Research and policy development led by Prof. Peter Berman focuses on how to improve health program performance through better health financing policies and practices in low and middle-income countries. The team developed and applied a “Resource Tracking and Management” (RTM) framework. The RTM framework provides an end-to-end health financing analysis by tracking resources, identifying bottlenecks, and applying policy solutions along 5 key steps of the flow of funds for health programs linked to key objectives. “Resources” include financing as well as physical inputs, such drugs and supplies and human resources.
Resource Tracking and Management Framework
The expandable tables below provide an orientation to each component of the RTM framework, as well as details about the ongoing work related to that area of the framework.
Resource mobilization refers to the means or mechanisms to generate resources, at the national and sub-national levels, to pay for goods and services used to deliver health care in a country. Health financing mechanisms used to generate health resources may include general government revenue, earmarked taxes for health, social health insurance, private health insurance, external aid, user fees (out-of-pocket spending at point of care) and other community contributions.
Key Tools/Methods: Fiscal space analysis
Key Tools/Methods: Public Expenditure Reviews (PERs), Cost-effectiveness analysis and priority setting, planning/budget process, and National Health Accounts (NHAs)
Key Tools/Methods: Public Expenditure Tracking Surveys (PETs), analysis of public financial management design, governance, and capabilities
Key Tools/Methods: Quantitative Service Delivery Survey (QSDS) or facility surveys, analysis of technical efficiency in service delivery (e.g. cost analysis, DEA/FPF analysis), assessment of efficiency/quality linkages
Key Tools/Methods: Benefit Incidence Analysis (BIA)
Resource Allocation: In addition to generating evidence for effective resource mobilization, the financing projection model (link) also analyzed resource allocation at federal, regional and woreda levels, analyzing the share of total and government health expenditure allocated to primary health care across Ethiopia’s different government financing channels. Our team has also supported the FMOH in implementing the 2016 national household health care utilization and expenditure survey for the sixth national health accounts analysis (link when ready).
Also contributing to evidence on resource allocation is a primary health care costing study which analyzed service delivery costs at 24 primary hospitals, 47 health centers and 22 health posts representing different regions around Ethiopia. Unit costs for specific services and departments such as outpatient, inpatient, MCH, and delivery services were calculated, disaggregated by ‘drugs and supplies’, ‘human resources’ and ‘indirect costs’. The study reports the shares of total spending on these facilities allocated to different types of services and inputs (link to report). Findings include estimates of differentials in spending across urban and rural regions of Ethiopia, a significant share of primary care spending being appropriately allocated to drugs and supplies, and evidence on variation in the productivity of health workers in primary level facilities.
Findings from the costing study are being used by FMOH to estimate the fiscal impact of expanding the exempted services package (services that are provided free to all patients in public facilities), develop tools to improve budgeting and planning at woreda and regional levels, and to develop strategies to achieve greater efficiency in service delivery – one of the core objectives of the HSTP.
Another study relevant to resource allocation was a report (link) on strengthening public-private partnerships (PPP) for better health outcomes in Ethiopia. The report reviews the PPP experiences in Ethiopia and globally, recommending devising clear standard operating procedures to manage PPPs, introducing cost-sharing, establishing PPP units at central and district levels and harmonizing the multitude of different contractual schemes that currently exist. Various modalities are proposed as being more effective, such as private provision of selected advanced diagnostic and treatment services, as well as the outsourcing of both clinical and non-clinical services. The report on public private partnerships can be accessed here (link).
Resource Utilization: Ethiopian data was analyzed to quantify the utilization of the government budget. This evidence could be used to improve resource use. For example our findings showed that the recurrent budget (e.g. salaries, drugs, medical supplies, facility running costs) was utilized at a rate that was above 95