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Table 1 Challenges faced in collecting data on reproductive health financing in sub-Saharan African countries

From: Challenges associated with tracking resources allocation for reproductive health in sub-Saharan African countries: the UNFPA/NIDI resource flows project experience

Country Limitations/Challenges
Country – West Africa • Underestimation of public expenditures (exemptions and personnel costs are not sufficiently taken into account).
• Households’ expenditures occupy a significant portion of health expenditures that are not considered by organizations while filling out the questionnaires.
• Political instability: the period for the data collection coincided with the Burkina political instability. Many employers have been affected by the events of 30 October 2014 and could not be investigated. Some business leaders and NGOs have still not been found due of these events. Moreover, the late transmission of information by certain structures has been a common/persistent issue.
Country – East Africa • Reluctance to provide data, especially by government departments.
• Delay by NGOs in completing the questionnaires.
Country- Central Africa • Plurality of persons involved in the filling of questionnaires: projects and programs for population activities and/or family planning are usually managed by several people; the person responsible for completing the questionnaires does not always have all the necessary information and is forced to appeal to the leaders of projects and programs, who are in turn often not available.
Country- Central Africa • Reluctance of some NGOs to provide the requested information.
• Incomplete questionnaires returned by some NGOs.
Country- Central Africa • Unavailability of data in the form requested due to the lack of organization/documentation of statistical information in the various public and private administrations.
• Budgets are often developed in a comprehensive manner and the disaggregation into specific components of population activities is not easy.
• Unavailability of technical expertise to help disaggregate data, leading to non-responses.
Country- Southern Africa • Accuracy of data: In the case of government budgets and expenditures, it was difficult to disaggregate and differentiate the components of the ‘costed package’ from all other areas of population and development spending. Estimates had to be provided because relevant population activities are commonly integrated within general development projects, and amounts are given as huge lump sums.
• Financial reporting systems: Various institutions have different financial reporting systems, which makes it difficult to provide data in the format required by the survey.
• Non response: Obvious reluctance by some government ministries to provide data mainly because of the challenge regarding categorization of budgets. Furthermore, the fact that the survey required giving definite amounts, including those specific for projects, posed a great challenge. In most institutions, employees responsible for project management of population activities are not well informed of the allocation of funds that go hand-in-hand with their projects. As such, questionnaires required staff from both the accounts and the project/programme departments to work together in providing the information. This alone took more time, and both parties showed lack of commitment in filling in the questionnaire.
Country- Southern Africa • There are no benchmarked funds for various population activities and money disbursed is put in one basket.
• State budget is not disaggregated by types of activity and this makes estimation of domestic resources for population activities difficult.
Country- Southern Africa • Categorizations of expenditure within health include women and children at the lowest level. Expenditure is also recorded for strategic objectives, of which population activities are equally distributed across the board. Within the strategic objectives, sub-programmes do not have earmarked funds.
• Current financial tracking data that exists within the health sector is very poor. It is possible to identify the total funding that goes to various provinces and districts, but disaggregating this within the programme area is not possible for maternal and reproductive health. Current accounting systems within the Department of Health classify spending within the broader category of Maternal, Child and Women’s health.
• The focus of spending has also shifted to more integrated systems, which makes it harder to track individual spending. Spending for activities come from various funding streams. Within hospitals, the hospitals are funded as a whole and individuals spread their time across sectors, hence an analysis of expenditure at health care level was not feasible. In order to accurately determine spending at this level a time-motion study would be required.
• Population and research expenditure falls across a number of government bodies and the source of these funds, while mostly domestic, are from various streams. Hence, it is difficult to track expenditure.
Country- Eastern Africa • Non-cooperative respondents/institutions even after several call-backs.
• Inconsistencies in the data provided. Some institutions provided figures for similar reference years with different data.