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A Strategy for Financing Priority F1 Investments

A Strategy for Financing Priority F1 Investments. National Staff Meeting Department of Health April 19-21, 2006. Overall Approach to Developing A Financing Strategy. Proposed investments Rationalizing investments Available sources of financing Implementation thru budget reforms.

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A Strategy for Financing Priority F1 Investments

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  1. A Strategy for Financing Priority F1 Investments National Staff Meeting Department of Health April 19-21, 2006

  2. Overall Approach to DevelopingA Financing Strategy • Proposed investments • Rationalizing investments • Available sources of financing • Implementation thru budget reforms

  3. Proposed Investments – 16 Convergence Sites • Total requirement = P7.8B over 5 years • Average per year = P1.6B • Average per site per year = P0.1B • Expected DOH support = P0.58B for 5 yrs • Average of P7.2M per site per year • Largely TA/TR support • PHIC premium counterpart = P7.2B • Average of P90M per site per year • Assumes high enrollment and 90/10 sharing

  4. Proposed Investments – National Support for Service delivery • Total requirement = P29.9B over 5 years • Average per year P5.98B per year • Components • Public health = P29B • Health promo = P0.2B • HEMS = P0.2B • NEC = P0.3B • NCHFD = P0.2B • Investments for retained hospitals assumed to be limited to revenues

  5. Proposed Investments - National Support for Regulation • Total requirement = P0.9B over 5 years • Average per year = P180M • Components: • BFAD = P0.6B • PMU50 = P0.2B • BHFS = P0.1B • BHDT = no estimate submitted • BQIHS = no estimate submitted

  6. Proposed Investments – National Support for the NHIP • Total requirement = P23.5 billion over 5 years • Average per year = P4.7 billion • Other investment concerns • National government arrears • EO 276 arrears

  7. Proposed Investments – National Support for Governance • Total requirement = P7.5B • Average per year = P1.5B • Components • HRH = P6B • IMS = P1.3B • Others = P0.2B • CHD stewardship = not yet included

  8. Summary of Proposed Investments • TOTAL = P69.6B • 16 sites = P 7.8B • National support = P61.8B • Average per year = P 13.92B • Estimated requirements exceed the proposed 2006 DOH budget

  9. Rationalizing Proposed Investments • Focus on incremental investment requirements • Exclude those already funded (DOH, PHIC, LGU, FAPS) • Remove overlaps, duplication, redundancy • Those with clear and valid basis for cost estimates • Prioritize those that meet F1 criteria (AO 2005-0023) • Doable given available resources • Sufficient groundwork and buy-in • Triggers a reform chain reaction • Produces tangible results and generates public support

  10. Rationalizing 16 4-in-1 Site Fund Requirements - RESULTS • Examples of items removed or reduced: • LGU requests for additional TA/TR/RX already being funded in regular program (e.g. TB-DOTS) • IP enrollment based on municipal poverty rates and conservative assumption on enrollment growth • Items that are part of LGU counterpart (e.g. salaries, TEV, local monitoring, etc.) • Non-priority activities like study tours, community-based health financing

  11. Rationalizing 16 4-in-1 Site Fund Requirements - RESULTS • Examples of items removed or reduced: • LGU requests for additional TA/TR/RX already being funded in regular program (e.g. TB-DOTS) • IP enrollment based on municipal poverty rates and conservative assumption on enrollment growth • Items that are part of LGU counterpart (e.g. salaries, TEV, local monitoring, etc.) • Non-priority activities like study tours, community-based health financing

  12. Rationalizing Fund Requirements for National Support - RESULTS • Examples of items reduced or removed: • Items already funded by DOH budget (e.g. TB drugs, vaccines, etc.) = • Estimates based on needs of entire population were reduced by at least 15% to account for private sector utilization and excessive buffer stocks • MIS needs by program overlap with IMS proposal • Redundant and repetitive TA/TR activities (e.g. policy guidelines development)

  13. Rationalizing Fund Requirements for National Support - RESULTS • Examples of items reduced or removed: • Enrollment limited to areas with valid poverty id system • Conservative projection of enrollment growth using municipal poverty rates were used • Arrears not included

  14. Rationalizing Fund Requirements for National Support - RESULTS • Examples of items reduced or removed: • Cost requirements that did not show any basis or estimation procedures • Only HRH requirements for DOH were included

  15. Summary of Rationalized Investments Over 5 Years • 16 sites = P1.6B • National support = P8.2B • Service delivery = P3.0B • Regulation = P0.3B • Financing = P3.5B • Governance = P1.4B • Grand total = P9.8B (P1.96B per year)

  16. Matching Needs & Sources of Funds (average per year)

  17. Financing Issues Under the LOW Scenario • Financing GAP = P1.7B (average per year) OPTIONS: • Renegotiate FAPS • Prioritize on “zones” & MDG linked programs • Secure IP subsidy for roll-out • Regulation & governance to Phase 2

  18. Financing Issues Under the HIGH Scenario • Financing SURPLUS = P2B (average per year) PRIORITIES: • CHD stewardship & roll-out sites • Revolving upgrade fund pool • Additional public health commodities • Expand IP enrollment

  19. Allocation of Incremental Priority Investment Using New Budget Structure • National support P4.4 • Governance P1.40B • Policies & standards P0.75B • Program implementation P2.25B • CHD Operations* P0.4B • Governance P0.22B • Field implementation P0.18B • PHIC P5.0B • TOTAL P9.8B *Note: CHD operations budget only reflects those implied by submissions from national programs and the 16 convergence sites

  20. Performance Based Disbursement Plan • National level governance, policies & standards, and program implementation • weighted average of CHD performance • accomplishment of benchmarks for specific interventions (e.g. seals, scorecards, budget reforms, SDAH, fiduciary reforms, etc.) • cost recovery targets, target efficiency gains • CHD Governance & field implementation • accomplishment of benchmarks contained in 16 sites • LGU service level agreements – by disease or program • improvements in LGU scorecard (overall & by component) • PHIC • new enrollment using valid IP identification tool • quality of services received by members • level of financial protection

  21. Summary (1) • Proposed investments (=P69.6B) needed to be trimmed; gaps remain (CHD & hospitals) • Rationalization exercise using F1 criteria derived priority incremental investments (=P9.8B) • Available sources of funds depending on two scenarios (from P0.25B to P4B) • If LOW, address deficit • If HIGH, prioritize use of surplus

  22. Summary (2) • Investments must be implementation thru budget reforms • Incremental amounts allocated using new budget structure • Investments disbursed using performance benchmarks • Budget reform plan must be backed by joint agreement between DOH, and DBM, DOF

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