As a budget advocate for over a decade now, I have come to realise the immense power citizens have in influencing the public budget if their evidence-based advocacy is well targeted.
Without this knowledge, the ordinary citizen and civil society organizations (CSOs) may feel powerless in their ability to reverse inequities in the desired areas of intervention. I gladly agreed to travel to Tanzania to train the White Ribbon Alliance Tanzania (WRATZ) and its members to help them develop their budget advocacy skills.
In Tanzania 144 newborn and 24 women die daily in the process of child bearing due to unavailability of comprehensive emergency obstetric and newborn care (CEmONC).
80% of these deaths could be prevented if CEmONC is adequately budgeted for and if these services are provided in the health centres and hospitals across the country.
In response to this situation, the White Ribbon Alliance Tanzania (WRATZ) initiated a campaign on
Zero tolerance to maternal deaths. Be accountable
Holding the government accountable
The campaign seeks to hold government at all levels accountable in ensuring all pregnant women and newborns in Tanzania benefit from lifesaving CEmONC services.
The WRATZ secretariat set aside a day training during a two day campaign orientation meeting for hands-on training on budget advocacy in August. Core secretariat staff were trained the following day on budget analysis. This technical support was provided by the Africa Health Budget Network (AHBN), a network of over one hundred members from across Africa working on health budget advocacy.
I started by familiarizing WRATZ members on the stages of budget cycle.
We then had a practical session on the budget development process co-facilitated by the Ministry of Health, Community Development, Gender, Elderly and Children. We had a robust discussion on the budget planning process of Comprehensive Council Health Plans (CCHPs) of the districts and how we can identify spaces and opportunities for CSOs to participate in the budget planning process.
The budget development process may be documented in guidelines, but I have found that there are nuances that may not be found in guidelines which CSOs should be aware of. It is important that CSOs realise they do not have all the information on the budget planning process and should rely on experts within government to provide such information.This provides CSOs with accurate understanding of who the target audience is and when to carry out advocacy.
The SMART test
We reviewed the objectives of the campaign together both to create a common understanding for buy-in, and also to pass the objectives through the “SMART test”.
This process interrogated targets and milestones set by WRATZ in order to assess how achievable these targets were. At the end, partners were better positioned to design activities that will ensure quick wins in increasing budget allocations for CEmONC in the 2017/18 budget.
They also discovered that the time to start is NOW. Another interesting discovery was the fact that working from bottom up to increase the budget might be a less challenging and faster route to influence CEmoNC plans and budgets.
Budget analysis is an interesting experience because it reveals that facts that are not always available at face value when looking at the total amounts allocated to a particular sector or intervention.
WRATZ staff training
The training for WRATZ staff was no different. Armed with the CCHPS from a few regions we went to work.
Staff were taken through the principles for budget analysis which includes participation, transparency, equity, efficiency and adequacy of allocations.We used simple analytical tools such as calculating shares, converting nominal amounts to real values among others.
An interesting finding from the practical session using the 2016/17 CCHPs revealed that some of the districts did not budget for CEmONC interventions. A few districts that indicated that funds were allocated for CEmONC in fact budgeted for items that were not related to services provided under CEmONC.
This shows that WRATZ has its task clearly cut out to ensure reorientation of budget officers at the district levels as well as at the various levels of budget approval to ensure that CEmONC allocations are not paying for other services and that CEMOC services are adequately budgeted for across facilities.
The experience with the WRATZ staff was quite rewarding as they exhibited a quick grasp of the concepts of budget analysis and how to relate figures from analysis to realities to enable policy makers understand the issues.
Rose Mlay, National Coordinator for WRATZ, said,
It was an eye opener for me to find out even the Maternal Newborn and Children Health supposed to be a Priority Area number 2 in health budgets; was not a priority at all. Very small percent was allocated to this area compared to the entire health budget. Of the five districts' Comprehensive Council Health Plans that we worked on only one had a CEmONC clearly identified as a budget line item in the intervention area. So we have a valid reason for advocacy here
I wish Rose and the rest of the WRATZ team the best of luck with their health budget advocacy.