Emergencies preparedness, response

Health financing

Ebola: Health services recovery

Health financing policy focuses on mobilizing and pooling financial resources and allocating them to health care providers in an equitable and efficient way.

Ebola in Guinea: Marie-Claire Fwelo-Mwanza, a social mobilization expert from WHO, speaks to students about Ebola messages.
WHO/P. Haughton

Health financing policy focuses on mobilizing and pooling financial resources and allocating them to health care providers (purchasing) in an equitable and efficient way. This will enable provision of essential health services of good quality to all, especially to the poorer communities, and in populations in rural areas.

In the context of post-Ebola health systems recovery, the national health financing policies and strategies need to be refocused and operationalized in order to effectively contribute to the revitalization of district health systems, while following these guiding principles.

Revenue collection

The share of out-of-pocket expenditure in total health expenditure needs to be substantially reduced in the 3 Ebola-affected countries as they create a financial burden (in the form of catastrophic and impoverishing expenditure), resulting in people foregoing care. Moreover, the out-of-pocket expenditure cannot be considered as a reliable source of funding to build a resilient service delivery systems.

Revenues should come from prepaid sources, the main source being the budget, with the potential addition of donor funds. The latter should seek alignment with or integration within country funding mechanisms.


Separate schemes for formal sector employees must be avoided. They have a strong fragmenting and distorting effect, they contribute to unequal access to health services, which would be difficult to overcome at a later stage. It is therefore essential that the extension of coverage benefits all population groups.

Community based health insurance is not a solution either for increasing financial protection of the population or for generating more financial resources to develop essential health services. On the other hand, strengthening community involvement in the management and quality control of district health systems is a different and separate issue.


Purchasing mechanisms are essential to channel funds where they are needed, incentivize providers for quality and efficiency and to ensure equity across the whole country. For instance, performance-based or results-based financing is one option, especially when coupled with free health-care policies (gratuités). Per-capita funding can also effectively contribute to the development of primary health care in areas that are currently underserved.

Public finance management

Public finance management rules have limitations in effectively channeling funds to pay providers (low budget execution rates, late disbursement, etc.). Shifting to output-based budgeting is one option to accompany enhanced service delivery availability and health financing reforms.

Coverage of the informal sector and poor population groups

One immediate way to enhance coverage is to focus on funding free health care policies (or gratuités, i.e. specific services for all or for specific population groups), that is eventually expanded to a more comprehensive package.

Any discussions on health insurance needs to be based on a universalist approach from the start. This avoids a narrow focus on formal sector employees and instead requires the state budget to be considered as a means to fully or partially subsidize the enrollment of those outside the formal sector. This is particularly true for the poor as well as for other vulnerable population groups. This requires building strong institutional capacity.