New tool to monitor expenditure on child and maternal health

By Flavia Nassaka

Shs300bn feared lost annually

The Ministry of Health has launched a new electronic tool to be used by government to track all resources allocated to maternal, newborn and child health (RMNCH).

The tool which will be used to track all funds inform of foreign aid and budgetary allocations shall also track  all monies  received by Civil Society Organisations (CSOs) to cater for RMNCH  from their sources to the ultimate health function they serve.  It is estimated that over Shs300 billion is allocated to maternal and child health programs annually by CSOs and government but most of this money is misappropriated by the players along the value chain.

Through the tool, which was launched on May 8, it will be easy to establish the source of funding, who the managers and the implementers are, and what areas of intervention and inputs they are.

This information is expected to aid in better resource allocation and ensure value for money, improve accountability at the national and district levels, and guide in design of high level sector strategies.

Speaking to The Independent, Tom Aliti; the Assistant Commissioner for planning at the Ministry of Health said the problems of maternal and newborns health have not been successfully addressed due to poor planning and monitoring of programmes. He said this has made Uganda trail the world on Millennium Development Goals (MDGs) indicators.

Countries that signed onto the MDGs agreed to reduce the deaths of children under five years old by 60% between 1990 and 2015. This came to be tagged MDG 4. The under-five death rate is the probability per 1,000 that a newborn baby will die before reaching age five. To meet the goal, the country needed to record an average reduction of 5% per year in the rate of under-five deaths. But, in spite of the efforts put into reducing these rates, the infant mortality rate has stagnant at 54 deaths per 1000 live births since 2011 whereas under-five mortality is at 90 deaths per 1000 live births. Uganda still has 141, 000 children dying before reaching their fifth birthday. Of these, 26% die in their first month of life.

Regarding the health of mothers; which is MDG 5, the goal was to ensure that maternal deaths are reduced by 75% and there is universal access to reproductive health by 2015.  Unfortunately, Uganda’s maternal mortality rate stands at 438 deaths per 100,000 live births with at least 16 women dying every day from pregnancy and child birth related complications. At the end of every year, an alarming 342,900 maternal deaths are registered.  Aliti explained that 67% of mothers still do not receive any postnatal check-up yet over 60% of maternal deaths in developing countries are estimated to occur 23 to 48 hours after delivery. He said this is not because the resources are not available. The problem is in monitoring the money released for the job by both donors and the government. Aliti hopes the Resource Tracking tool will handle this.

To come up with the tool, the Ministry together with other partners used data collected in 2014 from 44 institutions; four were government entities, 32 CSOs, four multi-lateral and three bilateral donor entities.

Dr. Rogers Ayiko, the Principal health officer in charge of policy analysis at the East African Community secretariat, the strategies recommended for improving health systems in the region include putting in place sustainable yet cost effective measures to increase access to information and adequate supervision. He said the problems result from poor tracking of intermediary resources and insufficient linkage between planning and budgeting processes. These two come with inadequate utilisation and dissemination of data.

Ayiko explains that resource tracking data is now recognised as essential part of the annual assessment of the health sector since the annual financial statement and other expenditure reports do not provide insight into spending on interventions and diseases.  Joan Kilande, a programs officer at Coalition for Health Promotion and Social Development (HEPS) Uganda appreciates the tool as a new avenue to avert duplication of programs and accelerate better funding into maternal health and newborn programs. But, she says, it may not bring a direct benefit of accountability since it only allows government to monitor what other entities do with the funds, without allowing CSOs to monitor public expenditure.  HEPS is one of the CSOs sampled while conducting trails on the efficacy of the tool.