Sustainable financing for universal health coverage
Collaborative agenda on fiscal space, public financial management and health financing
Public financing is essential for countries to make sustainable progress towards universal health coverage (UHC). These funds need to be used efficiently and directed to priority populations and services to ensure equitable access to quality health services and financial protection for all. Recognizing this, WHO has been implementing the jointly agreed upon Collaborative Agenda on Fiscal Space, Public Financial Management (PFM) and Health Financing since the end of 2014.
This program of work focuses on ensuring health financing policy decisions, including implementation planning and sequencing, are:
1. guided by evidence of what works and does not work;
2. directly consider overall macroeconomic and fiscal realities; and
3. focus on strengthening and aligning PFM systems that determine how budgets are formulated, allocated and executed with health financing functions and health system objectives.
Despite the proven importance of public funds for making progress towards UHC, new evidence published in Toward universal health coverage: thinking public suggests that the role of domestic public financing has declined in some low- and middle-income countries in recent years. To address this issue, a policy brief on Raising revenues for health in support of UHC gives guidance to policymakers grappling with how to actually increase levels of domestic public funding for health on their path to UHC. Assessing fiscal space for health expansion in low- and middle-income countries: a review of the evidence takes stock of how fiscal space for health as a concept has been applied to assess and support the expansion of resources for the health sector. Related to both of these topics, Spending targets for health: no magic number shows that reaching a health expenditure global target or benchmark does entirely not determine how well a country will perform in terms of UHC.
- Towards UHC: thinking public / Overview of trends in public expenditure on health (2000-2014)
- Raising revenues for health in support of UHC: strategic issues for policy makers
- Assessing fiscal space for health expansion in low- and middle-income countries: a review of the evidence
- Spending targets for health: no magic number
A review of Earmarking revenues: from theory to practice stresses that any specific revenue sources should be viewed within the wider fiscal framework. Similarly, the System-wide approach to analysing efficiency across health programmes provides a way to assess programmes within the frame of the overall health system, to identify and address key sources of inefficiency derived from overly-segmented organizational arrangements.
- Earmarking revenues: from theory to practice
- System-wide approach to analysing efficiency across health programmes
A core part of this overall collaborative agenda focuses on the importance of Aligning public financial management and health financing to enable and sustain progress towards UHC. A companion Process guide builds on the framework to align public financial management and health financing arrangements to help health and finance authorities at the country level engage in productive dialogue.
All of these products feed into targeted guidance on Developing a national health financing strategy: a reference guide that is informed by sound Health financing country diagnostic so as to enable their effective implementation.
- Developing a national health financing strategy: a reference guide
- Health financing country diagnostic
As part of this agenda, two meetings here held in December 2014 and April 2016 that served to identify the key issues and questions related to this technical area, and also developed the conceptual foundations related to particular sub-topics. A third meeting will be held in October/November 2017, that will centre on the practical issues countries face in implementing policies and reforms that intend to institutionalize and sustain progress towards UHC. These meetings bring together representatives of national health and finance ministries and other relevant government bodies, partner agencies, foundations, initiatives, and civil society organizations to discuss and agree upon priority topics and issues within public finance and health financing.
Funding from the UK Department for International Development (DFID) under the Program for improving countries’ health financing systems to accelerate progress towards universal health coverage and the Ministry of Health and Welfare of the Republic of Korea under the Tripartite program for Strengthening Health Financing Systems for Universal Health Coverage is gratefully acknowledged.
Meetings of the Collaborative Agenda on fiscal space, public financial management and health financing: sustaining progress towards universal health coverage.