1. EC-SIHSIP
Debriefing Presentation
Dr. P. C. Dash
Financial Management Specialist
Date: 22/10/2008
10/22/2008

2. Summary of activities on Financial Management
- Identified by SIHSIP
• Developing, pilot testing and implementing
district health accounting manual for improved
flow of CFET
• Developing tools for health expenditure analysis
at districts and national level and initiate the
intervention
• Developing tools for performance based
budgeting and implement them in the districts
and hospitals
• Establishing a system for continuation of the
above activities in the future
10/22/2008

3. Proposed activities for the reporting period
May – October 2008
1. Review of existing tools related to planning and
budgeting, inadequacies and suggestions
2. Develop a Chart of Accounts (CoA) structure based on
those used in District level
3. Preparation of draft procedure for annual health plan
and budget execution estimates
4. Collection of feedback from DHO and Hospitals and
preparation of final format
5. Produce draft revised health accounting manual in
book keeping form
6. Preparation of Manual: – ‘District Health Expenditure
Review – DHER’
10/22/2008

4. Financial Management Cycle
10/22/2008
Planning and
budgeting
Resource
Allocation
Evaluation
and reporting
In-year Management:
Operating, Monitoring
and Safeguarding

5. Planning- Current procedure
• Formation of committee at the ministry Level
• Decision on Budget envelop
• Orientation workshop
• Preparation of DIP by Institutions
• Presentation, discussion and modification
• Consolidation at central level
• Revision of the plan after the budget circular
10/22/2008

6. Planning- Drawbacks and suggestions
Drawbacks
 Poor understanding about
the importance of HMIS in
planning
 Limited use of HMIS in
planning at districts
 No uniform formats across
the districts posing
difficulties for consolidation
 Lack of adequate time for
district as well as central
level
Suggested measures
 Strengthening of HMIS and
orientation on their use
 Orientation of district level
planners on the use of HMIS
 Uniform planning format
 Three year rolling plan as
strategic plan
 Current years plan as
operational plan – Methods
included in the manual
10/22/2008

7. Budgeting – Pre-requisites
 An organisational structure with responsibility
centres
An accounting – Chart of Accounts that parallels
the organisations chart
Data collection system that collect statistical and
financial data on historical basis
A management reporting system that parallels
organisation structure, CoA and Budget (CPV)
Preparation of budget calendar with
responsibilities
A budget manual
10/22/2008

8. Budgeting – Chart of Accounts
Budgeting – Chart of Accounts
• Ministry of health- 15
• Secretariat - 1501
• Divisions - 150101
- 150102
...
- 150124
• Programs - 24 Pgms
(Title of programs same as
division only the code
changes)
Budgeting – Chart of Accounts
• Sub Program - 24 Sub-pgm
(Given the same title as Program)
Note: Divisions=Programs
=Sub Programs
• Activities - Sub programs
classified
• Appropriation categories:
(W&S, G&S, CM, CM,
Transfers) –
• Items - Preparation of budget
• Line items – Reporting
10/22/2008

9. Budget- Reporting System (CPV)
REPUBLIC DEMOCRATIC OF TIMOR LESTE
Ministry of Finance
Central Fiscal Authorisation
COMMITMENT & PAYMENT VOUCHER
CPV #:
SUB -FUND Treasury account DIRECT PAYMENT ADVANCE
PROGRAMME PROCUREMENT PARTIAL
LINE ITEM Postage SUPPLY FINAL
DISTRICT ADDITION
AL
AMOUNT
AMOUNT IN
WORDS
10/22/2008

10. Planning and Budget – Missing Link
Planning – Health programs and
Activities
• Maternal and child health
• Communicable diseases
• Non-communicable disease
• Other health Pegs. (oral,
mental, eye. Etc)
• Health promotion
• Other services (Pharmacy,
Administration etc.)
Budget – Programs activities
• Programs are same as the
name of the institutions
• Activities: Activities are
same as defined as sub-
programs
10/22/2008

11. Reasons for Missing Link
1. The definition of programs and divisions in CoA are same
2. No linkage between the program defined in CoA and
Health Programs (as defined in planning)
3. Definition of activities in the planning is not same as
activities in CoA
4. The CPV is prepared by taking in to consideration of fund
source, Program, Line Item and Location (as defined in
CoA) – thus making it difficult to trace the program wise
budget and expenditure
5. As the budgets are prepared centrally, it is not matched
with the planning.
10/22/2008

12. Necessary Steps
1. There is need for revising definition in CoA for
health sector
2. The budget preparation needs to be
decentralised
3. The Planning and budgeting are to be linked
together
4. The budget should be program based (the excel
sheets should be for each of the health programs)
– Subject to discussion
5. Need for capacity development
10/22/2008

13. Budget, Expenditure and Financial
Management
• Budget is executed as per the guidelines issued by the treasury and
follows four measure steps
(a) Funds allocation
(b) Commitment authorisation
(c) Procurement
(d) Payment approval
• In between these four steps there are several steps linked with the
movement of a file from one table to the other – which causes delay in
the payment process.
• For a simple payment like the disbursement of Imprest fund the
file/proposal/CPV has to move a minimum of 13 times
• The payment mechanism for the procurement of drugs and capital items
are still more complex and takes months till it reaches at treasury for
payment
It is suggested to make these procedures less complex for better
execution of the budget
10/22/2008

14. Financial Management Manual – Module 4
• Budget and free-balance system
• Financial autonomy – Districts
• Concept of Pretty cash and imprest fund
• Procedure of getting the imprest fund
• Guidelines for distributing the funds below
the district level
• Reporting and feedback mechanism
• Budget monitoring
10/22/2008

15. In-year Management of Finances –
Module 5
• Financial accounting system and its need
• Procedures of release of salaries in TL
• Procedure of release of funds for goods and services –
Imprest fund
• Registers and records of expenditure, advance etc.
• Expenditure reports – quarterly / monthly
• Records on drugs and consumables
• Asset Management (Records and registers)
• Procedures for managing the expenditure
• Performance evaluation and DHER
10/22/2008

16. Manual on District Health Expenditure
Review (DHER)
• Importance of DHER in service and financial
Planning for the districts
• What DHER does? – Equity, Resource
allocation, Efficiency, Sustainability
• Indicators and their computation related to
each of these aspects
• District cost centres (Institutions)
• Methodology for computation of the
indicators
10/22/2008

17. Indicators of district performance
10/22/2008
Indicators for DHER
Cr i t e r i a ( A ) Eq u i t y :
(Do the people
have equitable
access to
services?)
( B) Re s o u r c e
A l l o c a t i o n: (Are
the resources allocated
effectively?
( C)
Ef f i c i e nc y
(Are resources
used
efficiently?)
(D)
Su s t a i na b i l i t y :
(How reliable is the
funding?)
Co s t
c e nt r e s
District A1: District
expenditure per
capita
A2:
Expenditure per
capita per sub
district
B1: Spending on each
level of service e.g.,
proportion of local
expenditure analysed by
hospitals, primary
facilities, and
community services
D1: % funds from
different sources
D2: % allocated
funds spent
Primary
health
facilities:
1. Fixed
(HP)
2. Mobile
3. CHCs
4. DHCs
A3:
Expenditure per
capita per
facility
B2: Referral rate per
facility
B3: Nurse/Doctor client
ratio
B4: Per capita visit per
facility
B5: Proportion of
resources to different
inputs (% expenditure
per line item per
facility)
C1.1: Cost per
visit
- Staff cost
-Drug cost
C1.2: Referral
rate to highest
level of care
C1.3: ALOS,
BOR and
Admission per
capita
Referral
/National
Hospital
A4:
Expenditure per
capita per
hospital for IPD
and OPD
B6: % expenditure per
line item per facility
B7: Utilisation rate per
facility (both inpatient
and outpatient)
C2:Cost per
visit
-IPD, OPD,
PDE
- Per line item
C3: ALOS
BOR and
Admissions per
capita
Community
level
programs
B8: Expenditure on
SISCa as proportion of
total expenditure in the
district
B9: Proportion of
resources to different
inputs (% expenditure
per line item per service
program-SISC)
Emergency
medical
services
C4: Cost per
Km.
C5: Cost per
patient
transported

18. Next Steps
Ministry of Health
Forming working groups:
• For the review of
‘Integrated Health
Accounting Manual’
• For the review of manual on
‘District Health Expenditure
Review’
Finance specialist
• Incorporate all the suggestions by the
Ministry of Health
• Should pre-test the modules at least in
three proposed districts (Covalima,
Manatuto and Baucau) and modify the
manual accordingly
• Assist the ministry in preparing the
training plan for both the Modules
• Carry out the TOT, facilitate and guide
the workshops at the district level
• Facilitate the institutionalisation of
MTEF, hospital costing, Accounting and
DHER manuals by the MoH and district
level authorities
• Assist the district level authorities for
planning and budgeting for the year
2010
10/22/2008

19. Recommendations
• The Finance Specialist must have access to
relevant MOH and MOF staff.
• Place the Financial Specialist in the relevant
Department
• Place an appropriately qualified counterpart
to work side by side with the Specialist
• Collaborate with agencies working on
financial tools and activities i.e., WB-AusAID,
SAMES.
10/22/2008

20. Thank You.
Obrigado
10/22/2008