Day: July 9, 2022

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Public financial management for effective response to health emergencies: Key lessons from COVID-19 for balancing flexibility and accountability

Public revenues are the cornerstone of funding for governments’ response to health emergencies; as such, public financial management (PFM) – the rules and mechanisms governing the allocation, execution and reporting of public funds – has been an integral part of the health response to the COVID-19 pandemic.

• This rapid review highlights the importance of PFM for health emergencies, by analysing various countries’ experiences of financing their national health response to COVID-19 and identifying some early lessons. This review can help countries to enhance their understanding of good practices, and key requirements for adjustments to their PFM systems.

• To be able to effectively adapt and quickly respond to health emergencies, PFM may need to be overhauled. Key PFM policy actions summarized in Table 1 include recommended adjustments for each phase of the budget cycle (formulation, spending, and reporting), to ensure health financing is more agile, flexible and responsive to emergency needs, while assuring transparency and accountability.

• One of the key PFM-related lessons emerging from the COVID-19 health response is the need to shift from budgeting by line items to budgeting based on programmes. Programme-based budgets are more readily structured to allow for more flexible allocations of public resources, and are thus more effective responses to health emergencies.

• The COVID-19 pandemic has shown the need to prepare expenditure management systems by updating emergency spending protocols and proactively empowering frontline providers to access, manage, and account for public funds in an agile way.

• The adoption of measures to balance speed and accountability is another key lesson. Better equipping financial management information systems to provide integrated reporting of emergency-related spending is a critical step to ensuring public trust for the response.

• Countries can better prepare for future health emergencies by strengthening their regular PFM mechanisms and capacities, while limiting the proliferation of parallel mechanisms which can exacerbate fragmentation of health financing and hinder alignment with national response plans. The use of extra-budgetary mechanisms without well-defined procedures is unlikely to result in the efficient use of public resources for health emergency response.

Introduction: why PFM matters for the response to health emergencies

Public revenues are the cornerstone of funding for the response to health emergencies. While private financing can contribute to a country’s response, public sources make up the largest share of the funding available for this purpose. This has been exhibited during the current pandemic, with the health response to COVID-19 predominantly funded from public sources, even in countries facing revenue constraints [1,2]. For example, in Ghana, COVID-19-related health spending in 2020 was mostly funded through domestic government funds (83%) with external and private funding representing 10% and 7% of the total, and in Burkina Faso, domestic public funding represented 53% [2]. The predominance of public funding promotes consistency, efficiency and equity in the response [3].

Given the importance of public finances, the ongoing COVID-19 pandemic has also shown that public financial management (PFM) should be an integral part of the response. Effectiveness in financing the health response depends not only on the level of funding but also on the way public funds are allocated and spent. This is determined by the PFM rules that guide how public funding is allocated, executed, and reported, and in turn how money flows to health service providers [4,5]. Early assessments have shown that PFM systems ranged from being a fundamental enabler to acting as a roadblock in the COVID-19 health response [6,7].

When the crisis hit, many countries’ domestic PFM systems were not ready or agile enough to support an effective emergency response. Challenges commonly faced by countries include [6,8-10]:

i) estimating and formulating budget provisions to align with response needs;

ii) tailoring spending modalities to ensure funds are quickly available for service delivery units and disbursed flexibly and on time;

iii) adjusting tracking and reporting systems to ensure public funds for emergency response are accounted for effectively and transparently.

While problems in service delivery have been extensively documented [11], the underlying PFM mechanisms of the response also merit attention. To highlight the importance of PFM in health emergency contexts, this policy brief analyses various country PFM experiences and identifies early lessons emerging from the financing of the health response to COVID-19. The policy brief is focused on documenting lessons from the budgeting and spending mechanisms and processes; it does not discuss the sources of funding, nor the content of fiscal policies in response to COVID-19, which are covered extensively elsewhere [12]. The assessment is done by stages of the budget cycle: budget allocation, budget execution, and budget oversight. Identifying lessons from PFM modalities used to finance the health response to COVID-19 is fundamental both for health policy-makers and for finance authorities, to enhance PFM system preparedness to respond effectively to future health emergencies. It can help to enhance understanding of good practices, as well as key requirements for future system adjustments.

The assessment is built on a non-systematic review of several activities initiated by WHO in 2020 to monitor countries’ health response from a PFM perspective (see Table 2). The evidence reviewed included a desk-based survey initiated in March 2020, which analysed budgeting, spending, and accounting modalities in financing of the health response in 183 countries. Technical consultations were conducted in 17 countries (Argentina, Australia, Brazil, Chile, China, Costa Rica, Dominican Republic, Ecuador, Indonesia, Lao People’s Democratic Republic, Malawi, Mexico, Mongolia, Peru, Philippines, South Africa, Ukraine) between June and September 2020 by WHO to further the understanding of PFM modalities. Complementary analyses conducted in 2021 to unpack specific PFM aspects of the health response, including an analysis of 40 extra-budgetary funds used to channel resources for the response [13], a mapping of PFM issues related to COVID-19 vaccine roll-out [7], and an in-depth assessment of PFM modalities in selected countries, including Argentina, the Philippines and South Africa [14,15] were also reviewed. In late 2021, the emerging findings in this paper were further explored and validated during the 5th Meeting of the Montreux Collaborative, a virtual meeting that gathered over 900 participants and 50 speakers over 5 days to explore policy options to help countries rebuild and strengthen health financing and PFM systems to make them more responsive to future shocks and able to sustain efforts towards universal health coverage (UHC). Finally, in early 2022, to gather the latest information on the response, another non-systematic review of published literature and publicly available audit reports on COVID-19-related expenditures was conducted to complement the understanding of the opportunities and risks associated with the use of emergency procedures.

Source: World Health Organization

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Africa’s Donkeys Are Being Stolen and Slaughtered for Chinese Medicine

JOHANNESBURG — How did a popular period drama on Chinese TV help lead to the theft and brutal slaughter of millions of donkeys in Africa?

It all started when fans of the show “Empresses in the Palace” saw the aristocratic characters using a traditional Chinese medicine called ejiao, which is made from donkey skin, Simon Pope, who works for U.K.-based charity the Donkey Sanctuary, told VOA.

“It was all set in the (Chinese) imperial court and at a certain time of the day the ladies of the court would all say, ‘Let’s have some ejiao,’” said Pope. Ejiao, also called donkey glue, is used as medicine or as a tonic for health and beauty in China.

“As a result of this program the demand for ejiao just literally went through the roof,” he said of the show first broadcast in 2011. “The problem was China simply does not have enough donkeys to be able to meet demand.”

The Chinese started looking for donkeys abroad, particularly in Africa where they’re used as a beast of burden by rural communities from Mali to Zimbabwe to Tanzania. When locals didn't want to sell, thefts started, with distressed farmers finding their precious donkeys skinned and left to rot on the veld.

China needs about 5 million donkeys a year to produce and meet the demand for ejiao, and about 2 million of these come from China’s own population of the animals. Of the remaining 3 million or more sourced abroad, the Donkey Sanctuary estimates that between 25% and 35% are stolen.

Now, years into the trade, populations are down, and some African countries are fighting back. Tanzania last month banned donkey slaughter for the skin trade, saying the country's donkey population was at risk of becoming extinct. Other African countries including Nigeria have also introduced bans on donkey slaughter or exports of the animal.

“I think the message that’s going to China, from Africa in particular, is that our donkeys are too valuable an asset to have them skinned and shipped off to China to have them made into medicine. Our donkeys are not for sale,” said Pope. However, he noted that because of China's economic clout on the continent and massive investment in infrastructure, other nations are loath to push back against the trade.

South Africa allows the butchering of donkeys but only at two licensed slaughterhouses and with a quota of 12,000 a year. Authorities here have been cracking down on the illegal trade in recent years, so criminal syndicates have gone underground, especially since COVID, said Grace de Lange, an inspector with the National Council of Societies for the Prevention of Cruelty to Animals (NSPCA) in South Africa.

Now South African donkeys are being smuggled into Lesotho, a tiny mountainous kingdom surrounded by South Africa.

“We are not sure exactly what the link is and how they’re getting it out – maybe easier from Lesotho,” she told VOA.

“We’ve had meetings with (the) government in Lesotho and they’re also investigating. … It’s going to the Chinese market,” she said, adding that authorities have also intercepted skins in warehouses and at the airport.

While small-time local criminals have been prosecuted after being arrested transporting the animals, the Chinese running the large syndicates are usually harder to get to, de Lange says.

Marosi Molomo, director of livestock services at Lesotho's Ministry of Agriculture, responded to VOA's questions about the donkey trade moving to Lesotho via text message saying: "It's not possible to give an answer without evidence."

Requests for comment from the Chinese embassies and consulates in both Lesotho and South Africa went unanswered.

De Lange said the animals are often slaughtered in a particularly cruel way. They are stunned with hammers or have their throats slit but are sometimes still alive when skinned.

“They’d actually been slaughtered in the most horrific manner,” she said.

Francis Nkosi, who works on a farm outside Johannesburg caring for some of the donkeys rescued from the skin trade, explained why the animal is so vital in Africa’s rural areas.

“Donkeys in our culture, they’re like transport. They help us,” he said as he fed fresh hay to Oscar and Presley, two of his charges who were rescued – in terrible condition – by the NSPCA last year on their way to slaughter across the border in Lesotho.

“If people get sick sometimes, we don’t have a car. We don’t have a transport. You can use the donkeys to transport some people to the hospital,” he added.

De Lange said she’s seen that donkey “numbers are dwindling” in the rural communities where she works and, for Pope, one major concern is how losing their donkeys has socioeconomic effects for many.

In some countries, “children had been pulled out of school and they were having to do the work previously the donkey was having to do,” Pope said.

While some argue Africa should set up donkey farms and benefit financially that way, Pope points out that China has tried mass farming the animals and been largely unsuccessful. Unlike other farm animals, donkeys can only produce one foal a year.

Ejiao has been used as medicine for the last two millennia, and in modern-day China it is available in various edible forms intended to aid circulation and help with aches and pains.

“Demand for donkey glue in China has affected communities halfway across the globe,” according to an article about the product in China’s state publication China Daily.

“The issue is sensitive, simply because some of these countries depend on the donkey as a working beast in both agriculture and transportation,” it said. “But this is also the reality of a tightening global network of supply and demand, and the fearsome power of being one of the largest consumer markets on Earth.”

The donkey skin trade has also become a conduit for other criminal activity, according to an investigation by the Donkey Sanctuary and researchers at the University of Oxford published in May. The report found donkey skins easily available for purchase online and that websites selling the product were also often offering endangered wildlife for sale and even illicit drugs.

There is a "vast online network of organized criminals offering donkey skins for sale, often alongside other illegal wildlife products including rhino horns, pangolin scales, elephant ivory and tiger hides," the Donkey Sanctuary said.

Source: Voice of America

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Advancing Resilience Measurement Consultation Report

Over the last decade, resilience has continued to be elevated as an analytic, programmatic, and organizing concept in development discourse and practice. In line with this, approaches to measuring resilience have proliferated, giving rise to a nascent evidence base on both the impact of resilience programming and the sources of resilience that explain why some households, communities, systems, and countries fare better in the face of shocks and stresses than others. Despite clear progress, significant challenges and gaps in resilience measurement and evidence remain. The demand for resilience evidence has also grown exponentially as conflict, Covid-19 and the accelerating impacts of climate change have reversed development gains on a massive scale and pushed hundreds of millions of people into crisis levels of poverty and hunger.

On May 17-18th 2022, the University of Arizona, the Global Resilience Partnership, and the United States Agency for International Development convened a group of 50 experts and development practitioners at the University of Arizona, DC Center for Collaboration and Outreach in Washington, D.C. with the aim of advancing resilience measurement and setting a common agenda for addressing these challenges and gaps. The group of experts and development practitioners included representatives from USAID, the State Department’s Special Envoy for Climate, UN agencies, the World Bank, private foundations, universities, and research institutions, NGOs, and governments and regional institutions, including the Government of Kenya and the Sahelian West Africa Permanent Committee for Drought Control.

Source: US Agency for International Development