10th EDF Multi-Sectoral General Budget Support Programme

Health Sector

The Dominica 2010-2019 Strategic Plan for Health includes high perinatal mortality rates as one of the major challenges in Dominica. The Government's objective is to reduce the perinatal mortality rate to 10 per 1000 births by the end of 2019. Current scientific knowledge shows that neonatal deaths and stillbirths stem from poor maternal health, inadequate care during pregnancy, inappropriate management of complications during pregnancy, delivery and the first critical hours after birth, as well as weaknesses in newborn care. Therefore, interventions to reduce perinatal mortality should target the maternal (pregnancy, labour and delivery and post partum) and neonatal periods.

A consultancy mission was therefore initiated and funded by the EU to provide technical support for the designing of an evidence-based, integrated and context specific support framework, supported by a sustainable data collection and information management system.

That is:

  • Provide recommendations for a sustainable intervention programme to reduce the IMR from 29.9 per 1000 to 10 per 1000 by the end of 2019 in keeping with objectives for reducing infant mortality stated in the National Strategic Plan for Health 2010-2019.
  • Develop an Action Plan for implementation of the programme with a time schedule and annual SMART Indicators. Propose two most relevant indicators for the needs of variable tranche under the 10th EDF Multi-sector Budget Support Programme.
  • Provide recommendations for implementation of comprehensive perinatal and neonatal databases, and
  • Provide recommendations for the resources required for implementation of the Intervention Programme and the Comprehensive Databases.

Coming out of this mission, the variable tranche indicators for the 10th EDF were also finalised and accepted by the EU Delegation, as follows:

  • Indicator #1: Review/update of MCH Manual to be in line with WHO/PAHO standards.
  • Indicator #2: Number of Neonatal deaths due to sepsis.

The Office of the NAO plays a monitoring role in this intervention as it relates to the implementation of the Action Plan to Reduce Infant Mortality.

Public Finance Management

The EU Delegation financed a first Public Expenditure and Financial (PEFA) Accountability assessment in Dominica in 2007. This first assessment showed a rather positive framework in the country. The main strengths included the credibility and comprehensiveness of the budgetary process, predictability and control in budget execution and in quality and timeliness of in year budget reports and financial statements. The weaknesses identified were related to the transparency of PFM systems. Specifically, to the oversight of fiscal risk from public sector entities, weak procurement systems, internal and external audit.

A repeated PEFA exercise was launched in March, 2010, lasting for approximately five months. The exercise was taken very seriously by the authorities, with a high level of representation at both the introductory and closing workshop of the PEFA process. The PEFA process went relatively smoothly with good cooperation from the relevant stakeholders and other donors. As a result the report was very thorough, and considered satisfactory by the authorities.

As a result and fostered by the PEFA 2010 assessment findings, the Government developed a three-year PFM Reform Action Plan with the technical support of CARTAC. The plan was formally approved by the Government in January 2011. It assigns level of priority to actions, identifies the agency responsible for implementing the actions, defines key performance indicators, establishes timelines, identifies possible sources of donor support, and its cost. The Plan proposes improvements not only in areas of clear weakness but also improvements to aspects that scored favourably in the assessment. Some of the improvements require minor adjustments to processes and procedures and making greater use of existing systems. Major initiatives include creation of a large and medium taxpayer unit, development of a cash flow forecasting model, the enactment of modern procurement and contract administration legislation, creation of a central internal audit committee, and formulation of rules for in-year amendments to the budget. Therefore, it can be said that the framework represents a major improvement in relation to previous PFM Plan. The timetable seems also to be rather objective assuming that several of the targets are currently under execution. Overall, the PFM Action Plan is considered a relevant and credible framework.

One of the general conditions for the disbursement of 10th EDF resources is an updated PFM Action Plan. The Office of the NAO, in collaboration with the PFM Focal Point and other Heads of Department of the Ministry of Finance, has been engaged in the continuous updating of the Action Plan in order to efficiently track the Government’s progress with reference to the following key PFM areas:

  • Credibility of the budget
  • Comprehensiveness and transparency
  • Policy-based budgeting
  • Predictability and control in budget execution
  • Accounting, recording and reporting
  • External scrutiny and audit