Funding health sector priorities including movement towards UHC can be challenging, especially when a country’s budget is already straining to meet multiple demands across sectors.

Earmarking is one mechanism that countries use to increase fiscal space and mobilize resources for the health sector by setting aside all or a portion of a government revenue source to fund a health sector objective.  The arguments for and against earmarking are numerous but they often remain theoretical. Despite vast country experience with this policy instrument – at least 80 countries earmark for health – little empirical evidence has been introduced into the debate.

Do earmarks bring the intended benefit of a stable and growing resource base for the health sector? On the other hand, could the opponents of earmarking be correct? Do they introduce rigidity and inefficiency into the government budgeting process?

R4D in partnership with the World Health Organization (WHO) is bringing practical country experience into the earmarking debate by collecting and synthesizing qualitative country experiences in mobilizing revenue for the health sector through earmarks. The research is part of WHO's collaborative agenda on Fiscal Space, Public Financial Management, and Health Financing.


The second product in the R4D-WHO series of resources under the collaborative agenda, "Earmarking for Health: From Theory to Practice" discusses the theoretical foundations of earmarking and analyses country experiences with earmarking for health and its impact on health sector budgets and the broader fiscal environment. The goal is to provide useful information to health and finance authorities and to the development partners who support them on the practical realities of designing, adopting and implementing earmarking policies. 

Download the full paper "Earmarking for Health: From Theory to Practice" here.

Resources included in this paper: 

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