Rethinking how development assistance for health can catalyse progress on primary health care

Tobias Kasper, MPA † Prof Gavin Yamey, MD  †Sinead Dwyer, MA Kaci Kennedy McDade, MPA
Jon Lidén, BA Cora Lüdemann, MA et al.

Summary

Global campaigns to control HIV, tuberculosis, malaria, and vaccine-preventable illnesses showed that large-scale impact can be achieved by using additional international financing to support selected, evidence-based, high-impact investment areas and to catalyse domestic resource mobilisation. Building on this paradigm, we make the case for targeting additional international funding for selected high-impact investments in primary health care. We have identified and costed a set of concrete, evidence-based investments that donors could support, which would be expected to have major impacts at an affordable cost. These investments are in: (1) individuals and communities empowered to engage in health decision making, (2) a new model of people-centred primary care, and (3) next generation community health workers. These three areas would be supported by strengthening two cross-cutting elements of national systems. The first is the digital tools and data that support facility, district, and national managers to improve processes, quality of care, and accountability across primary health care. The second is the educational, training, and supervisory systems needed to improve the quality of care. We estimate that with an additional international investment of between US$1•87 billion in a low-investment scenario and $3•85 billion in a high-investment scenario annually over the next 3 years, the international community could support the scale-up of this evidence-based package of investments in the 59 low-income and middle-income countries that are eligible for external financing from the World Bank Group's International Development Association.

Rethinking how development assistance for health can catalyse progress on primary health care - The Lancet  Number 10418 | Dec 09, 2023 p 2167- 2264

Published: November 12, 2023DOI: https://doi.org/10.1016/S0140-6736(23)01813-5

Interesting article on AI and UBI  by Philippa Kelly with references  to many studies

https://www.theguardian.com/global-development/2023/nov/16/ai-is-coming-for-our-jobs-could-universal-basic-income-be-the-solution

A very well researched report on regional policy has been published by Mossavar-Rahmani Center for Business & Government Harvard Kennedy School | www.hks.harvard.edu/mrcbg

WHY HASN’T UK REGIONAL POLICY WORKED? The views of leading practitioners

Dan Turner Harvard Kennedy School Nyasha Weinberg Harvard Kennedy School Esme Elsden University College London Ed Balls King’s College London Harvard Kennedy School October 2023


https://www.hks.harvard.edu/centers/mrcbg/publications/awp/awp216

Abstract
“UK domestic policy – especially in England - in recent years has focused on regional inequalities in economic outcomes and public service delivery, which are tied to a political ‘geography of discontent’ that emerged in the 2010s. These inequalities are nothing new; nor are public policy efforts to address them. We conducted interviews with ninety-three top level political and official policymakers across the UK (spanning six decades of experience). This paper summarises practitioners’ views on the lessons we can learn from past efforts to address to address regional divides. We find broad political consensus on a range of areas: that widening divides are not inevitable; that previous policy regimes have lacked sufficient ambition; that excessive past centralisation has driven policy instability. We find that the Mayoral Combined Authority model, coupled with sustainable local government funding, could form the basis for a cross-party consensus on regional growth. Our interviewees diverge on how future reforms ought to be prioritised, with open questions on: the division of powers across tiers of government; how much institutional pluralism there ought to be in devolved governments; how to devolve power (and whether the current ‘bottom-up’ approach ought to remain); and on the design of fair funding formulae and fiscal devolution.”


One of the aims of the work was learning the lessons of history.   The starting point of the investigation was 1979 and as a result it did not include the work of the Northern Region Strategy Team whose report was published in 1978.  One of the first actions of the incoming Government in 1979 was to dismiss the report, perhaps on ideological grounds.

The output of the NRST was a five-volume Strategic Plan for the Northern Region:

Volume 1 Main Report which was a summary of the analysis and recommendations
Volume 2 Economic Development Policies
Volume 3 Social & Environmental Policies
Volume 4 Settlement Pattern & Transport Policies
Volume 5 Public Expenditure Priorities

A great deal of hard work and research underpinned the realisation of these outputs. Key to this was the composition of the team which was made of economists with sector specialism in the main areas and strategic planners. Critical input also was the leadership. Head of the team was Bevan Waide who had previously been on the staff of the World Bank with deputies on the economic side, Nick Segal and on the planning side, Ian Crowther.  I have to admit a vested interest as I was responsible for the work on public expenditure which is covered in Applied Economic which is  referenced elsewhere in the PFM Board.

The PEFA Secretariat has produced a new guidance in relation to using PEFA for FRA.

Overview

Fiduciary assurance from a development partner lens is the process that involves assessing the fiduciary risk of financial support not being used for the proper intended purposes and that lead to the decision on degree of reliance on existing country systems to ensure achieving of development objectives of the financial support provided. For doing such assessment the development agencies have in place different methodologies aligned with the institutional consideration of fiduciary risk and identification of mitigation measures that may include identification of actions for strengthening such systems and institutions.
PEFA assessments have been used as input for the fiduciary work with variations in different aspects. As a matter of fact, PEFA Secretariat recently developed and launched Guidance on how to use PEFA for fiduciary assurance (“Guidance”) with the objective of utilizing the PEFA framework for fiduciary assurance.
 

Objective
The objective of this virtual knowledge event is to look at PEFA through a fiduciary lens, to explore how the “Guidance” works and to hear from development agencies on their experiences with fiduciary assurance mechanism with the intention of greater use of country PFM systems for routing development support.

There was an interesting webinar on this on 12 October 2023.

https://www.pefa.org/resources/pefa-fiduciary-guidance

The PEFA Fiduciary Guidance is not a methodology in itself, it aims to enhance the use of PEFA reports for fiduciary considerations on country systems. As it follows the standard PEFA methodology, its focus is on central government (CG), with deeper emphasis on the Budgetary Central Government (BCG). The guidance focuses on the elements of information in the PEFA report to consider in country systems from a fiduciary standpoint. It does not draw conclusions or prescribe mitigating measures in relation with the elements assessed.

The present document does not aim at substituting the fiduciary methodologies developed by the development agencies. Its intent is to help the fiduciary works by providing a guidance on how to use the PEFA reports as an input. It includes a correspondence table between fiduciary risk areas, and PEFA dimensions, and an analysis of the extent to which the PEFA dimensions can contribute to the fiduciary assessment. The use of PEFA for Fiduciary consideration has the advantage of being based on an established methodology used by development partners that could promote and support the donor harmonization agenda. As different institutions may have different risk appetites, they may conclude differently with the same information.

This guidance is based on the seven key fiduciary key areas of the PFM cycle:

(i) budgeting, (ii) flow of funds, (iii) internal controls, (iv) procurement, (v) accounting, (vi) financial reporting, and (vii) auditing. Each fiduciary area is broken down in critical PFM processes identified as fiduciary processes, which are linked to corresponding PEFA dimensions. Those fiduciary processes that are not covered by PEFA are not included in this guidance.

The guidance is prepared with focus on using the PEFA reports as source of information.

There is much on HS2 on the PFM Board – search HS2! I have chosen just this one to continue the debate.

First there was the Liz Truss - -Kwasi Kwarteng “mini budget” of 23 September 2022 which would have had mostly D scores in PIs 14 to 16 of the PEFA Framework.

Now there is abandonment of the second phase of HS2 from the West Midlands to the Northern West Midlands with the third phase to the Northern Central Midlands having already been scrapped.  What score on PI-11 Public Investment Management for the biggest investment of a generation?  While this may be a retrospective critique it must question the consideration of alternative scenarios in terms of costs and benefits and alterative investment.  Were these carried out, or has the wisdom of Petagny been prophetic in his various posts? 
And of course the Northern Powerhouse Rail connecting the West and East of the Northern Midlands is a misnomer to satisfy political expediency or really to create a camouflage.


To ensure political equality: has the Labour Party found a novel way of increasing spending on education by proposing that fees for private education be subject to VAT.  It may be if the receipts are added to the education budget as proposed, but a bigger contribution would be from the tax expenditure resulting from the continuation of no VAT on publicly funded school expenses!  Is that ever measured?  Is this a good way to increase spending on health with a similar proposal?  Or is this a fudging of basic tax policy principles?