DESK REVIEWS | 02.02.04.04. Who sets the priorities for funding?

DESK REVIEW | 02.02.04.04. Who sets the priorities for funding?

The budget to be spent on health follows a “transfer system” and priorities are set independently by each of the different government levels (federal government, states and municipalities) (Brazilian Ministry of Health, 2019m).

References:

Brazilian Ministry of Health. (2019m). Sobre o FNS. http://portalfns.saude.gov.br/sobre-o-fns

 

The Government sets the budget priorities annually. The Chief Executive and Financial Secretary conducts Budget consultations, Appropriation Bill, Estimates of Expenditure, and Reading debates through the Legislative Council to make decisions on how the funding should be spent.

The previous description clearly indicates that priority setting itself is a complex exercise and depends on the central government, the states, and also on the NITI Aayog. There are programmes that are centrally sponsored, but responsibility for implementation lies with the states. The states also set their priorities and implement several programmes where the Centre does not play any role. However, since the states depend on the central budget allocation for much of their funding, ultimately, the total amount of funding for the health sector –which comes from the states’ own revenues and central transfers – does affect how the priorities get implemented.

The priorities for funding are set by the Ministry of Health based on the RPJMN as mentioned above. For the RPJMN 2020-2024, one of the directions of policy and strategy is to increase access and quality of health service and to work towards universal health coverage with an emphasis on the strengthening of primary care. This was to be achieved through several action plans, including those focusing on disease control for HIV/AIDS, Tuberculosis, malaria, heart disease, stroke, hypertension, diabetes, cancer, emerging diseases, diseases with outbreak potential, overlooked tropical disease (lepra, filariasis, schistosomiasis), mental health, injury, vision problems, and mouth and dental problems. Dementia and ageing were not mentioned in this document; however, they might be seen as part of the wider mental health agenda (Kementrian PPN/BAPPENAS, 2019).

The Government of Indonesia prioritised funding of health insurance for low-income and vulnerable income groups as well as for the strengthening of primary care (Puskesmas) and the enhancing of specific programmes, such as maternal and child health and family planning (Agustina et al., 2019, p.90; Mahendradhata et al., 2017, p.241).

References:

Agustina, R., Dartanto, T., Sitompul, R., Susiloretni, K. A., Suparmi, Achadi, E. L., Taher, A., Wirawan, F., Sungkar, S., Sudarmono, P., Shankar, A. H., Thabrany, H., Susiloretni, K. A., Soewondo, P., Ahmad, S. A., Kurniawan, M., Hidayat, B., Pardede, D., Mundiharno, … Khusun, H. (2019). Universal health coverage in Indonesia: concept, progress, and challenges. The Lancet, 393(10166), 75–102. https://doi.org/10.1016/S0140-6736(18)31647-7

Kementrian PPN/BAPPENAS. (2019). Rancangan Teknokratik Rencana Pembangunan Jangka Menengah Nasional 2020 – 2024.

Mahendradhata, Y., Trisnantoro, L., Listyadewi, S., Soewondo, P., MArthias, T., Harimurti, P., & Prawira, J. (2017). The Republic of Indonesia Health System Review (Vol. 7, Issue 1). https://apps.who.int/iris/bitstream/handle/10665/254716/9789290225164-eng.pdf

The sector working groups organized within the context of UN-classification of the functions of the government (COFOG) are responsible for formulation and prioritization of sector budget proposals. Within the health sector, the sector working group representatives are from the ministry of health and comprise of (Republic of Kenya, 2018a) page 15:

  • “A chairperson accounting officer mutually selected by other accounting officers”
  • “Sector governor appointed by the national treasury”
  • “Sector governor appointed by State department for planning”
  • “Technical working group appointed by the sector working group”
  • “Sector working group secretariat appointed by the accounting officers to coordinate the activities of the sector”
  • “Representatives from development partners”
  • “Representatives from the private sector”
References:

Republic of Kenya. (2018a). Guidelines for the preparation of the medium-term budget for the period 2019/20 -2021/22. Nairobi, Kenya.

Each institution sets their priorities. Financing is negotiated with the Ministry of Finance.

National departments set their budget priorities annually, where Provincial departments make decisions on how the budget will be spent in the province to achieve these priorities (see section on budget process).