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Method of Accountability
Utilizing Sound PFM: a Case of Ghana,
Using the Ghana Health Service (GHS)
and
Ministry of Health (MOH)
Dr. Opoku Fofie Rev. Sam. K E A Boateng,
Head, Fin. Reporting & Monitoring Head, Fin. Reporting & Monitoring
Central Reg. Health Directorate, Ghana Min. of Health Headquarters, Ghana
The Importance of PFM in Ghana
• Prudent PFM as the Main thrust to drive economic and
social development in Ghana is contained in the
“Directive Principles of State” (Chapter 6: clause 36 & 37) of the
1992 Constitution
• Between 2000 -2015, very important PFM Laws have
been passed by the Parliament of Ghana, to strengthen
transparency and accountability
- Public Procurement Act, Financial Administration Act, and the
Internal Audit Agency Act, amongst others
- The Ministry of Health (MOH) and Ghana Health Service have
been key in the drive to improve PFM within Ghana
- We present to you, some salient issues for discussion:
Brief Introduction of Focus Area
• Ministry of Health (MOH) is charged to provide
Health Care to All Residents in Ghana
• The Ghana Health Service (GHS) is one of the
Agencies under the MOH responsible for Health
Service delivery
• For effective monitoring and accountability, it has:
- 10 Regional Health Directorates
- 216 District Health Directorates
- 216 District Hospitals
- Over 6000 Sub-District facilities spread countrywide
Into what is known as “Budget Management Centers”
(BMCs)
MOH/GHS : Pre - 1996
• Numerous Vertical Programmes (Competing)
• Numerous Bank Accounts held at BMCs
• Very weak Internal Controls
• No Standardize Formats for Record or Report
• Numerous Accounting Systems
• No Computerization/Automation
• No Management Information Systems
• Un-Reconciled Accounts & Unreliable Financial
Reports
What was wrong and the lessons learnt
• Weak personnel quality/capacity – no training regime
• Lack of standardized Recording, Accounting and Reporting
methods
• Weaknesses in existing Financial Control and
Accountability Governance Framework
• Weaknesses in surveillance led to abuses and misuses of
Public Funds and Assets
• Inadequate funding of Reforms efforts and weak Change
Management protocols
• Ineffective monitoring, systematic and timely diagnosis
and evaluation of the Financial System
• Absence of an effective Feedbacks System
Financial Control was targeted to
ensure ….
• Public Accountability within MOH/GHS
• Proper co-ordination of BMC Plans and Budgets
• Internal Control mechanisms work to prevent service
over-lapping and duplication
• The Control of BMC revenue and checking for
Regularity and Legality of BMC expenditures
• Economy, effectiveness and efficiency in operations
– Best known model of British Audit Committee
• That financial information is provided on timely basis
• Preparation of Periodic MOH Consolidated Financial
Reports
Method of Achieving Accountability
• MOH/GHS initiated its own departmental concept of
Financial Control & Accountability in the mid-1990s, as
part of a larger Health Sector Reforms
• In 1996: in collaboration with Partners, a Change Agent
developed a Departmental FM Manual - major legal
framework to inspire accountability
• 1997: the Product - Accounting, Treasury and Financial,
Rules and Instructions (“ATF” Rules) was completed and
became the Standard – to ease Consolidation
• 1998: Nationwide Training of all Finance & Non-Finance
Managers on the “ATF” Rules
• 1999: Support & Supervision Unit created at Headquarters
to spearhead change; and National & Regional Financial
Monitors appointed
ATF Implementation – Key Goals
Raising Awareness
Highlighting the
importance of a
strong Financial
Controls and
Accountability.
Showcasing the work
of the FM in BMCs.
Supporting FM and
the work of Financial
Monitoring, and ATF
requirements .
Sharing knowledge
Promoting good
practice in PFM
development.
Exchanging
approaches to
adoption and
implementation of ATF
standards and good
practices.
Enhancing
Development
Partnerships
The MOH Increasing
BMC understandability
of HR capacity
challenges and success
factors.
Promoting an aligned
approach to
development efforts
on PFM using ATF
Design of MOH/GHS AccountabilityDelegation
Accountability
Delegation Delegation
Legislation
ATF/
Legislator
Oversight
- M&R - AExecutive
Authority
ATF
Implementation
ATF
Implementation
Jnr
Managers
Jnr
Managers
Jnr
Managers
Middle Level
Managers
Middle Level
Managers
Middle Level
Managers
Middle Level
Managers
Top Management Top Management
Middle ManagementMiddle ManagementMiddle Management
Operational Personnel
MOH/GHS Accountability
Strategy for PFM Improvement
• Identify the Gaps and established mechanism for
continual Updates to Legal Framework –“ATF” Rules
• Scale up Modules enshrined in ATF at the BMC
• Create effective Financial Monitoring and Reporting
units to oversee the implementation of ATF
• Use of Category “A” BMCs to provide peer-review
standards and served as practical training grounds
• Quarterly Financial Validation exercises – all levels
• Build HR Capacity (both Finance & Non-Finance) and
logistical improvement
Tools Deployed for Financial Control
BMC Plans and
Budgets
as control measure
Financial Reporting meeting
criteria using the Reporting Tool
Inventory and Stock
Control and Payroll
Financial Monitoring,
Inspection and
Investigation
Internal and External
Auditing – Audit
Conferences
Select Committee on
Public Accounts
Outcome of our Efforts
• Through incessant training, HR is highly augmented in
capacity, skills and know-how
• Pooled rather than Vertical funding of Health Programs
and Activities at all levels is the norm
• Total accountability of all resources at all levels
• Full adherence to stipulations of ATF, resulting in
accuracy, integrity and reliability of data
• Timely submission of Financial Reports to C&AG and
other Stakeholders
• Auditor General’s comment on the MOH/GHS Financial
Statement in 2011
• Increased Health Partner confidence in PFM
Trajectory of Accounting system
1998 - 2009
Cash Accounting/
Treasury System & IGF
2010 -2015
Modified Accrual Accounting
/Treasury System including
IGF
1990 - 1996
Incomplete Records
/Treasury System & IGF
Revenue and
Expenditure
Books/Ledgers
Cash Books & Activity
Ledgers /Template
Reporting of Rev.&Eep.
Modified Accrual
Accounting /Treasury
System & IGF
Cash Items Revenue
& Expenditure
Returns
Statement of Revenue
and Expenditure
Financial Statement
including Cash
Flows Statements
Account Basis Books of Accounts Financial Reporting
Financial Control in Action
Mentoring the Path to
Sustainable
Development in PFM
Establishing Governance in
PFM
Establishing IT
Infrastructure for Financial
Reporting & Personnel
Unearthing the Power of
Professionalism in BMCs
Monitoring, Evaluation & Correcting
Actions and Behavior
Accountability and Transparency facilitating
Unethical Behavior
The Way Forward
FinancialReporting,Treasury
andInformationSystems
Management
SupplyChain,Payroll,
Inventory,Operationsand
PerformanceManagement
Reports
ATF
MOH/GHS INTEGRATED REPORTING
Effective Communication about Value Creation over time
Strategy, governance, performance
and perspective reporting
Transparency, Comparability and
Decision Making
Economic Growth
MOH/GHS Control for Accountability
Framework for Public Accountability and Control
Regularity Control Performance Reporting
Laws Strategic &Operational
(The ATF) Goals and Objectives
Regulations Service Priorities
Policies Budget and Resources
Mgt. Decisions Performance indicators
Compliance Performance
Reporting
Financial Statements
Strategic Action Plans and Budgets
Audit Reports
Supporting
Organizational
Structure
Processes
Outcomes
Conclusion
“Accountability is not about accounting, it is about
improving peoples’ lives by holding governments
responsible to deliver on their obligations without
hiding the fact about who will pay for them”
(Thomas Muller-Marques Berger , Rome, 12 Nov. 2014)
THANK YOU FOR YOUR ATTENTION

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  • 1. Method of Accountability Utilizing Sound PFM: a Case of Ghana, Using the Ghana Health Service (GHS) and Ministry of Health (MOH) Dr. Opoku Fofie Rev. Sam. K E A Boateng, Head, Fin. Reporting & Monitoring Head, Fin. Reporting & Monitoring Central Reg. Health Directorate, Ghana Min. of Health Headquarters, Ghana
  • 2. The Importance of PFM in Ghana • Prudent PFM as the Main thrust to drive economic and social development in Ghana is contained in the “Directive Principles of State” (Chapter 6: clause 36 & 37) of the 1992 Constitution • Between 2000 -2015, very important PFM Laws have been passed by the Parliament of Ghana, to strengthen transparency and accountability - Public Procurement Act, Financial Administration Act, and the Internal Audit Agency Act, amongst others - The Ministry of Health (MOH) and Ghana Health Service have been key in the drive to improve PFM within Ghana - We present to you, some salient issues for discussion:
  • 3. Brief Introduction of Focus Area • Ministry of Health (MOH) is charged to provide Health Care to All Residents in Ghana • The Ghana Health Service (GHS) is one of the Agencies under the MOH responsible for Health Service delivery • For effective monitoring and accountability, it has: - 10 Regional Health Directorates - 216 District Health Directorates - 216 District Hospitals - Over 6000 Sub-District facilities spread countrywide Into what is known as “Budget Management Centers” (BMCs)
  • 4. MOH/GHS : Pre - 1996 • Numerous Vertical Programmes (Competing) • Numerous Bank Accounts held at BMCs • Very weak Internal Controls • No Standardize Formats for Record or Report • Numerous Accounting Systems • No Computerization/Automation • No Management Information Systems • Un-Reconciled Accounts & Unreliable Financial Reports
  • 5. What was wrong and the lessons learnt • Weak personnel quality/capacity – no training regime • Lack of standardized Recording, Accounting and Reporting methods • Weaknesses in existing Financial Control and Accountability Governance Framework • Weaknesses in surveillance led to abuses and misuses of Public Funds and Assets • Inadequate funding of Reforms efforts and weak Change Management protocols • Ineffective monitoring, systematic and timely diagnosis and evaluation of the Financial System • Absence of an effective Feedbacks System
  • 6. Financial Control was targeted to ensure …. • Public Accountability within MOH/GHS • Proper co-ordination of BMC Plans and Budgets • Internal Control mechanisms work to prevent service over-lapping and duplication • The Control of BMC revenue and checking for Regularity and Legality of BMC expenditures • Economy, effectiveness and efficiency in operations – Best known model of British Audit Committee • That financial information is provided on timely basis • Preparation of Periodic MOH Consolidated Financial Reports
  • 7. Method of Achieving Accountability • MOH/GHS initiated its own departmental concept of Financial Control & Accountability in the mid-1990s, as part of a larger Health Sector Reforms • In 1996: in collaboration with Partners, a Change Agent developed a Departmental FM Manual - major legal framework to inspire accountability • 1997: the Product - Accounting, Treasury and Financial, Rules and Instructions (“ATF” Rules) was completed and became the Standard – to ease Consolidation • 1998: Nationwide Training of all Finance & Non-Finance Managers on the “ATF” Rules • 1999: Support & Supervision Unit created at Headquarters to spearhead change; and National & Regional Financial Monitors appointed
  • 8. ATF Implementation – Key Goals Raising Awareness Highlighting the importance of a strong Financial Controls and Accountability. Showcasing the work of the FM in BMCs. Supporting FM and the work of Financial Monitoring, and ATF requirements . Sharing knowledge Promoting good practice in PFM development. Exchanging approaches to adoption and implementation of ATF standards and good practices. Enhancing Development Partnerships The MOH Increasing BMC understandability of HR capacity challenges and success factors. Promoting an aligned approach to development efforts on PFM using ATF
  • 9. Design of MOH/GHS AccountabilityDelegation Accountability Delegation Delegation Legislation ATF/ Legislator Oversight - M&R - AExecutive Authority ATF Implementation ATF Implementation
  • 10. Jnr Managers Jnr Managers Jnr Managers Middle Level Managers Middle Level Managers Middle Level Managers Middle Level Managers Top Management Top Management Middle ManagementMiddle ManagementMiddle Management Operational Personnel MOH/GHS Accountability
  • 11. Strategy for PFM Improvement • Identify the Gaps and established mechanism for continual Updates to Legal Framework –“ATF” Rules • Scale up Modules enshrined in ATF at the BMC • Create effective Financial Monitoring and Reporting units to oversee the implementation of ATF • Use of Category “A” BMCs to provide peer-review standards and served as practical training grounds • Quarterly Financial Validation exercises – all levels • Build HR Capacity (both Finance & Non-Finance) and logistical improvement
  • 12. Tools Deployed for Financial Control BMC Plans and Budgets as control measure Financial Reporting meeting criteria using the Reporting Tool Inventory and Stock Control and Payroll Financial Monitoring, Inspection and Investigation Internal and External Auditing – Audit Conferences Select Committee on Public Accounts
  • 13. Outcome of our Efforts • Through incessant training, HR is highly augmented in capacity, skills and know-how • Pooled rather than Vertical funding of Health Programs and Activities at all levels is the norm • Total accountability of all resources at all levels • Full adherence to stipulations of ATF, resulting in accuracy, integrity and reliability of data • Timely submission of Financial Reports to C&AG and other Stakeholders • Auditor General’s comment on the MOH/GHS Financial Statement in 2011 • Increased Health Partner confidence in PFM
  • 14. Trajectory of Accounting system 1998 - 2009 Cash Accounting/ Treasury System & IGF 2010 -2015 Modified Accrual Accounting /Treasury System including IGF 1990 - 1996 Incomplete Records /Treasury System & IGF Revenue and Expenditure Books/Ledgers Cash Books & Activity Ledgers /Template Reporting of Rev.&Eep. Modified Accrual Accounting /Treasury System & IGF Cash Items Revenue & Expenditure Returns Statement of Revenue and Expenditure Financial Statement including Cash Flows Statements Account Basis Books of Accounts Financial Reporting
  • 15. Financial Control in Action Mentoring the Path to Sustainable Development in PFM Establishing Governance in PFM Establishing IT Infrastructure for Financial Reporting & Personnel Unearthing the Power of Professionalism in BMCs Monitoring, Evaluation & Correcting Actions and Behavior Accountability and Transparency facilitating Unethical Behavior
  • 16. The Way Forward FinancialReporting,Treasury andInformationSystems Management SupplyChain,Payroll, Inventory,Operationsand PerformanceManagement Reports ATF MOH/GHS INTEGRATED REPORTING Effective Communication about Value Creation over time Strategy, governance, performance and perspective reporting Transparency, Comparability and Decision Making Economic Growth
  • 17. MOH/GHS Control for Accountability Framework for Public Accountability and Control Regularity Control Performance Reporting Laws Strategic &Operational (The ATF) Goals and Objectives Regulations Service Priorities Policies Budget and Resources Mgt. Decisions Performance indicators Compliance Performance Reporting Financial Statements Strategic Action Plans and Budgets Audit Reports Supporting Organizational Structure Processes Outcomes
  • 18. Conclusion “Accountability is not about accounting, it is about improving peoples’ lives by holding governments responsible to deliver on their obligations without hiding the fact about who will pay for them” (Thomas Muller-Marques Berger , Rome, 12 Nov. 2014) THANK YOU FOR YOUR ATTENTION