adminlooked forward to establishing what priorities would be given a premium.
The 2013 budget highlights that the state will prioritise agriculture and food security; social and pro-poor services; infrastructure; industrialisation and job creation.
Trend analyses of previous budgets show evidence that Government has made some deliberate attempts to allocate more resources to social sectors as these often have the largest shares of the national budget. To a large extent, the state has always been ‘prioritising’ social sectors though much has not changed by way of improving the situation for ordinary women and men. Social sectors constitute those considered ‘people-centered and directly or indirectly tied to poverty alleviation like for example education, health and agriculture.
As the prioritisation of ‘social sectors’ is a song we have heard many times before, it becomes critical to assess how this pans out in practical terms. Among other things it can be imagined among ordinary people that such entails increased and meaningful allocations to specific sectors informed by real needs, strategies for turn around and compliance with international standards or best practices among other things.
This week we take a close look at health as a sector that plays a very critical role in the socio-economic development of women. With a vote of US$380,9 million, the 2013 budget share allocation for the Ministry of Health and Child Welfare sits at 9,87 percent of the total budget. A trend analysis of 2010 – 2013 shows that on average, health has been getting allocations in the region of 8,2 percent. The Abuja Declaration recommends government to allocate 15 percent of the total budget to health.
Moreover, the World Health Organisation stipulates that the ratio of the health budget allocation to the Gross Domestic Product should ideally be at least 5 percent.
Zimbabwe’s allocations to health in previous years (2010-2013) have been floating between 2-3%, in relation to the GDP. This in essence means that the allocation to health falls far short of generally accepted recommendations.
Despite that the maternal mortality rate rose by 73 percent 2005-2011 and currently stands at 960 deaths per 100 000 live births, it is interesting to note that the budget line for maternal health has actually fallen from US$10 million in 2012 to US$6 million in 2013. In 2012, only approximately US$2,1million had been disbursed as of June. Because of the cash budgeting system, late disbursements of funds remain problematic; which affects effective implementation of projects.
Ultimately, this disbursement versus absorption challenge also affects how future allocations are made. Although not disaggregated between maternal and child health care, the US$6 million set aside to the effect of eliminating user fees though commendable, is too little. What remains clear is that there has not been any significant improvement in maternal health conditions.
Half of the deaths among mothers are due to preventable factors such as the three delays, that is, delays in seeking care, delays in reaching care centres and delays in receiving effective treatment.
For a sector that is being ‘prioritised’, it would have worked well not only to get an explanation of why the maternal health budget line has actually gone down but also what plans are in place for improvement towards the Abuja and WHO declarations. While we remain cognisant of the welcome move and ultimate objective to remove maternal user fees through support from the Health Transition Fund, there is lack of clarity on progress made thus far. The HTF is a five year planned budget of US$435 million largely financed through external donor support and intended to address maternal mortality.
The 2013 budget statement highlights that to date, the donor contribution status stands at approximately US$62 million out of pledges made towards the US$435 HTF. There is no indication of how the government plans to finance the deficit and the outlook looks unfavorable.
The budget statement also stipulates that out of the overall health budget allocation, a total of US$9,8 million was obtained as an “external loan” to augment the “purchase of much needed medical equipment”. Because Zimbabwe is currently using a cash budgeting system, clarity is needed for why this portion was borrowed, and how it will be paid back in a context of already inflated external debt.
Suggestions for effective prioritisation include the need for maternal and child health budget lines to be separated in order to get a clearer per capita picture. Secondly, the government can explore other means of financing the maternal emergency say through ring-fencing the ‘sin tax’ to this rather than education, which got the highest allocation in 2013 anyway.
Sin tax is levied by government on products or services that are seen as vices, such as alcohol and cigarettes, to discourage individuals from partaking in such. Because it generates enormous amounts of revenue, sin tax can and often is recommended to help fill some budget gaps.
There is also need for serious exploration of how the informal sector can be regulated to start remitting much needed revenue into the fiscus. Imagine what a dollar-a-week levy from each and every flea market seller in Zimbabwe being ring-fenced towards maternal health could potentially accomplish.
The Zimbabwe Women’s Resource Centre & Network (ZWRCN) is an information-based organisation advocating for gender equality and equity. Feedback is welcome on email: [email protected] or phone numbers: +263 4 700250/252388. Visit our website: www.zwrcn.org.zw and follow us on Twitter @zwrcnwomen
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