Frameworks for Optimization

Resource Tracking & Management

Project Overview

From 2013 to 2017

Resource Tracking & Management

Concurrently with the latter phase of the HEPCAPS 2 project, Professor Berman launched the Resource Tracking and Management (RTM) project in India and Ethiopia with the support of the Bill & Melinda Gates Foundation. The project aimed at enhancing efficiency, effectiveness and equity in primary care delivery in Ethiopia and India by developing and regularly applying a financial resource tracking and management (RTM) framework.

The RTM framework provides an end-to-end health financing analysis by tracking resources, identifying bottlenecks, and applying policy solutions along 5 key steps of the flow of funds for health programs linked to key objectives. “Resources”include financing as well as physical inputs, such as drugs, supplies, and human resources.

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The RTM framework (Figure 1):

  1. Resource Mobilization - Resource mobilization refers to the means or mechanisms to generate resources, at both national and sub-national levels, to pay for goods and services used to deliver health care in a country. Health financing mechanisms used to generate health resources may include general government revenue, earmarked taxes for health, social health insurance, private health insurance, external aid, user fees (out-of-pocket spending at point of care) and other community contributions. Key Tools/Methods: Fiscal space analysis.
  2. Resource Allocation – How are funds allocated to different programs and functions at national and sub-national levels, and what factors determine the allocation to primary care? Key Tools/Methods: Public Expenditure Reviews (PERs), Cost-effectiveness analysis and priority setting, planning/budget process, and National Health Accounts (NHAs).
  3. Resource Utilization - Are the allocated funds being utilized? What factors drive successful budget execution? What are the existing bottlenecks? Key Tools/Methods: Public Expenditure Tracking Surveys (PETs), analysis of public financial management design, governance, and capabilities.
  4. Resource Productivity - How effectively are resources being translated into services? What are the effects on volume and quality? Key Tools/Methods: Quantitative Service Delivery Survey (QSDS) or facility surveys, analysis of technical efficiency in service delivery (cost analysis, DEA/FPF analysis), assessment of efficiency/quality linkages.
  5. Resource Targeting - Are inputs benefiting the intended individuals and population? Is public spending reaching the poor? Key Tools/Methods: Benefit Incidence Analysis (BIA).

Resource Tracking & Management

Achievements.

Resource Mobilization

As a first step, a review of resource mobilization results since the endorsement of Ethiopia’s 1998 Health Care and Financing Strategy (HCFS) was conducted. Complementing this work, a financial projection model was developed presenting resource availability with possible financing scenarios and projected resource needs for primary care through 2035, in alignment with the MOH vision for universal health coverage.

Resource Allocation

  • Developed a financing projection model analyzing federal, regional, and woreda-level resource allocation, including primary health care spending.
    Supported the MOH in executing the 2016 household health care utilization and expenditure survey for the sixth national health accounts analysis.
  • Conducted a primary health care costing study at 24 hospitals, 47 health centers, and 22 health posts, analyzing service delivery costs and spending shares.
  • Findings informed the fiscal impact of expanding exempted services, budgeting tools, and strategies for efficient service delivery under HSTP.
  • Reviewed public-private partnerships (PPP) in Ethiopia and globally, offering models and recommendations for improved health outcomes.

Resource Utilization

Ethiopian data from the prior 6 years was analyzed to quantify the utilization of the government budget. The findings showed potential capacity and efficiency issues since the recurrent budget (e.g. salaries, drugs, medical supplies, facility running costs) was utilized at a rate of 95%, while the capital (e.g. infrastructure, capital medical equipment procurement) budget was utilized at a lower rate of 75%. Budget utilization also varied across primary health care facilities between 51% to 104%.

Resource Productivity

  • Analyzed facility-level resource efficiency using findings from the public health care costing study, identifying cost discrepancies in hospitals and health centers.
  • Estimated potential savings of millions of birrs if inefficient facilities matched the efficiency of top-performing ones.
  • Found significant correlations between financial/physical inputs and outputs in efficient health service production.
  • Studied the productivity and challenges of health extension workers in rural and urban areas.

Resource Targeting

As part of the HCFS review, the team undertook an assessment to analyze the targeting of the fee waiver program, which found the program to be performing poorly except in Amhara region. The team continued to work closely with the Financing and Resource Mobilization Directorate at MOH to develop a benefit-incidence analysis combining evidence from household surveys, public expenditure analysis in Ethiopia’s NHAs, and costing study results.