CEGAA's Contribution in Open Government Governance in South Africa

1. CEGAA’s contribution in open economic governance
in South Africa: A district level budget monitoring
effort on health, HIV/AIDS & TB in South Africa
Presentation to:
The Power of Open: A Global Discussion
Teresa Guthrie, CEGAA

2. The concerning global situation
• Shrinking financial resources for social spending – domestic &
global
– Increased dependency on foreign aid
– Yet contributions to Global Fund decreasing
• Committed ‘aid’ or public allocations often do not materialize
to transferred funds or remain unspent or mismanaged
• Inadequate or weak health information systems
• Inefficiencies in relation to optimal and effective use of existing
scarce resources
• Lack of sound public finance management system
• Insufficient financial & project management capacity & skills
• impacting on transparency and accountability, as well as
forward planning and reporting
• Weak M&E systems, even weaker financial information
systems
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3. The problem in many African countries
• Communities and civil society organizations (CSOs) have not adequately
participated in budget making processes affecting health, HIV/AIDS and
TB service issues.
• There are insufficient monitoring processes at community level for
social accountability.
– Resulting in poor identification of community needs required in
planning and budgeting for the response to HIV/AIDs and TB
• South Africa is rated highly on the international Open Budget Index but
insufficient budget openness at sub-national levels, especially at local
government and health facility level.
• Real citizen participation is required at community level where public
services should be delivered in line with community needs and available
resources.
– Thus communities need to be capacitated at local level to track
expenditures and their outcomes on health and development
for their ongoing empowerment in holding different levels of
government, including local authorities, accountable.

4. Thus, strategic interventions are needed to
strengthen financial management and M&E
systems, and facilitation of, and capacity
building for CSO participation and effective
oversight by relevant bodies, such as
parliaments, to have a greater impact on scarce
resource allocation and utilisation for health
service provision
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5. CEGAA’s Response to that Need
• Established in 2006
• As an African regional NGO committed to
achieving efficient, effective, equitable and
developmental economic governance
responses to HIV/AIDS and TB in Africa through
capacity building, research, information
dissemination and advocacy with relevant
stakeholders
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6. The impact we are working towards
 Improved African government’s response to HIV and
AIDS as a development issue:
– Implies need to work directly with African governments
– Implies building the capacity of civil society to hold
governments accountable
– Implies building capacity of oversight bodies like
parliament to ensure accountability
 HIV and AIDS often spoken of as a developmental issue
yet financial response continues to be in silos, mainly
located within the health budget
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7. CEGAA’s Overall Aims
• Civil society is actively engaged in holding
governments accountable for effective
resourcing of the response to HIV/AIDS and TB
• Financial resources are increased and
effectively used by African governments to
strengthen their response to HIV/AIDS and TB
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8. CEGAA’s Strategic Result Areas
1. Increased civil society influence in HIV/AIDS & TB
budgeting and expenditure processes
2. Increased transparency and accountability of
governments and other stakeholders for HIV/AIDS & TB
spending
3. Improved use of evidence for effective and efficient
allocations and spending on HIV/AIDS, TB & related
health systems
4. Increased & improved spending for a multi-sectoral
developmental response to HIV/AIDS & TB
5. Enhanced influence through strategic global, regional
and national opportunities for increased access to
financial resources for the response to HIV/AIDS & TB
in Africa
6. Enhanced organisational functioning of CEGAA
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9. Results we have achieved to date
• Increased capacity by civil society organizations in the SADC
region to do BMET for effective advocacy, at national and
local levels
• Strengthened financial management skills by government
officials
• Improved skills to undertake NASAs in several SADC and
East & West African countries
• Improved generation and utilisation of evidence to inform
budget policy discussions and decision making
• Enhanced health budget and expenditure dialogue
between governments and civil society in our BMETA
countries
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10. Some of our interventions…
• National AIDS Spending Assessments in almost all SADC countries & some
East & West African countries
– Provided data on all sources of funding for HIV/AIDS activities
– Advising on improved financial information systems
– Informed national HIV/AIDS strategic plans & allocative decisions
• Budget Monitoring by CSOs in South Africa, Mozambique, Zimbabwe,
Zambia, Uganda, Nigeria
– strengthened their advocacy regarding HIV treatment, sexual reproductive
health, achievement of the MDGs, improving quality of water & sanitation
services etc
• Technical support provision to other partners, including International
Budget Partnership (IBP) partners. E.g. Great Lakes University of Kisumu
(Kenya), Amanitare, BEMF (SA), TALC (Zambia)
• Costing of the SA response to HIV/AIDS to 2031 – assisted govt and donors
to strategise regarding funding
• Planned intervention involving capacity building for
parliamentarians 10

11. Tools we support partners to use
• Budget analysis & expenditure tracking tools
• Citizen Report Card
• Citizen Satisfaction Survey
• Public hearing and accountability forums with
citizens and public officials
• HIV/AIDS expenditure tracking software
(UNAIDS: Resource Tracking Software)
• Excel - presentation of impactful findings
• Training for public officials in costing, budgeting,
financial management, improving financial
information systems

12. Successfully implementing a comprehensive
approach in Southern African countries…
Tracking of all
HIV/AIDS Spending Costing of the SA
at all Levels HIV/AIDS Response
Community (external, domestic to Inform Policy &
Monitoring of HIV & private) Allocative
Spending & Decisions
Quality of Services
at District Level
Improved
Evidence to Strengthening TAC
Inform Policy & BEMF Advocacy
Strengthening Choices, Improve Efforts with
Oversight Bodies Spending & Evidence
(eg. Parliament, Service Delivery
NACs)
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13. NANGO and members of the Zimbabwean Budget
Coalition are trained in analysing their government’s
budget

14. The Zimbabwe Budget Coalition work on
developing community monitoring tools of
various services

15. In Zimbabwe, members of the Community
Working Group on Health engage the Ministry of
Health on issues of access to health services

16. Zimbabweans demand their right to
health.

17. Case Study - South African CSO Project
OVERALL AIM:
To increase the delivery, accessibility, affordability and quality of
treatment for people living with HIV/AIDS and TB, thus ensuring that
ARVs and TB treatment are available as lifesaving and prevention
mechanisms.
OBJECTIVES:
• Enhanced community empowerment and participation in district budget
planning processes
• Better skilled district public servants, so as to improve their management
of their budgets
• More effective and efficient use of scarce resources to ensure their
greatest impact
• Improved health services for persons affected by HIV/AIDS and TB,
leading to their improved quality of life
• Strengthened health care systems, through improved health
care spending and outputs.

18. Interim SA Project Results
• Strengthened local level capacity to influence budget planning and to
enhance social and financial accountability
• Formation of a strong coalition of governmental and non-governmental
organisations monitoring the implementation of health and HIV/AIDS and TB
budgets at district level
• Satisfaction surveys indicated that more people needing treatment are
accessing it and that most people are happy with the quality of service they
receive, whilst
• Most health workers are not happy with the quality of health care services
they provide due to a numbers of reasons:, such as serious shortages of
specialist staff such as doctors, pharmacists & dieticians, staff burnout, lack
of basic admin necessities etc
• Ongoing community monitoring provides necessary information for lobbying
and local level planning
• Enhanced social accountability – through ongoing interactive
engagements between health officials, health workers and
citizens

19. In South Africa, the ART patients
reported long queues for their drugs

20. TAC & CEGAA present the evidence at
public hearings in SA

23. Public Hearing in SA – officials listen to
the people

24. CEGAA’s research to improve public
financing systems
• Costing
• Budget allocation monitoring
• Expenditure tracking
• Financial gap analysis
• Financial systems improvements

25. In forward projecting the impact &
costs of an expanded response to
HIV/AIDS in South Africa, CEGAA found
a potential funding shortfall – data
which should mobilise govt & donors &
business sector to collaborate more
transparently in their future he
development of their new Strategic
Plan and resource mobilisation

26. Projecting the impact of expanded
spending on HIV incidence in SA

27. SA Adult (15+yrs) HIV Prevalence
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28. Estimated Costs for 3 scenarios for
response to HIV/AIDS in SA

29. Projecting the costs of an expanded
response to HIV in SA

30. Estimated Cost by Programme

31. CEGAA’s assessment of total spending on
HIV/AIDS and TB in SADC countries

32. CEGAA’s assessment of the per capita HIV/AIDS
spending by region/ area can identify issues of equity
and efficiency in delivery

33. CEGAA’s comparison of regional HIV prevention
spending – assists countries determine if they
are targeting effective prevention interventions

34. CEGAA examined the cost drivers and efficiency of the
delivery of ART by region -variations showing need for
improved efficiency

35. Estimating the Funding Gap –
Mobilising Resources

36. Requirements for Civil Society engagement
• Online access to timely budgetary and expenditure data,
linked to performance indicators. Eg. South Africa OBI
rating & People’s Budget
• All development partners giving funds to Africa should
declare and align their intentions, spending & longer-
term commitments with the national priorities.
• District level budget/ development committees, involving
citizens and public officials – to determine their district’s
needs, set priorities, budget for these, and monitor
spending on them.
• HIV/AIDS multisectoral coordinating structures with
political power & commitment, to which all actors
must report regularly -activities and spending.

37. Enhanced Budget Monitoring and Expenditure
Tracking
• Empowers citizens to understand what their governments are doing
with public funds
• Helps them identify the key challenges with the financial information
systems, which are limiting sound economic governance
• So as to demand increases in efficient spending
• Also to call for improved financial data systems that will enhance
transparency and accountability
• It is not enough for citizens to be empowered with these tools –
government officials responsible for priority setting, costing, budgeting,
and spending according to plan require skills and enhanced financial
information systems, esp. at local levels
• All partners need to be transparent and accountable for their activities
and spending, especially development partners

38. Lessons Learnt/Observations Made
• Provincial and district health plans indicate increased efforts to
strengthen the fight against the epidemic – ongoing monitoring required
to monitor sustainability
• Budget and expenditure analyses indicate increased resources for
HIV/AIDS&TB – costing required to address adequacy issues
• Massive growth in ART beneficiaries – balance with prevention?
• Remarkable improvement on absorptive capacity, in line with increased
government and donor funds for ARVs
• Need for continuous oversight through Provincial Offices of the Premiers
that also serve as secretariats for Provincial AIDS Councils
• Need for improved information & financial management systems
undermining efforts for open governance & accountability

39. Contact Details
Teresa Guthrie
Director
Centre for Economic Governance and AIDS in Africa
teresa@cegaa.org
Tel: +27 21 425 2852
Mobile: +27 82 872 4694
Website: www.cegaa.org