Annual Programme of Work 2009 - Ministry of Health

9. 2009 HEALTH SECTOR BUDGET
The 2009 financial year is the mid-point of the third 5YPOW, and the first of a new political
administration. As such, it is not possible at present (November 2008) to finalise the majority
of the budget figures as final allocation will be the prerogative of the new Government.
The main sources of financing for the 2009 POW and budget will not differ significantly
from those of 2008, although the relative contribution of each is likely to change, particularly
with the continued increasing role of National Health Insurance. The general principle of
allocating significant funds to Item 3 and to district level facilities is maintained, and within
this support for maternal and neonatal health is prioritised.
The ceiling for GOG is tentative, not only due to the fact that the budget will only be
approved by the new Government around March 2009, but also due to two factors related to
the wage bill. Firstly, efforts are being made to ensure that all agreed staff are included on
the wage bill, ie to remove the monthly fluctuations which were experienced in 2008 due to
the wrongful exclusion of “ghosts” following the headcount. The issue of students coming
onto the wage bill mid-year is also being addressed. To date therefore, MOFEP has
requested information on the physical numbers of staff rather than the expected wage bill. In
addition, the ongoing work of the Fair Wages Commission will, when combined with staff
numbers, result in the new wage bill for the sector. In addition, the Item 2 ceiling is likely to
be affected as some employment-based allowances currently included as Item 2 are to be
incorporated into the new single spine pay scales under development. A combined ceiling for
Item 3 and 4 was given to the Ministry, but in the absence of clear figures for all other
sources of funding, there may still be adjustments to the currently proposed distribution.
In calculating the 2009 resource envelope, an effort has been made to remove the doublecounting
of IGF from the NHIS, though this is currently still based on informed assumptions
rather than concrete data. Based on the increasing importance of the NHIS, 70% of the IGF
has been assumed to come from claims reimbursement with the balance of 30% included in
the tables as User Fees. This means that the tables are not directly comparable with previous
years’ POWs.
The details of the National Health Insurance resource allocation formula are not currently
available. Although not yet confirmed in writing, the NHIF allocation from MOFEP is
expected to exceed the provisional allocation used in the earlier tables in this section, which
were based on last year’s MTEF projections. There may not therefore be need to draw on
reserves as indicated in Annex x. The value of NHIS activity has increased as a result both of
the introduction of the new tariffs which has increased the average cost per contact, and the
rapid increase in the volume of contacts due to rising membership and the addition of free
maternity services for all to the benefit package. The formula may ) increase both the flexible
funding available to MOH for Items 3 and 4, and b) provide an alternative estimate of the
volume of claims to be reimbursed through the DMHIS.
The figures for donor funding are potentially the most complete, but gaps remain for some
partners (eg WHO). In addition, there are still some inconsistencies to be ironed out, for
which additional information from (largely earmarked) partners may be necessary in order to
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