Challenge of Budget Delivery Remains

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By Constancio Hishiyukifa Mwandingi

Please allow me to add my comment to the exciting public debate following the tabling of the 2008-09 national budget by Finance Minister Saara Kuugongelwa-Amadhila before Parliament on Wednesday, 5 March 2008.

It is true that the budget in the main is a good one as pointed out by previous commentators. It is good on the surface and indeed meets most of the national macroeconomic targets. This is, however, not surprising given the fact that it is a pre-election budget.

However, a deep look at the budget reveals some problematic areas. As a health management professional, I am for example not happy that the Minister once more missed the opportunity to allocate adequate resources to health. She again missed the Abuja target by 5%, which by international consensus considers a 15% government budget allocation to health as satisfactory.

Although it is said that the health budget has been increased by 26%, the total health and social services allocation is still standing at 10.08% of the overall government budget for the 2008-09 financial year. This is a missed opportunity given that the Minister had enough cash for a fair distribution to national priorities, health included.

As it is understood that much of the additional funding to health will go to the vertical programmes of HIV-AIDS, TB and Malaria (which is obviously appreciated), then there will be little left for other health programmes such as the hospital services programme and thus the current problems are likely to persist.

This means that public health managers, especially those outside the aforesaid programmes, should still expect to do more with less money, even if this is to be expected of effective managers all over the world.

Although the budget allocation to the health sector is inadequate, health managers can still do more with the available resources if they improve technical efficiency within the health programmes and services, including innovation and the elimination of waste and corruption.

As pointed out by previous commentators, one thing that will hinder successful delivery of the national and the health budgets is obviously the pervasive incompetence (the lack of appropriate skills, knowledge and attitude) in the public sector. It is not possible to implement government programmes and produce the desired benefits with managers who have no capacity to demand let alone to utilise available resources effectively.

When for example some regional managers run out of money because they are not capable of budgeting or forecasting expenditures appropriately, when public managers under-spend and fail to deliver services at the same time, then there is indication of incompetence and it gives reason to be sceptical whether those managers who were lucky to get more funds this time will actually deliver at the end of the day.

The management of public health finance in Namibia is further exacerbated by the absence of an open, transparent and needs-based formula for the allocation of resources within the public health sector. This situation perpetuates inequity and unfair distribution of health resources in Namibia, because it allows the most powerful and not those in need of resources to bid for more resources.

To be brief, unless the current inefficient health resource allocation system is improved, efficient delivery of health services in Namibia will remain doubtful.

The Ministry of Health and Social Services has been considering the implementation of a needs-based resource allocation formula since 2001, but it appears that it is difficult to get it out of the pipeline.

The failure to implement this formula could only be explained by two main reasons – either by the absence of political will or the necessary technical skills to do so.

With appropriate competencies, improved technical efficiency and a needs-based resource allocation formula, Namibian health managers in the public sector could deliver more and better health services with the available resources.

It would be interesting to find out how much money is allocated to the development of personnel competencies during 2008-09 and over the MTEF period.

The Finance Minister Saara Kuugongelwa-Amadhila must be congratulated for producing a good 2008-09 budget that makes more funds available to national priorities, but the challenge of delivering on the budget remains.

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