|
|Chair(s): George Pariyo, Senior Lecturer and Head, Department of Health Policy Planning and Management, Makerere University School of Public Health, Uganda|
|Fiscal Space for Health Expenditure in Mozambique: Blocking Effectiveness of International Funds through Budget Support|
|Gorik Ooms, Analysis and Advocacy Unit, Médecins Sans Frontières, Belgium|
|Towards Successful Community Health Insurance: Lessons Learned from Five Years of Active Involvement in Sub-Saharan Africa|
|Maria-Pia Waelkens, Department of Public Health, Institute of Tropical Medicine, Belgium|
|Exploring SWAp’s Contribution to the Efficient Allocation and Use of Resources in the Health Sector in Zambia|
|Birger Forsberg, Public Health Sciences and Medical Management Centre, Karolinska Institute, Sweden|
|Contractual Arrangements between Community Health Insurance Schemes and Health Care Providers as a Means to Improve the Quality of Care: An Overview in Sub-Saharan Africa|
|Pascal Ndiaye, Department of Public Health, Institute of Tropical Medicine, Belgium|
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Contributors: Sue Hua (ICVolunteers)
Gorik Ooms, Analysis and Advocacy Unit, Médecins Sans Frontières, explained 'fiscal space' for health expenditure as a country's capacity to finance health expenditure from domestic resources within a foreseeable future. Whenever the combination of present domestic resources and present foreign assistance exceeds fiscal space, the excess foreign assistance is saved, rather than spent.
One fiscal space tool includes a ceiling on the government wage bill, which is most often expressed in the form of a percentage of the Gross Domestic Product (GDP). Therefore, even if donors were willing to pay for more salaries for health workers or teachers, a government is not allowed to exceed the ceiling. Other fiscal space tools include: a ceiling on the domestic primary deficit, medium - term expenditure framework (MTEF) and IMF programming of the use of foreign assistance.
During 2004 - 2006, Mozambique saved the equivalent of 91% of additional foreign assistance. Are donors aware of this? A survey was conducted with the major stakeholders of Mozambique's health sector and when they were informed that Mozambique had saved 91% of all additional aid during 2004-2006, most reacted in disbelief.
Budget support might be the best funding method, to improve harmonization among donors, alignment with government priorities and for financing recurrent general health expenditure. However, as long as donors are aware of the real impact of fiscal space constraints, and therefore do not challenge them, project support is much more effective than budget support.