The Expenditure Management Information System: Moving Toward Greater Transparency, Improved Planning, and Harmonized Reporting

The EMIS collects contract, budget, and expenditure information on the health sector in a Microsoft Access database, producing financial reports for the Ministry of Public Health (MoPH) and donors as necessary. The EMIS was developed in response to several MoPH data and system needs. One of the primary drivers was the need for systematic data collection for the National Health Accounts (NHA), an internationally recognized framework for measuring health expenditures. The first NHA in Afghanistan was produced in 2009/2008, resulting in crucial health finance information that motivated nationwide discussion in the Parliament, among donors, and at line ministries. The NHA has been recognized as an important tool for health managers and policymakers, and a more cost-efficient and effective approach to collecting necessary financial and expenditure data is essential. Another key driver for the EMIS was the need for evidence-based planning and decision making with the availability of advanced economic analyses. Experiences with the NHA taught the MoPH that expenditure data vary in quality and are presented as aggregates, making it difficult to conduct the necessary financial and economic analyses. Routine data collection would ensure high-quality data that are verifiable, consistent, and at the level needed for analyses to inform policy, planning, and decision making at the central level. The EMIS also aims to address the need for harmonized financial reporting across health programs. An assessment of the financial management capabilities of NGOs conducted in early 2011 found that health program implementers such as NGOs and line ministries had difficulty complying with various financial reporting requirements and for the NHA, when requested. The report recommended collecting financial information at the clinic level and creating a software solution to harmonize financial reporting. Furthermore, the EMIS aims to improve transparency and accountability in the health sector by providing policymakers with evidence-based decisions by looking critically at inputs with outputs. The EMIS will also facilitate linkages of financial inputs with health outputs, enabling the MoPH to make critical decisions for improving the efficiency of health service delivery. Understanding the cost per outpatient visit or the cost per antenatal care visit at the facility level is essential for such decision making. The initial use of the EMIS will be at the BPHS and EPHS implementation level, with plans for expansion to all implementers in the health sector, including NGOs, line ministries, and international partners. A system for data entry, reporting, and feedback has been developed and will evolve to meet users' needs over time. The EMIS is not itself a financial management system or decisionmaker, but rather a tool to support decision making and planning. Progress in EMIS implementation has been made, including the completion of a pilot among NGOs, the official launch by the MoPH, training workshops for implementing partners and stakeholders, and the use of EMIS among NGO implementing partners. Plans have also been developed for enhancement to a web-based platform, with offline functionality intact, and the development of the EMIS web-based platform is expected to be complete at the end of 2014. Continued commitment and support from stakeholders are needed to ensure the sustainability of the EMIS. Specific recommendations include developing and approving EMIS policy, continuing sensitization workshops and conducting routine EMIS coordination/working group meetings with stakeholders, and supporting the long-term institutionalization of the EMIS by including it in MoPH contracts and advocating for donor and government commitments to finance the expansion of the system.