Health financing

Transition to programme budgeting in health in Burkina Faso: status of the reform and preliminary lessons for health financing

Hélène Barroy, Françoise André, Abdoulaye Nitiema

Publication details

Editors: World Health Organization
Number of pages: 48
Publication date: 2018
Languages: English, French
WHO reference number: WHO/UHC/HGF/HEF/CaseStudy/18.11


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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 Burkina Faso from a health financing perspective. It documents the budget reform process and analyses the effects of these reforms for the health sector, making recommendations on addressing the remaining challenges.

Since the end of the 1990s, Burkina Faso (a French-speaking West African country) has initiated profound reforms relating to the management of public finances, in line with regulations set by the West African Economic and Monetary Union (WAEMU). One flagship measure within this reform was the introduction of a programme budget, marking a shift away from a purely input based budget. Institutionalizing this reform in Burkina Faso took twenty years, with the adoption by Parliament in 2017 of a budget presented using a programme based approach - the first in the WAEMU region. The Ministry of Health was one of the first ministries to engage in and institutionalization this reform, by consolidating a budget around three major budget programmes that aligned with the National Health Plan (the Plan National de Développement Sanitaire (PNDS)). Burkina Faso‘s shift to a programme budget for health offers interesting lessons for other countries engaged in similar reforms.

While Burkina Faso is advanced in budget programme implementation, particularly in the health sector, some challenges remain. In 2018, the Ministry of Health rightly initiated a review of the content and contours of two main budget programmes, to bring them into line with the department’s new strategic directions and improve their overall quality. Defining a more relevant performance-monitoring framework is a key aspect to be strengthened. In parallel, building the capacity of newly appointed Programme Directors and their teams will be essential to ensure better defined programme budgets, and thus coherence in their implementation. Strengthening the links between budget reforms and priorities under the health financing strategy, notably the creation of the Health Insurance Scheme (RAMU), also requires close monitoring by decision-makers to ensure coherence and coordination.

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