Health financing

Leveraging public financial management for better health in Africa: key bottlenecks and opportunities for reform

Helene Barroy, Grace Kabaniha, Chantelle Boudreaux, Tim Cammack, Nick Bain

Publication details

Editors: World Health Organization
Number of pages: 57
Publication date: 2019
Languages: English
WHO reference number: WHO/UHC/HGF/HFWorkingPaper/19.2


Why PFM matters for health?

Public financial management is at the core of UHC. A robust PFM system is integral to enabling progress towards UHC. Subject to a country’s available resources, this involves optimising not just how public funds for health are raised, but also how they are allocated, managed, and accounted for throughout the PFM system. Core PFM requirements include having reliable budgets that are aligned with sector needs, executed according to plans in a flexible manner, and transparently accounted for. The health financing reforms initiated in many African countries since the mid-2000s have revitalised interest in PFM for the sector. By placing public funds at the core of health financing, the move towards UHC has transformed PFM into a central issue for sector results in the African region.

What can health ministries do to accelerate PFM reform in health?

After taking stock of PFM reform progress for health in a number of countries, the report offers a PFM action framework for health ministries. To accelerate PFM reform implementation in health, this report suggests three distinct areas of engagement for health ministries:

  • Be actively aware and up to date on general PFM reforms, for example monitoring the implementation of multi-year budgeting approaches that can increase predictability in health financing
  • Contribute to designing and implementing PFM reforms specifically applied to the health sector directly applicable to health: defining budgetary programmes in health to ensure they are aligned with sector priorities and needs
  • Lead policy development for health specific PFM interventions: designing or refining regulatory frameworks for financial autonomy of health facilities.

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