Public expenditure tracking survey in health : a case study of Kabul National Hospitals

Abstract

Public Expenditure Tracking Survey is a tool which tracks the government budget from the original to the frontline it is used in small scale of hospital levels. The study analyses the linkage between public spending and development outcomes and finally identifies the factors responsible for the emergence of inefficiencies in the system. The budget of Kabul National Hospitals and a sample of two big complex and specialty hospitals in Kabul (Malalai Maternity hospital and Indira Gandhi Pediatric Hospital) are considered for the Solar year 1390 (March2012-March 2012). The study consists of both a quantitative and a qualitative (In-Depth interview). The quantitative part include data from the central budget allocation in 1390 year, data on the materials and equipment procured and submitted to the hospitals from Central Stock and finally data from the hospitals. The qualitative part consists of interviews from the relevant stakeholders including the Ministry of Finance, Ministry of Public Health and different directorates, hospitals and finally health beneficiaries. The study found a substantial delay In process of materials procurement and supply for the hospital, in solar year 1390 the system was centralized and the budget was delayed by more than a year (i.e, 378 days) counting from the start of the budget process until the end of the budget approval by the cabinet and by the parliament. Hospital requirement materials and items in the Central Stock took an average of 145 days to be purchased and reserved. Then the receipt of the hospitals requirements (i.e. items /materials) from the Central Stock took an average of 15-20 more days and often requested materials were not available in the stock. The value of money affected by delay in Real Term is $ 30,477 and finally the problem was identified from the central level of MoPH specifically at the procurement department. As with all the process and decisions were taken centrally, it is recommended that the hospitals has full autonomy with the capacity building of staff involved in financial management system of hospitals and it is recommended that the bureaucratic procedures at all levels of involvement be reduced.