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Summary

Under USAID’s Health Policy Plus (HP+) program, we provided support to the Mozambique’s Ministry of Health (MISAU) to develop an investment case for the Global Financing Facility (GFF) to improve reproductive, maternal, neonatal, child, and adolescent health (RMNCAH). We currently provide technical assistance to operationalize the investment case at the provincial level while strengthening policy and coordination among partners at the central level.

Through embedded technical assistance, we support MISAU to strengthen public financial management functions across the ministry and improve monitoring and evaluation planning processes. We conduct capacity building activities at the central and provincial levels and develop tools to improve the efficiency of public financial management activities. Finally, we support MISAU to consolidate the planning and budget functions in e-SISTAFE via a planning and budgeting module, in collaboration with the Ministry of Finance. This module implements the planning and budgeting system to increase effectiveness in governance and achieve a more responsive, participatory, transparent, and accountable financing system for the health sector.

Breaking New Ground

Co-ordination among health partners and within MISAU departments is crucial for the investment case’s successful implementation. ThinkWell leads informative sessions to health partners on the investment case to foster transparency of information among stakeholders. Additionally, ThinkWell revitalized technical working groups on maternal and child health and ensure continuous technical support on the investment case’s implementation.

Challenges

In Mozambique, weaknesses in resource flow and management often limit the amount of funds that reach the point of service. This impacts improvements in health outcomes. Strong public financial management capacity is more important than ever. With decentralization underway, provinces and districts will have greater autonomy, which must be accompanied by more accountability. As one of the largest sectors, the health sector must be able to manage public finances, efficiently use systems—such as the planning and budgeting system—and implement other reforms undertaken by the Ministry of Finance. When donors have confidence in public financial management systems, they are more open to direct on-budget funding—which can be executed by the state—to further enhance the health system.

Approach

Our goal is to increase health governance effectiveness to achieve a more responsive, participatory, transparent, and accountable health system. ThinkWell’s approach strengthens public financial management, monitoring and evaluation, and planning and budgeting through embedded technical assistance in MISAU. We also create tools and procedures, with a capacity transfer plan that is mindful of the specific limitations of the MoH’s structure. Additionally, ThinkWell strategically supports MISAU to ensure its technical ownership on the investment case’s implementation.

Results

Through HP+, ThinkWell improved adherence to finance procedures manual requirements both at the central and provincial levels where HP+ continued its efforts to decentralize public financial management procedures. ThinkWell assembled national guidelines on public financial management and rolled out a training package on public financial management nation-wide. To strengthen the government’s public financial management capacity, we conducted an evaluation of public financial management training from 2014 to 2018. We summarized the evaluation’s findings in a document that offers a series of evidence-based recommendations to make future public financial management trainings to MISAU’s staff more effective. This document can be found here.

In the public financial management domain, we developed a dashboard to allow MISAU to analyze financial data around health delivery and resources to support decision-making processes. We also created user manuals to ensure proper documentation is available for the dashboard’s future use. We assessed the health sector audits from 2013 to 2017. Financial audits are an important tool to enforce compliance and accountability as well as to identify gaps in people’s understanding and practices. This audit assessment provided an overview of MISAU’s audit findings as well as recommendations for corrective actions. The document can be found here.

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