Background
In Somalia, a new environment is emerging from decades of conflict and violence that left the health sector dilapidated of infrastructure, human resources, availability of supplies and functioning public health administration structures at zonal and sub-zonal levels. Only 20% of the population has access to health services, mainly in urban areas, through the unregulated private sector.
Security gains especially in South Central Somalia and increased peace and stability across the country are giving the space for opportunities to engage in strategies towards economic development and the building of solid governmental structures and processes. Following the Bustan conference 2011 on the “New Deal in Fragile States”, the Federal Government of Somalia singed the “New Deal for Somalia” Compact at the Brussels conference in September 2013 that defines priorities for the next three years, including six “Peace and Stability Goals (PSG)” of which PSG 5 addresses revenue and services and is relevant to the health sector. The Compact builds on the South-Central six pillar programme, Puntland’s second “Five Years - ” and the “Somaliland National Development Plan”.
Priorities under PSG 5 include: 1) increase the provision of equitable, accessible, and affordable social services by creating a regulatory environment that promotes decentralized delivery and prioritizes key investments that extend and increase access to services; 2) enhance transparent and accountable revenue generation; 3) strengthen PFM to enable the different levels of government to better manage financial resources in a transparent and accountable manner, in support of national priorities.
Substantial work is on-going at the Ministries of Planning and Finance to building solid public financial management systems and collecting better economic and population data. In Somaliland, a public expenditure review was performed and a PFM Reform Action Strategy formulated. Alignment of assistance to Government processes and emphasis on capacity transfer to support strengthening and building key government functions are reflected in joint programmes and Global Health Initiatives’ projects. As such, the health sector stands out as an example for being the first sector with a solid sector coordination mechanism in place and a multi-year strategic plan (the Health Sector Strategic Plans 2013 – 2016 for each zone) developed with respective zonal annual work plans and budgets.
The Somali Health sector is largely depending on external funds with an increasing trend (reaching 7 to 10 US $ per capita in 2006) and around 30% flowing into emergency health projects. Although this allocation is higher than in other fragile states, current funding levels are not sufficient to meet basic health needs. Substantial funding is still going into vertical programmes and the allocation of scarce resources needs to be better aligned to health priorities and existing health plans and strategies.
There is little analytical data to support formulating a strategic vision on how to finance the health system. External funds are not channelled through governmental systems and a funding tracking system is not yet in place. Work is on-going on decentralizing public services to regional and districts teams but the degree of decentralizing functions, especially budgeting still needs to be worked out in in light of existing limited capacities at sub-zonal levels.
Hospitals and private clinics generate a large part of their income from charging for medical tests and medicines. The Government share in the GNP is only 5% with an allocation to the health sector of only 1%. An estimated 35% of health financing results from taxes and 50% is being collected through user fees. Out-of-pocket expenditure is estimated at 80% and health expenditure per capita at 114$. However, authorities in all three zones have committed an increase of health sector allocation in the current fiscal year (6% in SL, 4% in PL; 1-2% in SC).
2014 is a critical year for the legitimacy of the Government and success in the health sector. The Essential Package of Services (EPHS) is being rolled out and the HSSPs are under review. The SHAs have included health financing as one of the top priority areas for formulating policies to strategically and equitably allocate limited resources and evaluate their impact. An understanding of current health financing is not only critical for implementing the health sector strategy and for guiding evidence based decision making but also for demonstrating capacities to implement one of the Compact’s flagship programmes (the EPHS) and to transparently and efficiently effectively manage resources that are available through the Somalia Reconstruction and Development Facility (SDRF) and new funding opportunities like the UN Multi Partner Trust Fund and Global Health Initiatives such as Global Fund and GAVI.
This consultancy will contribute to a better understanding of the origin of funds in each zone and the reliability of health financing information and their timeliness in regard to the planning cycle of the Government.
General Objectives
The overall objective of this assignment is to obtain a clear picture of zonal health financing in terms of the origin, allocation, expenditures and availability of funds. An emphasis is to be given that Somalia health authorities are actively involved in the process to independently execute this activity.
Specific Objectives
I. Support the three Somali Health Authorities in:
a. Understanding available public and external financial resources and assessing: composition of resource envelope; reliability of financial projections; decision space of the Somali health Authorities;
b. Analysing existing budget allocation and expenditures for current and development budgets; comparing budget allocations with sector policies and plans; determine allocative equity and efficiency; review budget processes and tools (eg, budget/planning cycle);
c. Reviewing budget execution and its management efficiency, and compare with health outcomes;
II. Recommend measures to improve the budget processes and outcomes, including the timely estimation of a reliable resource envelope.
III. Facilitate the process of linking planning to budgeting in line with Governmental fiscal planning and integrate MoH budgets within the Government Planning Cycle;
IV. Discuss ways to increase MoH capacity to develop policy related budgets and monitor their execution
Scope of Work
The review will be conducted in the public health system in the three zones, understood as expenditure incurred by the MoH and/or in the MoH network of facilities, even if spent by external partners (UN agencies, Global Health Initiatives projects). The private sector is excluded because of the complexity to obtain data from numerous small, informal providers. To the possible extent, services provided by the main NGOs –particularly those in close relationship with the MoH or public services—will be included.
Expected deliverables
1) An inception report five days after the start of the assignment;
2) A public expenditure review report at all zones for the current and the last three years; this review should include regional, and if applicable, district levels;
3) Recommendations on how to improve strategic expenditure allocation;
Duration and Timing
The consultancy is planned to be conducted within 45 days but can include more consultancy days as required. Initial work will take place in Nairobi to review back ground documents and budget data and to meet with relevant partners. The consultant(s) will visit each zonal Ministry of Health to consultant and work with the Ministry team and, if relevant, other Ministries and stakeholders. A debriefing workshop is supposed to be organized at the end of the assignment. Its location is to be determined.
Competencies
The candidate should have:
- Hands on experience of preparing, reviewing and analyzing health sector plans and budgets;
- Experience and understanding of implementation of public sector budgeting and budgetary reforms;
- Strong facilitation skills with particular attention to transfer of knowledge and skills to MoH public health managers;
- Ability to work under pressure;
- Excellent communication and facilitation skills;
Qualifications and experience
· Advanced university degree in Public health, Finance, Public Administration / Management or equivalent;
· Experience of working with Ministry of Finance and Ministry of Health;
· Experience in similar programmes related to health sector reform and analysis in post-conflict countries;
- Ability to provide practical methodological and technical advice and guidance to Ministry staff;
How to apply:
· Qualified female candidates are encouraged to apply.
· Interested candidates are kindly requested and strongly encouraged to apply in writing sending their CVs and expected fee to:
Administrative Officer, WHO Somalia; recruitment@nbo.emro.who.int
