How to (or not to) . . . measure performance against the Abuja target for public health expenditure
Citation
Witter, S., Jones, A. & Ensor, T. (2013-06) How to (or not to) . . . measure performance
against the Abuja target for public health
expenditure, Health policy and planning, pp. 01-Jun.
Abstract
In 2001, African heads of state committed 'to set a target of allocating at least 15% of
our annual budget to the improvement of the health sector'. This target has since
been used as a benchmark to hold governments accountable. However, it was never
followed by a set of guidelines as to how it should be measured in practice. This
article sets out some of the areas of ambiguity and argues for an interpretation
which focuses on actual expenditure, rather than budgets (which are theoretical),
and which captures areas of spending that are subject to government discretion.
These are largely domestic sources, but include budget support, which is externally
derived but subject to Ministry of Finance sectoral allocation. Theoretical and
practical arguments in favour of this recommendation are recommended using a
case study from Sierra Leone. It is recommended that all discretionary spending by
government is included in the numerator and denominator when calculating
performance against the target, including spending by all ministries on health,
social health insurance payments, debt relief funds and budget support. Conversely,
all forms of private payment and earmarked aid should be excluded. The authors
argue that the target, while an important vehicle for tracking political commitment
to the sector, should be assessed intelligently by governments, which have
legitimate wider public finance objectives of maximizing overall social returns, and
should be complemented by a wider range of indicators, to avoid distortions.