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- 1. OPM (Clara Picanyol) Tracking of Resources Planning, Costing and Financing Community of Practice CIFF CSN Donor Network REACH Questions
- 2. Spending to Save Challenges and opportunities for financing Nigeria’s Saving One Million Lives initiative Kelechi Ohiri, Banji Filani, Robert Hecht, Helen Saxenian, Paul Wilson, Marty Makinen, Milan Thomas, Adeel Ishitiaq, Sasha Frankel and Mark Roland
- 3. Saving One Million Lives 3 | R4D.org An initiative launched in October 2012 to rapidly improve outcomes in Nigeria through evidence-based, cost-effective investments in six pillars: 1. Essential medicines for neonatal, child, and maternal health 2. Immunization 3. Malaria prevention and treatment 4. Maternal-child health (MCH) 5. Nutrition 6. Prevention of mother-to-child transmission of HIV (PMTCT) The goal is to save one million additional lives between 2010-15
- 4. Given the importance of achieving national targets in health, the PDU asked R4D, with support from CIFF, to perform a fiscal space analysis for SOML pillars 4 | R4D.org Key questions this work addresses: How much will it cost to achieve national targets for the six pillars? How much funding has been secured to pay for pillar activities? How large are the remaining gaps, and what might be done to fill these gaps partially, if not fully? Answers to these questions will help government policy makers and donors to make resource mobilization and allocation decisions. Relevant to the actions of key ministries, partners, and bodies such as the Global Fund Country Coordinating Committee.
- 5. Methodology 5 | R4D.org 1. Revision of 2012 resource needs estimates 2. Updating of probable financing estimates 3. Development of alternative projections 4. Aggregation and estimation of overall funding 5. Analysis of scope for increasing domestic financing Using 2012 Model, National and Donor Plans Limitations and caveats: State and LGA-level health expenditure are not captured in pillar analyses, because of unavailability of data Baseline spending estimates for some pillars are uncertain because of weak expenditure reporting and tracking Resource needs and financing estimates continue to evolve as implementation progresses and donor priorities and budgets change Variable quality of plans – many coverage assumptions overly optimistic
- 6. Illustrative scenarios for generating additional domestic funds for SOML-supported activities* 6 | R4D.org • Health share of GGE increases by 0.2 percentage points/year, 15% allocated to SOML-supported activities • US$158 m additional resources Scenario 1: Expanded Commitment to Health • Health share of GGE increases by 0.2 percentage points/year, 25% of the increase allocated to SOML- supported activities. • US$263 m in additional resources Scenario 2: Expanded Commitment to Health and to SOML-supported activities • Same as Scenario Two • In addition, 5% of FMOH allocation to tertiary hospitals redirected to more cost-effective SOML-supported activities • US$398 m in additional resources – enough to avert 140,000 child deaths through the Nutrition pillar Scenario 3: Expanded Commitment to Health and SOML, and modest reallocation from tertiary hospitals: *Other levers for increasing fiscal space are explored in the recommendations section of the report
Notes de l'éditeur
- However, given the realities of Nigeria’s constrained economic and fiscal position today and for the foreseeable future, it may not be possible to finance all elements of SOML. In this light, we propose that the Government consider a combination of measures, including: Increased fiscal effort: Raise the share of the budget for health from 5.7% today to 6.4% by 2017 (the LMIC average is 8.8%), and allocate 25% of the increment to SOML areas; sustain special funding from SURE-P and the MDG Fund until 2020, or incorporate these funds in the regular FMOH allocation for SOML activities Greater targeting of spending: Give special priority to incremental funding for two pillars which are relatively neglected and have the highest cost-effectiveness ( less than $1000 per life saved) – Nutrition and Essential Medicines (commodities and services for child and maternal health) Signaling to partners: Meeting the Government’s already-stated commitments for increased funding for nutrition, family planning, and AIDS (only the latter appears in the 2014 budget) Challenging donors to create more flexible funding mechanisms: Focus on increasing the share of external development assistance which is fungible across SOML areas, through e.g., the World Bank’s new results based financing project, DfID’s health systems support program, and the Global Fund’s delegation to the Country Coordinating Mechanism of decision-making over the allocation of Nigeria’s new funding envelope ($1.1 billion over 2014-16) across the three diseases