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TAKP13-PFM: STTA Junior PFM Research Associate – E4H Programme KP & Federal

Job title: TAKP13-PFM: STTA Junior PFM Research Associate – E4H Programme KP & Federal

Company: Palladium Pakistan (Pvt.) Limited

Job description: TORs: National Junior STTA – PFM Research Associate

Scoping review for Public Financial Management in the Department of Health Khyber Pakhtunkhwa

Programme Overview

Evidence for Health (E4H) is a new Foreign, Commonwealth & Development Office (FCDO)-funded programme aimed at strengthening Pakistan’s healthcare system, thereby decreasing the burden of illness, and saving lives. E4H (2023-2027) provides technical assistance (TA) to the Federal and Khyber Pakhtunkhwa (KP) governments and will subsequently operate in Punjab. The KP and Federal component is being implemented by Palladium along with Oxford Policy Management (OPM).

Through its flexible, embedded, and demand-driven model, E4H KP & Federal will support the government to achieve a resilient health system that is prepared for health emergencies, responsive to the latest evidence, and delivers equitable, quality, and efficient healthcare services. Specifically, E4H will deliver TA across three outputs:

Output 1: Strengthened integrated health security, with a focus on preparing and responding to health emergencies, including pandemics.

Output 2: Enhanced information systems and capacity for evidence-based decision-making to drive health sector performance and accountability.

Output 3: Improved implementation of Universal Health Coverage, with a focus on ending preventable deaths.

E4H works in partnership with the Ministry of National Health Services, Regulations & Coordination (M/o NHSR&C) at the Federal level, and the Health Department in KP.

Background and Problem Statement

The Public Financial Management (PFM) system is a set of rules and institutions governing all processes related to public funds and includes three distinct stages: 1) Budget formulation involves making macroeconomic projections to help determine what level of total government expenditure will be feasible and how much will be allocated to the sector based on strategies and policy priorities; 2) Budget execution is the process by which the financial resources made available to a public agency are directed and controlled toward achieving the purposes and objects for which budgets were approved; 3) Budget monitoring involves ensuring that spending agencies and entities comply with laws and regulations, implement good financial management systems with reliable financial reports and internal controls and audits, and achieve budgetary objectives.

Khyber Pakhtunkhwa (KP)’s Health Policy (2018) has prioritised ‘Enhanced Health Financing for Efficient Service Delivery & Financial Risk Protection for people of KP’ as a major health outcome in the province. Strategic priorities related to area include:

  • Public sector health care financing will be scaled up using predominantly tax-based revenues managed under the health financing strategy for the province
  • The DOH will agree on mechanisms with the BISP, Zakat, Baitul Maal and other Poverty Reduction programmes in the province to ensure efficient and effective use of funds for healthcare under these programmes
  • Budget for health will be reviewed to rationalize allocations for tertiary, secondary and primary health care levels and services. Gradually current budget will be balanced development budget as well as between salary and non-salary components
  • Inadequate budgetary allocations to the health sector have resulted in a scarcity of funds for crucial healthcare services, infrastructure development, and capacity building. The current allocations fall significantly short of meeting the requirements outlined in the Minimum Health Service Delivery Package (MHSDP) and Essential Package for Health Services (EPHS)
  • Centralised budget management in the health sector poses challenges, limiting service delivery units’ involvement, resulting in inadequate resource allocation, and compromised service quality. This centralised approach also hampers budget tracking at the service delivery level
  • Budget releases are disproportionately skewed towards the end of the financial year, posing significant challenges to effective service delivery planning and implementation. Moreover, the Finance Department’s release policy does not align with the specific needs of the health sector
  • While the recurrent health budget remains largely allocated to salaries, The implementation of the development budget has faced challenges and delays in the procurement process, budget release, actual expenditure, and utilisation. Furthermore, the lack of recording and reporting on a commitment basis has reduced control over non-salary expenditures.
  • Amidst shrinking financial resources, there is an absence of operational realignment and prioritisation strategies to maximise value for money. Analytical work is generally absent, hindering informed budget policy formulation.
  • Public health spending is characterised by weak management systems and input-based budgeting. Insufficient linkage exists between service delivery performance and budgetary allocations. The absence of a budget review mechanism to analyse spending vis-a-vis service delivery performance compounds this challenge
  • Resources lack earmarking for specific interventions like social health protection scheme, which have recently experienced closures. Despite creating a Financial Management Cell in the Health Department to bolster PFM capacities, weaknesses persist at the directorate, district, and health facility levels, with no dedicated PFM staff at the district and facility levels
  • Inadequate delegation of powers at the district and facility levels hampers swift responses to service delivery requirements through budgetary actions
  • Double and triple dipping of resources, such as medicines purchased through various funding sources like Primary Care Management Committees (PCMCs), medicine top-up financing, and routine purchases by the District Health Offices (DHOs), obstruct efforts to enhance allocative and spending efficiencies
  • Limited funds allocated for healthcare infrastructure and equipment maintenance contribute to facility deterioration, adversely impacting overall health service quality. Some equipment remains dysfunctional due to a lack of funds for minor repairs.
  • The existing Chart of Accounts (CoA) does not effectively capture health expenditure information crucial for policy formulation. For example, the CoA does not facilitate reporting by the level of healthcare.
  • Weaknesses in financial accountability mechanisms, including improper and insufficient internal audit practices, may lead to inefficiencies in budget spending and hinder transparency in public resources within the health sector. Strengthening these mechanisms is crucial for ensuring fiscal responsibility and effective resource utilisation
  • Therefore, a scoping review in this context is crucial as it will help identify health PFM gaps and recommend risk mitigation measures for strengthening of the department’s PFM system.

Specific Objectives

The objectives of the technical support for the KP PFM scoping review in the DOH are to: * Provide an overview of the best practices and literature on health PFM practices

  • Assess the strengths and weaknesses of the current PFM system in the KP DOH, while assessing current partners’ support in the KP DOH’s PFM
  • Identify key challenges and obstacles faced in implementing effective PFM practices in the health sector
  • Evaluate the impact of the PFM system on financial transparency, accountability, and efficiency in the health sector
  • Identify potential strategic TA areas with recommendations that will markedly enhance transparency, accountability, and efficiency in the KP DOH PFM framework.

Scope of Work and Methodology

Leveraging on the existing FCDO support to the KP DOH, a team of consultants is expected to conduct a scoping review of PFM in the KP DOH, encompassing the following activities:

  • The team will commence with a literature review encompassing current PFM practices in KP DOH, trends in KP Health Accounts, Pakistan 2023: Status of Health Financing Report, KP Essential Package for Health Services (EPHS), third-party evaluation of Sehat Card Plus, findings of KP PEFA (2017) by World Bank and other published and non-published evidence focusing on KP health PFM.
  • After conducting a thorough literature review, the team will engage with stakeholders, including the KP DOH, the Finance Department, and the Planning & Development (P&D) Department. There will be a focus on the new ideas developed by the Sub-National Governance (SNG) II such as the performance monitoring report that is now mandatory for the DOH to understand the PFM reforms
  • These consultations will aim to uncover challenges within the ongoing reforms and review elements of PFM, such as budgeting practices, financial planning, expenditure control, reporting, and accountability mechanisms
  • Having gained insights into best practices and existing & proposed reforms within the province, it is imperative to understand the role and contribution of development partners in PFM. This could entail mapping the support of donors/ development partners and consultations with these partners or conducting focused group discussions to analyse their contributions and output. The current FCDO investments in the province, such as the SNG II and KP Spending Effectively for Enhanced Development (SPEED) supported by the World Bank to examine the institutional support at the level of the DOH and FMC have been provided in KP including innovations at the level of health facilities for budgeting, execution and monitoring
  • Identify potential strategic TA areas in future with recommendations, that will markedly enhance transparency, accountability, and efficiency in the KP DOH PFM framework
  • The team is also tasked with presenting the findings of PFM challenges at a workshop and gathering feedback from relevant stakeholders on proposed actions (short term, medium term and long term) aimed at strengthening PFM efforts throughout the province

LOE and Timeline

The duration of this position is 40 working days over the period from February – April 2024.

Requirements

  • Masters in Accounting/ Finance/ Public administration / Public health
  • More than five years of experience public health/ financial management
  • Strong convening, report writing skills
  • Working with others; Analysis, and use of information; Communicating with others.

Expected salary:

Location: Peshawar, Khyber Pakhtunkhwa

Job date: Fri, 26 Jan 2024 04:00:16 GMT

Apply for the job now!

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