FISCAL SPACE AND: IMPLICATIONS TO THE HEALTH SECTOR

1. FISCAL SPACE AND: IMPLICATIONS TO THE HEALTH SECTOR OF ZAMBIA REPUBLIC MINISTRY OF FINANCE AND NATIONAL PLANNINGDepartment of Economic and Technical Cooperation By: Mr. David N. Ndopu DIRECTOR

2. FISCAL SPACE • Definition: “room in a Government’s budget that allows it to provide resources for desired purpose without jeopardizing the sustainability of its financial position or the stability of the economy.”

3. GENERAL OUTLINE • In some countries, there may be room for increased taxes or reallocation of expenditure. • In others, tax burden already at limits of what is desirable for a low-income country (LIC); or a significant share of expenditures are likely to be nondiscretionary or difficult to prune. • In some, high domestic debt burdens, combined with high real interest rates, make it difficult to find fiscal space without action to reduce the burden of domestic debt (requiring responsible fiscal consolidation efforts).

4. SOURCES OF FISCAL SPACE • Domestic borrowing: can be an important source of debt burden. • A higher tax burden: raising tax rates, new taxes and strengthening revenue administration efforts. • Cutting expenditure, particular unproductive expenditure. • Enhancing effectiveness of current spending in health and other sectors. • Promoting a high growth mix of expenditure - higher growth rates can facilitate greater revenue potential.

5. SOURCES OF FISCAL SPACE CONT’ • External resources: • External grants: an obvious source of additional source of fiscal space but still subject to sustainability or/and predictability. • Loans: Concessional borrowing.

6. FUNDING FOR THE HEALTH SECTOR: WHAT IS THE MESSAGE FOR ZAMBIA? • There is very limited scope to use domestic resources to finance more spending, especially in short-run, with taxes high, expenditure relatively inflexible, and large domestic debt, especially with adverse debt dynamics (difference between growth rate and interest rates). • Also for Zambia printing money not option because of the macroeconomic parameters. • In medium term, must rationalize spending. • Grants and concessional loans necessary.

7. CRITICAL CONCERNS IN FISCAL SPACE • There is likely to be competition from other parts of government for any available fiscal space. • Infrastructure vital for growth. • Other social sector needs. • What is the situation in Zambia regarding the funding towards the health sector?

8. SECTOR ALLOCATION

9. FNDP SECTOR ALLOCATION

10. BROAD FNDP SECTORAL ALLOCATIONS (K’ BILLION) FOR HEALTH

11. SUSTAINABILITY IS A CRITICAL CONCERN IN CONSIDERING THE USE OF FISCAL SPACE FOR HEALTH • The issues are several: • Grants preferable to loans (even concessional); do not raise debt service issues. But even with grants, • How should a government respond to a sizeable increase in sectoral grant support but with no guarantees of sustained external support beyond 2-3 years?

12. SUSTAINABILITY IS A CRITICAL CONCERN IN CONSIDERING THE USE OF FISCAL SPACE FOR HEALTH • Particularly for human resources for health (HRH), we must train and employ for a long period; Can we count on donors providing resources for a long enough time period that we can make employment commitments? • Concern of a minister of finance: expand a program and then find that in a subsequent year, other cutbacks or borrowing will be required to sustain a program. Limits on the extent of such exposure. • Greater long-term predictability in donor assistance thus enhances fiscal space!

13. CONCLUSION • Significant limits on how much fiscal space can be created in the absence of external grant/concessional loan support in short to medium term. • There is competition for such fiscal space. • Greater predictability over the long-term in donor assistance can create more effective fiscal space. • Caution is needed, post-debt cancellation, with new borrowing. • The need for an integrated sectoral plan to determine how to expand the health sector is critical.

14. Thank you for listening