This document details a TA effort in Mozambique with the objective of establishing a health budget and allocation process. The Health Care Financing and Sustainability (HFS) Project worked with the Ministry of Health (MOH) and USAID/Maputo”s Office of Health to outline processes for correcting health financing problems. Based on this effort, this paper details expenditures on health by the Government of Mozambique (GOM) and donors, current MOH budgeting and planning procedures, and existing financial information systems. In a recently completed post-war plan analyzing Mozambique”s health financing situation, it was found that, compared with other sub-Saharan African countries, Mozambique had relatively low per capita spending on health, a relatively small percentage of government spending, and a high percentage of spending from donors. Funds are unevenly allocated to health facilities, with about 60% of combined donor and GOM capital directed to high-level facilities, such as central hospitals, while lower level facilities, such as rural hospitals, receive about 40%. In addition, some provinces are economically favored. MOH budgeting is plagued by related activities that run independent of each other. Resources for health programs are not defined, and health expenditure programs are not properly monitored or evaluated. Budgeting is not conducted by the same sources that develop health programs. To correct these imbalances, the MOH has created a plan that will gradually lessen dependence on external donors and re-allocate existing resources to develop primary and secondary care services. In addition, this report recommends installation of a financial management information system and training of MOH personnel in accounting and financial management systems. (Author abstract)
