2013年-世界发展银行全球_Below_the_Glass_Floor___Analytical_Review_of_Expenditure_by_Provincial_Administrations_on_Rural_Health_from_Health_Function_Grants_and_Provincial_Internal_Revenue_69页_4mb

Summary of "Below the Glass Floor"

Core Content

This report, Below the Glass Floor, provides an analytical review of how provincial administrations in Papua New Guinea (PNG) are spending funds on rural health services, focusing on the allocation, accessibility, and quality of service delivery. The analysis is based on data from Health Function Grants and Provincial Internal Revenue, and it highlights the challenges and opportunities in ensuring effective and equitable rural health service delivery.

Main Findings

• Funding Increase: Since 2009, there has been a marked increase in funding for rural health services, especially in provinces that rely on national grants.
• Minimum Priority Activities (MPAs): The three core MPAs for rural health are:
  • Operation of rural health facilities (MPA 1)
  • Integrated rural health outreach patrols (MPA 2)
  • Distribution of drugs and medical supplies (MPA 3)
• Other Spending Areas: The report also considers spending on patient transfers, clean water supply, and supervision activities.
• Fiscal Capacity and Funding Sources: Provinces with higher internal revenue (e.g., from GST and natural resources) tend to allocate less to frontline rural health, while those with lower revenue depend more on grants.
• Inconsistencies in Funding: There is a lack of standardized budgeting and spending practices, and many provinces do not allocate sufficient funds to rural health services.
• User Fees and Free Primary Health Care Policy: Some provinces rely on user fees for funding, which may conflict with the government's emerging policy of providing free primary health care.
• Regional Variations: There are notable regional differences in how funding is allocated and spent, with some provinces (e.g., ENB and Sandaun) spending more on facility operations than others.

Key Issues and Recommendations

Allocation of Expenditure

• Funding Gaps: Many provinces, particularly those with high fiscal capacity, are under-spending on rural health compared to estimated costs.
• Need for Standardization: There is a pressing need to systemize and standardize how rural health facilities and outreach activities are funded.
• Role Clarification: The roles and responsibilities of provincial, district, and local governments, as well as church-run facilities, need to be clearly defined to ensure equitable and efficient resource allocation.

Accessibility of Funding

• Timeliness and Consistency: Funding release by the Treasury is often inconsistent and delayed, affecting the ability of provinces to deliver services effectively.
• Direct Disbursement: There is a question about whether funding for facility operations and outreach patrols should be directly disbursed to facilities or managed through provincial or district levels.
• Supervision Activities: There is little visible spending on supervision, which is essential for ensuring quality service delivery.

Quality and Effectiveness

• Service Delivery Efficiency: The report suggests that more funding is being allocated to facility operations, but the effectiveness of this spending is not always clear.
• Maintenance Needs: Some provinces (e.g., Highlands, Momase, and Central) have invested in maintenance, and these practices should be studied further.
• Cost Estimation: The NEFC's Cost of Services Study provides a baseline for estimating the costs of rural health services, but these estimates are conservative and may not fully reflect actual needs.

Proposed Fieldwork

The report proposes fieldwork to:

• Examine the effectiveness of spending in provinces with higher allocations.
• Investigate the role of maintenance in service delivery.
• Explore how provinces manage and allocate funds for rural health, including the use of user fees.
• Assess the impact of the 'free primary health care' policy on funding mechanisms and service delivery.

Conclusion

The study underscores the importance of understanding the real-world implications of funding decisions and the need for more transparent, equitable, and effective mechanisms for rural health service delivery. It also highlights the role of policy in shaping these mechanisms and the potential for improvement through field research and better coordination.

Key Tables and Figures

• Table 1: Compares spending on priority activities with cost estimates, showing significant gaps in many provinces.
• Table 2: Profiles rural health spending across provinces, highlighting those with high fiscal capacity but low frontline spending.
• Figure 1: Illustrates the trend in spending on frontline services from 2006 to 2010.

Appendices and Supporting Information

• Appendix 1: Provides a country summary of PNG and comparator regions.
• Appendix 2: Details the rural health context in PNG.
• Appendix 3: Outlines the funding streams for rural health.
• Appendix 4: Compares activity spending with cost estimates.
• Appendix 5: Explains the analytical methodology used.
• Appendix 6: Provides an explanation of the NEFC analytical methodology for the Provincial Expenditure Review.
• Appendix 7: Lists proposed fieldwork questions for further investigation.

Glossary and References

• A glossary of key terms is included for clarity.
• References to supporting studies and data sources are provided for further reading.