By: Jesse Waterschoot and Damiano Stella, Enabel Mozambique

The Public Expenditure and Financial Accountability (PEFA) assessment of the Mozambican health sector was launched in March 2020 with a seminar. Since then, the consultants have gathered the necessary documentation for conducting their analysis and scoring the indicators.

In brief, a PEFA is an evaluation of the Public Financial Management of a country or a sector. The objective of the current assessment is to obtain a diagnosis of the progress made by the Health Sector in Mozambique, by collecting and analyzing the data available between the period 2016-2018 and relevant elements of the year 2019. This evaluation will be the 3rd PEFA assessment of the Health Sector. A PEFA has 7 pillars, measured by several indicators. These indicators consist of one or more sub-indicators or dimensions. Those dimensions get a score, ranging from A (best practices) to D (worst practices). The score of an indicator is constituted by its different dimensions, either through their average, or the score of the lowest indicator.  For more information about the methodology of a PEFA and the reason that lead to the decision to conduct a PEFA evaluation for Health Sector in Mozambique, see the following link: https://open.enabel.be/en/MOZ/2234/1028/u/pefa-2019-seminar-assessment-launch-and-workshop-on-mozambique-s-health-sector.html

The consultants decided to use 23 indicators, the relevant ones for the sector. The field visits to the provinces of Sofala and Nampula were cancelled due to the Covid-19 circumstances and only one field visit to Gaza province took place. However, contacts and interviews were done remotely, so this had limited to no impact on the PEFA’s quality and content. Initially, the consultants conducted interviews with the different sector institutions and collected evidence for the evaluation. After that process, they gathered information from other relevant institutions, such the Ministry of Economy and Finance (MEF).

Seminars are another important part of a PEFA evaluation. These are used to inform the relevant partners and familiarize them with the PEFA methodology as well as for confirming the information shared, the interpretation of the data and consequent scoring given to each dimension. In light of this, two seminars already took place; firstly, the PEFA launching seminar was held in March 2020 followed by the Technical Level Validation Seminar held on the 1st of October 2020. During the second seminar that took place in October 2020, the PEFA consultants presented a preliminary scoring report for discussion on the findings. The team leader, Andrew Lawson, could not be present due to the Covid-19 circumstances. The two locally based consultants, Mariam Umarji and Thomas Selemane, explained the relevance of the indicator to a sector analysis, followed by the reason of the scoring.

In general, the Mozambican Health sector preliminary scores are low on the pillar of Budget Credibility (mostly D), Transparency of Public Finance (Mostly C and D) and Predictability and Control of the Budget Execution (Mostly C), but has good practices for the Budget Preparation Process (A) and Budget Classifications (B) [1]. An important note is that a PEFA review cannot be given one single score. The scores are an assessment of the distinctive pillars and dimensions and should not be summed up.

After the overview on indicators, the focus of the seminar shifted towards the next steps. The PEFA scores are useful to gauge of the sector’s PFM system is working and it can signal the areas where reforms are needed. Therefore, the partners and consultants held a discussion on how these scorings can be improved, and which areas in the sector need to be improved. They identified ten PFM areas under the direct control of the Health sector that can be improved in the medium-term:  (i) Internal Revenue, (ii) Management Accounts, (iii) Planning, (iv) Decision making process for Investments in Infrastructures, (v) SPO (Planning and Budgeting subsystem), (vi) Directorate of Planning and Cooperation, its organization and quality of the budget, (vii) Functional Classification and Service Delivery,  (viii) Aid in-kind (ix) Decentralization, and (x) Transparency. The partners will provide their comments and additional documents on this preliminary PEFA, after which the final report will be concluded.

 [1] At the moment, no more details on the scoring can be given. The final scoring will be published when the report is finished.