How can African countries mobilize resources for health needs, how to ensure stable delivery of necessary testing kits, PPEs, masks, ventilators and other medical supplies needed to better respond to COVID-19, and how to efficiently allocate scarce resources to different needs in times of pandemic? In no time would strategic purchasing for health be more relevant for African countries than now. Strategic purchasing refers to “active, evidence-based engagement in defining the service-mix and volume and selecting the provider-mix in order to maximize societal objectives” according the WHO. Strategic purchasing is central for Public Financial Management in health.
On April 30th, CABRI organized an online panel titled: Applying strategic purchasing in times of economic recession, a delicate balancing act for African Ministries of Finance. The event aimed to provide a platform for professionals from across the continent to share experiences on practice of strategic purchasing of health in the context of COVID-19. The panelists included Neil Cole, the executive secretary of CABRI; Dr. Benjamin Djoudalbaye, Head of Policy and Health Diplomacy at Africa Centres for Disease Control and Prevention; and Dr. Evelyn Abena Arthur, the Director of Budget at Ministry of Finance of Republic of Ghana. The webinar was moderated by Ashveena Gajeelee, head of CABRI’s programs and technical team.
Mr. Neil Cole kicked off the panel by reviewing four broad options currently pursued by African governments to expand fiscal space in the face of COVID-19. The first is loans and relief funds from international agencies such as the IMF, WB, BRICS Bank, and African Development Bank. The second is reprioritization of budget allocations from goods and services and capital expenditure to health financing. The third option is drawing from contingency and national disaster funds. Finally, many African governments utilized innovative financing methods such as establishing dedicated trust and solidarity funds for Covid-19, and they receive contributions from private individuals and the public. Neil also presented the COVID-19 Public Finance Response Monitor, which CABRI has recently launched. The monitor provides data on African government responses to the pandemic, including measures to secure health financing, accelerate procurement and fund release, and mitigate economic and social consequences.
A second area discussed was accelerating procurement and streamline procedures. Measures adopted by governments in this regard included (a) emergency clearances and simplified licensing to rapidly respond to health needs, (b) enacting emergency procurement processes from already existing PFM regulations and laws, (c) utilizing digital platforms to secure and manage supply of health equipment and medicine, and (d) ensuring continuity of regular treasury functions, such as integrated PFM, and salary payments during the time of lock-down and when many civil servants are working remotely.
The panellists also discussed measures to limit price scourges. As demand for health equipment and medicine goes up, needed supplies go into shortage, and prices increase. These measures included providing subsidies, regulating prices (and imposing fines for price increases), and reducing or eliminating duties on imports of medicines and medical equipment.
The second panellist, Dr. Benjamin Djoudalbaye from Africa CDC, presented their efforts to meet the need for medical supplies across the continent. The strategy was endorsed by African Health Ministries early February. They set up Africa Coronavirus Taskforce to work on three fronts: preventing transmission, preventing deaths, and preventing social harm. The Bureau of Heads of States at the African Union established three subcommittees: one on finance to mobilize resources for COVID-19 response, one on transport and logistics to coordinate key supplies and rapid response, and one on health to support adoption of public health response strategy. The continental steering committee of the taskforce oversees seven technical working groups on various relevant issues.
Africa CDC introduced a new initiative called Partnership for Accelerated COVID-19 Testing (PACT), which aims to scale up testing and ensure that 10 million tests are conducted in the continent in four months. It also aims to establish an Africa-wide pooled procurement and storage and distribution hubs, and to deploy 1 million health workers for contact tracing. The initiative also aims to standardize and deploy new technologies for surveillance.
Taking the discussion to country level, Evelyn Abena Arthur, the Director for Budget at Ghanaian Ministry of Finance, provided an in-depth analysis of Ghana’s response. In the face of increasing health expenditure needs and shortfall of revenue, the government took several measures to secure finances. It used the Petroleum Revenue Management Act to draw from the Oil Stabilization Fund. It also sought the IMF Rapid Credit Facility to support priority programs and interest payments, and the World Bank Fast Track Credit Facility. The government reallocated expenditure from goods and services and capital expenditure to health. Additionally, the government is considering suspension of fiscal responsibility rules to allow exceeding deficit caps. The government also set up the COVID-19 National Trust Fund, which is led by a former Chief Justice and open to contributions from the public.
To address the economic and social consequences of the pandemic, the parliament also approved the Coronavirus Alleviation Programme (CAP). The program supports households with food packages and three months’ bills of provision of water and sanitation. CAP also provides relief to health workers, including waiving personal income tax, and providing salary raise for frontline health workers. Finally, the program provides soft loans for micro, small, and medium size business.
The Q&A session discussed measures taken by Africa CDC with regard to pooled procurement mechanisms, and the role of ministries of finance in the process. The discussion highlighted lessons from Ebola outbreak, such as the importance of coordination between ministries of finance and health, and the recognition of underinvestment in healthcare. Questions also discussed measures to ensure accountability and transparency in COVID-19 related expenditure and fund management and how this should be in line with existing regulations and laws.
Panellists concluded with remarks on what to take from the pandemic for the medium term. Evelyn pointed to Ghana’s President commitment to more investment in healthcare infrastructure as a result of the pandemic. Dr. Djoudalbaye recommended particular priorities: strengthening national public health institutes as drivers for international health regulations implementation, and decentralizing Implementation of international health regulations to sub national level, in addition to establishing better governance for managing and sharing of public health data. Neil Cole concluded with emphasizing the importance of increasing investment in health quality and access, which would require innovative financing mechanisms, especially post COVID-19.