In the landscape of health service delivery, the management of public finances plays a crucial role. It is the invisible pipeline that ensures that resources flow to finance services, so communities and citizens receive the care they need.   

The efficiency and effectiveness of the provision of services depend on the well-functioning of the pipes' framework that is supposed and expected to remain invisible. Indeed, as one expects to have water when one turns the tap, one does not want to see the pipes that bring water into one's house.  

The PFM4SD (Public Financial Management for Service Delivery) project financed by the Government of Flanders has this declared objective enshrined in its name. The implementation of the Public Expenditure and Financial Accountability (PEFA) 2020 and its Action Plan was one of the means to achieve its objective.  

Starting the Race: A Journey of Adaptation 

 Like any journey, ours has been filled with challenges along the way. Conducting the PEFA evaluation during the COVID-19 pandemic and the restrictions to gathering, posed logistical hurdles.   But this wasn't exactly journey. Rather a relay race with obstacles that demanded strength, stamina, adaptability and the end of a phase marks the beginning of a new one. Passing along the baston. Come with us as we unveil each step of the race.  

The project played along with the hurdles and was able to transform them into opportunities that multiplied the visibility and the impact of the assessment:  

• The final launching seminar was postponed because of COVID. What looked like a delay, become a lift from a powerful car. The PEFA Health was launched together with the National PEFA, with a larger audience and a broader forum that could look at PFM both from the point of view of the institution that has to keep the revenues and expenditures in equilibrium – the Ministry of Economy and Finance – and a sector that must provide services and therefore requires resources at the right time.  

• The resources saved from the last seminar were used to elaborate an Action Plan to address the identified weaknesses. This was functional to pass the baton to government for tackling the system weaknesses and sitting on the bench for coaching. 

Overcoming obstacles 

The implementation of the PEFA evaluation and of the Action Plan represented more than just a checklist of tasks — it was an opportunity to invest in the capacity of personnel within the health sector.  The project from the bench kept its commitment to support the team.

Through targeted training programs and knowledge transfer initiatives, we mobilised our expertise and resources to empower technicians with the skills and knowledge necessary to drive sustainable change. One of our key achievements has been the implementation of technical improvements aimed at addressing longstanding inefficiencies within the sector. By focusing on capacity-development initiatives, we have contributed to the training of local technicians to analyse public financial management processes independently, fostering a culture of self-reliance and ownership.  

Passing the Baton: A Vision for Tomorrow 

Just like in a relay race, every end is followed by another start. Despite the progress made, challenges and opportunities for improvement remain. The implementing reforms and fostering behavioural change to improve the quality of public service – healthcare services for what we are concerned in this case - requires consistency as well as the capacity to identify and transform in opportunities that situation generates, without limiting the scope of its action to preset targets.   

Issues such as closing bank accounts outside the Single Treasury Account – (Conta Única do Tesouro - CUT) and settling overdue expenses stand out as areas that need continued attention and redoubled efforts. In addition, the need for capacity building and institutional strengthening remains pressing, especially regarding the planning and budgeting subsystem and investment and infrastructure management.   

Looking ahead, we envision a future where our assistance becomes obsolete, where our partners gain independence in identifying and resolving issues. We aim to pass the baton, disappearing like salt in water, leaving behind a legacy of strengthened capacity and empowered institutions.  

As we prepare for the next phase, we remain steadfast in our commitment to overcoming roadblocks and fostering effective policy-based budgeting. Our goal is clear: to ensure that resource management continuously enhances service delivery, paving the way for a healthier and more prosperous Mozambique.  

The Government will now use the resources from the Global fund to finance the new PEFA. The current thinking is that the evaluation will be done by the personnel of the sector. The external capacity will be responsible for training the people, oversee the entire process and guarantee the quality of evaluation. The project will be sitting on the bench coaching the people that take responsibility for the process.