Health financing

Budget structure in health and transition to programme budgeting: lessons from Armenia

Elina Dale, Artak Kyurumyan, Samvel Kharazyan, Hélène Barroy

Publication details

Editors: World Health Organization
Number of pages: 31
Publication date: 2018
Languages: English, Russian
WHO reference number: WHO/UHC/HGF/HEF/CaseStudy/18.12


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Public funds are essential for making progress towards universal health coverage (UHC). No country has made significant progress towards UHC without relying on a dominant share of public funds in financing health. It is increasingly understood that the quality of budgeting in health is key to support progress towards UHC. Specifically, budget formulation, i.e. the way budget allocations are presented, organized and classified in budget laws- has a direct impact on spending and ultimately the performance of the sector. Several countries have modified the way budgets are formulated and executed to enable better alignment with sector priorities. However, all face challenges in this transition process, including issues related to programme definition and performance measurement framework.

Motivated by this experience, WHO’s Department of Health Systems Governance and Financing is providing support to Ministries of Health in this transition process, with the following aims: 1) building the knowledge base on good practices in health budget reforms, including the development of an online health budget portal and country case studies; 2) providing technical support and guidance to countries transitioning to programme budgeting in health; 3) capacity development at global and country level. By documenting country experience of budget reforms in the health sector, lessons can be drawn and shared with other countries.

This is the first report to look at budgeting reforms and budget structure in Armenia from a health financing perspective. It documents the budget reform process, including motivation for reforms and the key actors, with a focus on the role of the Ministry of Health. The effects of reforms for the health sector are analysed, and recommendations made on how to improve the existing programme budget structure to ensure it realizes its full potential.

Armenia has been implementing budget reforms since the late 1990s, and emerging evidence indicates that the country has made visible progress in the shift to programme-based budgeting in health. At the same time the effects of these reforms have been limited because of:

  • unclear links between policy priorities as expressed in strategic policy documents and budgetary programmes
  • a weak performance measurement framework
  • continued approval of the budget at a detailed activity level
  • weak role of programme managers

The report recommends measure to address these remaining weaknesses to ensure that Armenia’s budget enables real progress towards universal health coverage.

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