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World Bank Document Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Health Systems for Outcomes Publication Outcomes Systems for Health FINANCING IN SOUTHERN SUDAN CARE HEALTH FOR SUSTAINABLE PRIORITIES AND STRATEGIC OPTIONS August 2009 Christine Rogo, Ombaka, Olivia and Lomoro Bengt Herring Amponsah, Kofi Samuel Mills, Wasunna Owino, Khama Table of Contents ACKNOWLEDGEMENTS .................................................................................................................................................... V ABBREVIATIONS AND ACRONYMS ...................................................................................................................................... VI EXECUTIVE SUMMARY ................................................................................................................................................... VII 1. INTRODUCTION ............................................................................................................................................. 1 Health System ....................................................................................................................................................... 2 Poor Health Status ................................................................................................................................................ 2 National Health Policy Statement on Health Financing ........................................................................................ 3 CURRENT MACRO ECONOMIC TRENDS ............................................................................................................................... 3 Trends in the Composition of Government Sources of Revenue ........................................................................... 4 THE STATE OF HEALTH SECTOR FINANCING ......................................................................................................................... 5 Trend in Government Funding .............................................................................................................................. 5 Sectoral Comparison of the Health Budget (2008-2009) ...................................................................................... 6 Health Expenditure Indicators (2006-2009) .......................................................................................................... 7 RATIONALE FOR THE STUDY .............................................................................................................................................. 8 OBJECTIVES OF THE STUDY ............................................................................................................................................... 8 METHODOLOGY ............................................................................................................................................................. 9 2. HEALTH SECTOR RESOURCE MOBILIZATION AND ALLOCATION ................................................................... 10 Budget Preparation Process at the GoSS and State Levels ................................................................................. 10 Budget Allocations to Health .............................................................................................................................. 11 Multi-Donor Trust Fund and Other External Funding ......................................................................................... 13 Multi-Donor Trust Fund .................................................................................................................................................... 13 Other External Funding Sources ....................................................................................................................................... 14 Other external funding sources ........................................................................................................................................ 15 Sources of Funding for the SMoHs ...................................................................................................................... 16 THE FUNDING GAP ....................................................................................................................................................... 17 FISCAL SPACE ANALYSIS ................................................................................................................................................. 22 Fragile/Post-Conflict States Context ................................................................................................................... 22 Creating Fiscal Space for Health ......................................................................................................................... 22 INTERGOVERNMENTAL FISCAL RELATIONS AMONG THE MOH-GOSS, SMOHS, AND CHDS ........................................................ 23 The MoH-GoSS and the SMoHs ........................................................................................................................... 23 The SMoHs and the CHDS ................................................................................................................................... 23 General Conditions of the SMoHs and CHDs Administrative Offices ............................................................................... 24 3. BUDGET EXECUTION AND FINANCIAL MANAGEMENT CAPABILITIES ........................................................... 25 BUDGET EXECUTION ..................................................................................................................................................... 25 The MoH-GoSS’s Budget Execution Process ........................................................................................................ 25 The MoH-GoSS’s Budget Execution Performance ............................................................................................... 25 FINANCIAL MANAGEMENT CAPABILITIES OF MOH-GOSS, SMOHS AND CHDS ........................................................................ 27 Overview of an Effective Financial Management System ................................................................................... 27 Financial Management Capabilities of the MoH-GoSS ....................................................................................... 28 Financial Management Capabilities of SMoHs and CHDs ................................................................................... 28 SOURCES OF FUNDS AND FINANCIAL MANAGEMENT CAPACITIES AT THE HEALTH FACILITIES ....................................................... 28 Sources of Financing for Health Facilities ........................................................................................................... 29 Selected Health Facilities by Levels of Care ......................................................................................................... 30 The Tertiary Hospitals ......................................................................................................................................... 30 Juba Teaching Hospital (Central Equatoria State) ............................................................................................................ 30 Wau Teaching Hospital (Western Bahr el Ghazal State) ................................................................................................... 31 Malakal Teaching Hospital (Upper Nile State) .................................................................................................................. 31 State and County Hospitals ................................................................................................................................. 32 ii Lui Hospital, Mundri East County, Western Equatoria State ............................................................................................ 32 Tumbura Civil Hospital, Tumbura County, Western Equatoria State ............................................................................... 33 Torit Civil Hospital, Torit county, Eastern Equatoria State ............................................................................................... 33 Kejokeji Civil Hospital, Kejokeji County, Central Equatoria State ..................................................................................... 33 St Luke International Medical Centre, Juba County, Central Equatoria State .................................................................. 34 Primary Health Care (PHC) Facilities ................................................................................................................... 34 Bengasu PHCC .................................................................................................................................................................. 34 Yubu PHCC ........................................................................................................................................................................ 35 4. EXISTING MECHANISMS FOR GENERATING RESOURCES .............................................................................. 36 USER FEES .................................................................................................................................................................. 36 User Fees Mechanism in Neighboring Countries................................................................................................. 37 THE NATIONAL HEALTH INSURANCE
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