Basic Steps in Conducting Expenditure Tracking

1. Basic Steps in Conducting Expenditure Tracking Teresa Guthrie Centre for Economic Governance and AIDS in Africa OSI Workshop, Istanbul Sept 2006 Presentation based on slides provided by UNAIDS, Resource Tracking and Projections Unit

2. Resource Tracking Process The 5 broad steps in expenditure analysis: • Planning and preparation • Data Collection • Data Processing • Data Analysis • Final Report & Dissemination

3. Process Outline

4. Step 1: Planning (1) • Establish core research team - including research agency, advocacy organisation, assoc. of the people affected e.g. PLWHAs, the National AIDS Commission (or appropriate National Authority board) • Conduct stakeholder meetings and workshops, secure support for and buy-in to process • Stakeholders should advise on data required and purpose of data collection

5. Step 1: Planning (2) • Collection of all background materialsepidemiological, socio-economic, demographics: • Description of the health sector, key programmes, and legislation • Description of the health financing mechanisms in the country, budget process • Collection of any costing studies in the health topic being examined

6. Health Issue in the country Magnitude, distribution, composition, trends National response Laws/policies NSP & programmes Organisation Services & Providers Groups covered Standard protocols Health expenditures Amounts Sources, agents, providers Flows Cost studies on AIDS/issue Date, coverage, source Information sources Access, quality Budgeted allocations Background Information to collect

7. Step 1: Planning (3) • Agreement on focus, scope and methodology - selection of the specific health programme (or beneficiary group) • Mapping the national response – ie. Identifying all sources, all agents, all providers, all functions, all service-providers – public, private and foreign (this can be done through questionnaires to stakeholders at initial meeting)

8. Chile: Health Sector Organization Chile: Health Sector Organization Ministry of Health Ministry of Health Regulation Regulation Financial Financial Treasury Treasury Employees Employees Companies Companies Sources Sources (Mechanisms) (Mechanisms) 0.9% 0.9% Allocation Allocation Subsidies Subsidies 7% 7% Insurance Insurance AAFF MoH FONASA Pub.Hth.Ins ISAPRE Pvt.Hth.Ins Mutual Mutual Funds Funds 61% 61% (affiliation) (affiliation) 22% 22% 3 3 - - 4% 4% Hospitals Hospitals SNSS SNSS Hospitals Hospitals Provision Provision Physician Physician Pvt Clinics offices offices Clinics Clinics PUBLIC SECTOR PUBLIC SECTOR PRIVATE SECTOR PRIVATE SECTOR Financial flows

9. Step 1: Planning (4) • Prioritisation of key respondents from the list of all players – get contacts! • Development of the necessary sampling frames (e.g. of all NGOs providing health services for the selected programme/ beneficiary group), and selection of appropriate sampling technique • Planning the data collection steps – involves identification of key people within in each organisation/ institution, and setting up interview appointments.

10. Step 1: Planning (5) • Coding of the classifications and categories of functions (services provided), ensuring clear definitions and mutually exclusive categories (use NASA or NHA codes) • Note differences in terminology and standardise • Special projects, activities and services not specified in current classifications: include them in data collection forms • Data collection forms must reflect all the categories identified and coded

11. Step 1: Planning (6) Selecting data sources: • List all potential sources • Rank them by expected share of expenditures • Rank them by quality of records (complete, reliable, certified) • Rank them by accesibility • Prioritise data sources with a large share of the expenditures and better data quality

12. Step 1: Planning (7) • Define strategies & checklist for data collection (interviews, mailing forms, other) • Key informers are informed about the task at hand • Get appropriate permissions to access data, clinic records etc. • Development of data collection tools – different questionnaires for sources / agents and service providers

13. Step 2: Data Collection • Phone each respondent, explain project and use of data, and send appropriate data collection form asking them to gather the sources of required data to complete form • Thorough explanation of project, confidentiality and use of the data are essential • Make an appointment with each and together complete the form using the information they gathered • Collect data using appropriate form, thoroughly and accurately

14. Step 2: Data Collection (2) • Although Agents are more familiar than Sources with respect to HIV/AIDS data, they still are not always keen to provide information, so also need an appropriate approach • Design an appropriate strategy for specific sources of information, especially those not willing or difficult – obtain information to make estimations based on costing techniques

15. Step 2: Data Collection (3) • For providers of goods and services, except for ambulatory care centres (OPDs) and hospitals, it is recommended that appointments be made with all of them or the most important ones in terms of political relevance or expenditure level • Contacting Out-Patient Centres, Clinics, and Hospitals 1. Director of the centre, and 2. Clinical nurse. NURSES are key informants in the study, they know what we want to know. • A permanent monitoring process is a must in place to solve problems that may arise during the data collection process – deadlines must be maintained

16. Step 3: Data Processing • Completed forms must be checked for inaccuracies, missing data etc. • Data is captured into excel sheets and cleaned - checks data, identifies gaps, inconsistencies or double counting • If HIV/AIDS study – data can be exported to the NASA-RTS software (if available) • The data input reconstructs each transaction, Where estimates of expenditure have to be undertaken, all assumptions must be clearly explained

17. Step 4: Data Analysis • In this Phase the financing and expenditure flows are completed and cross checked • The indicators are calculated by relating them to other figures such as country population, PLWHA, national health expenditure and others. • Analyse and present the data in appropriate tables and graphs. • Conclusion are drawn.

18. Step 5: Final Report • The draft report is circulated to key stakeholders and government officials, to get their assistance in correcting any errors and filling any gaps. ‘Validity meeting’ suggested • The advocacy messages and strategies are agreed and the report is finalised • The report should point out the areas that need to be translate into action in the immediate future as well as in the mid and long term • The report should be disseminated widely to key audiences in appropriate formats • Awareness raising and advocacy campaigns

19. Exercise • List the key SOURCES of funds in the field that you are studying • List the key AGENTS of funds in the field that you are studying • List the key PROVIDERS of services in the field that you are studying • Draft the sampling strategy that you would use to obtain data from each of these groups • Identify the sources and types of data that you will require from each of these groups, and rank them.

20. Thank you! Teresa Guthrie Centre for Economic Governance and AIDS in Africa guthrieteresa@yahoo.com teresag@cegaa.co.za Tel: -27-82-872-4694 Fax: +27-21-553-0308