The Health Sector Pool Fund under the direction and leadership of the Pool Fund Steering Committee chaired by the Minister of Health and Social Welfare continues to provide oversight and decision making for the use of the funds provided by donors to support the National Health Plan. The direction for the use of the funds follows the objectives for which the fund was established in 2008.
The objective of the pool fund is three –fold:
- To help finance priority unfunded needs within the NHP
- To increase the leadership of MOH in the allocation of sector resources
- To reduce the transaction costs associated with managing multiple projects from different donors.
Since the establishment of the Health Sector Pool Fund in 2008, the pool fund have received over $ 70 million8 in contribution of which 99 % has been committed to the unfunded priorities of the National Health Plan and 89% has been spent. Due to the continued commitment by donors to using this mechanism, the Government of Liberia has identified the pool fund as a key feature of the National Health and Social Welfare Financing Policy and Plan.
The current Donors to the Pool Fund are: Irish Aid, Department for International Development (DFID), Swiss Agency for Cooperation and Development (SDC), AgenceFrancaise de Development (AFD) and UNICEF.
The Health Sector Pool Fund has received a total of US $ 6,502,521 for 2014(inclusive of bank interest), which cuts across two fiscal periods (FY 2013-2014 & 2014-2015) received at different times in the year. The highest contribution during this year was received in December 2014.
On average the Pool Fund annual expenditure ranges between US $ 11-12 million. The development of the Annual Strategic priorities and Plan for FY 2014-2015 was done based on the changes in the funding situation, experiences in implementation from the previous year and assumption of expected contribution for FY 2014-2015 from a few donors.
January – December 2014: Currently there is additional commitment of US $ 6,868,703 million made by contributing donors for FY 2014-2015. This includes US $ 1,578,947 committed by the SDC, US $ 4,289,756 by DFID and US $ 1,000,000 by AFD for this fiscal year (July 2014- June 2015).
Strategic Priorities for FY 2013- 2014, (2014-2015) January – December 2014
The health sector pool fund within this year have supported the implementation of the National Health Plan based on strategic priorities identified and proposal developed and submitted to the Pool Fund Steering Committee for approval.
In the 1st six months of this year, support was provided to the Central MOHSW Support system and the CHSWTs in 10 counties and the 2nd half of the year support covered critical areas to complement the GOL allotment for the counties and continued central level support.
I. January – June 2014 (FY 2013-2014)
This period focused on support to the central level MOHSW support systems (Office of Financial Management, Internal Audit and Compliance, County Health Services, Monitoring and Evaluation and External Aid units/departments) the implementation of the risk management project, supervision and monitoring, training and capacity building in financial management for county level personnel and county level support focusing on personnel, performance based financing bonuses, goods and services inclusive of drugs and medical supplies , operational funds for the counties , capital cost and overall support to the Pool Fund Management firm which cuts- across both periods. Contracting –In with the CHTs and Contracting –Out with NGOs was still ongoing for this period.
II. JULY – DECEMBER 2014 (FY 2014-2015)
At the start of FY 2014-2015, there was a shift in the annual priorities funds and mechanism for funds counties activities. The last 2 NGOs (MERCI and AHA) funded through Pool Fund contracts ended and were not renewed due to funding situation. A non- cost extension was given for all projects up to September 2014 for the completion of activities and easy transition to the CHTs.
In July 2014, the Pool Fund Steering Committee approved the pool fund’s Annual Plan of Strategic Funding Priorities for 2014-2015. The budget accompanying the annual plan was US $8.3 million allocated across four investment areas: human resources (63%), essential medicines, (29%) risk management (7%), and pool fund administration (1%)9. Based upon a recommendation by the Pool Fund Steering Committee to increase the proportion of the annual pool fund budget allocated to risk management, the MOHSW submitted a revised budget that was approved by the committee in October 2014, in the amount of US $8.8 million, out of US $9.2 million in total funds available for fiscal year 2014-2015.
- HUMAN RESOURCES: This covers Incentive payment for health workers and CHSWTs as well as key support system staffs at central MOHSW at an estimated cost at about of US $ 5,6 million for this fiscal year. Incentives are being paid for CHSWT & Health workers at 10 counties (2709) and Support system (48). This covers about 26% of the estimated 10,767 staff in the health workforce paid through the pool funds.
- ESSENTIAL DRUGS AND MEDICAL SUPPLIES An amount of US $ 2.6 million was allocated for the procurement of essential medicines, supplies, basic equipment, Laboratory reagents/supplies and administrative and logistical funds for NDS which includes of storage at NDS warehousing facilities, distribution of pharmaceuticals and supplies, monitoring/inventory control, and reporting on the use of commodities. This underpins the delivery of the EPHS as a complement to drugs and medical supplies procured by the GoL (estimated US $ 3.7 million) and other donor sources .The amount allocated is usually insufficient to cover the actual drugs and medical supplies needs annually. Currently there are about US $ 1.8 million essential drugs and medical supplies procured through Mission Pharma being delivered from previous year’s allocation.
- RISK MANAGEMENT AND MITIGATION: There are two primary types of risk to be considered and addressed with relation to the HSPF: programmatic and fiduciary. The current pool fund allocation for risk management activities supports the overall MOH fiduciary risk management plan. This is very essential to ensure the right systems are in place for the management of funds provided to the counties, at central level and that they used for the intended purpose.
The key areas/activities being supported are:
- Independent Annual Audit
- Regional Auditors support to counties
- Integrated supervision and monitoring visits
- Independent project evaluation
- OFM, Internal Audit and Compliance support
- Monitoring and Evaluation support
- POOL FUND ADMINISTRATION: The HSPF management firm continues to have two principle responsibilities: 1) management of the pool fund mechanism, and 2) management and control of the fiduciary risk associated with use of the pool fund. PF administrative cost for fund management is covered by the Pool Fund .The PFMF will continue to efficiently and effectively manage the pool fund mechanism and control fiduciary risk associated with the fund. Performance Assessments is conducted periodically by a team of representatives from the Pool Fund Steering committee and the MOH to assess the Management firm based on the Terms of Reference for Fund Management. In this period an assessment was conducted between May – June 2014 with final results discussed with the Management firm and presented at the July 3rd Pool Fund steering committee meeting .The overall results of the assessment was satisfactory with a few areas indicated for improvement. The PF management firm contract, which ends on March 6, 2015, was extended for a period of 1 year ending March 6, 2016. The current Management firm (Hughes Development Inc.) have served as fund management firm since November 2012.
- Human resources: Payment of Incentives for health workers, CHT and support staffs at the central level remains the highest proportion of the annual PF budget for this year and has been a crucial unfunded gap covered under the PF. This has contributed to having health workers at health facilities in remote areas in the counties, as this has been the only source of income for those who are not on GoL payroll. A total of 2755 staffs (Health workers -95%, CHT staffs -4% and Support system -2% have been paid for this period.
- Joint Monitoring visits: the M&E team along with staffs visited all counties from other departments including the PF secretariat team. Out of the counties supported by the PF, 9 out of 10 10counties were visited with 48 out of 144 (33%) pool fund supported health facilities covered during monitoring visits. Additional counties were visited to support the payment of Health care workers in the response, review of financial management issues.
- Essential Drugs and Medical supplies: Out of over US $2.2 million essential drugs and medical supplies funded through the Pool Fund and managed by NDS, US $ 1.4 million were distributed across the 15 counties.
- Payment of PBF bonuses: In addition to incentives paid to the staffs in 8/10 PF supported counties, PBF bonuses in an amount of US $130,721 earned bonuses were also paid for 4 quarters (2 in this period) prior to the shift in the annual priorities for FY 2014-2015.
1. Risk Management: The following were some activities completed under the risk management project
- Recruitment and deployment of regional auditor to support the CHSWTs
- Training on the Electronic financial management system for CHT staffs (136) and follow-up
- Follow-up of audit recommendations
- Procurement review at the county level
- Field Audits at the county level
- Annual pool fund Audit
- Fiduciary risk assessment
- Capacity building plan developed
2. Pool Fund Administration
- The recruitment of a national Fund manager as part of the transitional plan for future handover of Fund management role to the MOH
- Organized four successful (March 6th, July 3rd, October 28 and December 11, 2014) Pool Fund Steering committee meetings with prepared packages with relevant documents, circulated as per schedule, documented all resolutions passed and minutes of all meetings.
- PFMF provided technical support and secretariat services for the MOH in the development of the Annual strategic priorities proposals, as well as other key activities lead by the MOH.
- Production of monthly financial updates, quarterly and annual reports as well as presentation on the HSFP at forums.
- Support in the management, coordination and response to the health workers strike and Ebola response
- PF manager was seconded to serve as the Deputy Incident Manager to support the Ebola Response.