Delivering better health services needs longer term, more predictable financing
Earlier today I met with Mauricio Cysne, the Country Representative of UNAIDS (Joint United Nations Programme on HIV/AIDS) here in Mozambique. Mauricio is a dynamic person, full of energy and a great networker. We discussed what to do to try to secure more Global Fund money for Mozambique. Unfortunately, Mozambique's only got part of the funding it asked for last year, which means that from 2009 onwards there is a serious risk of the country running out of anti-retroviral and anti-malarial treatments, unless other funding sources can be identified or unless a successful bid to the Global Fund can be made.
The Global Fund has been hugely important in terms of mobilising additional funds for HIV/AIDS, TB and malaria globally, and has been a major source of funds for Mozambique, providing nearly $50m in 2007. Whilst this money is much needed and very welcome, one of the challenges that it brings is the need to produce quite detailed reports with the year when funds are provided to secure that funding. Whilst this might seem perfectly reasonable to an accountant, when you are trying to plan the delivery of services to a population of 20 million people, it can present a considerable challenge.
I like to think of this challenge in terms of my own finances. I have various expenses each year - paying my mortgage, paying off my car loan, paying electricity bills and for food. I know what my salary is and now that the money will arrive each month, I can therefore ensure that I have enough money to cover my expenses, and I can plan for any additional expenses I might have, such as a school trip expense for one of my kids. If, however my annual salary was dependent on irregular payments, which could either come at the beginning of the year, or at the end - it would be much more difficult to plan. I would have to start of just doing the absolute essential, until I had enough money to cover the larger expenses.
Well, this second scenario is pretty much the challenge that Mozambique faced with the Global Fund Money. I have mapped out when Global Fund money arrives each year, and when in each year in this image (click to enlarge).
There is huge variation in the volume and timing of financing. So, imagine if you were the Minister of Health, and had to plan to deliver essential health services, but also to make some large payments a couple of times of year to buy drugs or other essential supplies. If all your money arrives at the start of the year, it is not a problem. If half your money arrives at the start of the year, but you know for sure the rest will come in August - you can also plan. However, if you have no idea when the second tranche of money will arrive it is difficult to plan any activities, as you don't want to incur a debt that you can't afford to pay, until you know when the money will be in the bank to meet any obligations.
One of the things we are pushing the Global Fund to do for Mozambique, is to give predictable funding in any given year. It will still be possible to keep the accountants happy, demonstrating that funds have been spent well - but if money is not spent efficiently in 2008, the consequences, in terms of reduced funding should be in 2009, so at least the planned activities in 2008 can still go ahead, and there is time to correct any problems encountered. What we would love to do here is launch a lobbying campaign on the Global Fund to remove the in-year triggers for release of funds. We recognise that it is important for funding to be based on performance, but we are seriously concerned about lack of predictable funding in any given year - it can seriously undermining the planning and implementation process.
Anyone wanting to join this little campaign should let me know!