Why Health Financing is Critical for Universal Health Coverage. Without financial resources, universal health coverage (UHC) – a United Nations Sustainable Development Goal (SDG) emphasizing that everyone should have access to the quality health services they need, and that the use of these services does not expose individuals to undue financial hardship – cannot be achieved. High Performance Health Financing ensures that the resources being used to finance UHC are adequate and sustainable, sufficient to spread risk, as well as efficient and equitable. In this way, high performance health financing also helps to build healthier, more productive populations that can contribute to improved human capital, and in turn, sustainable and inclusive growth.
The focus on effective service coverage and financial risk protection goals under UHC underscores that the way countries finance their health systems matters. Health financing policies address the functions of pooling and purchasing (i.e., how funds are organized and used) and revenue raising (i.e., the level and source of funds), and can help to achieve these goals. In developing countries, domestic public funds – in the form of mandatory, pre-paid and pooled resources – are an essential component of High-Performance Health Financing and progress toward UHC. As such, many policies for high performance health financing in resource limited settings focus on maximizing fiscal space for health through Domestic Resource Use and Mobilization (DRUM), or how domestic resources are mobilized (DRM) and then effectively and efficiently used.1 However, meaningful exchange and dialogue on the “how to” behind policy options is needed in order to move them to action—especially in a post-COVID world where fiscal space is reducing and difficult choices need to be made for prioritization of resources among and within sectors.
The Health Financing Technical Initiative (HFTI). Based on country surveys and responding to a high demand for a technical area on health financing to be part of the JLN’s offering, the HFTI was launched after additional rounds of consultations with JLN member countries and the JLN Steering Group in 2016. Consultations revealed that as countries move towards UHC, their health financing systems are undergoing rapid change and are faced with additional pressures related to transitioning external support, mobilizing domestic resources for health, and efficient allocation of resources given competing priorities. Revisiting conventional financing practices in a peer-to-peer knowledge exchange setting was thus seen as a valuable way forward for countries to gain practical know-how and technical support from each other. To respond to this need, the HFTI made available the following platforms for joint learning:
Since 2017, the Efficiency Collaborative focuses on two core issue areas: systematic priority setting (SPS) – defined as evidence-based allocation of health resources to improve efficiency, generating more outputs and better outcomes – and measurement of efficiency. Working with over 100 policy makers from 12 member countries and co-facilitated with the International Decision Support Initiative (iDSI), the collaborative has produced three knowledge products:
- Health Priority Setting: A Practitioners Handbook
- The Health Priority Setting and Resource Allocation (HePRA) Benchmarking Tool and Database
- Measuring Health System Efficiency in Low- and Middle-Income Countries: A Resource Guide
The collaborative is now in its second phase of work which includes facilitation of a community of practice specific to the collaborative to support adaptation and implementation of current knowledge products, as well as exploration of new knowledge on a theme identified with phase 2 participants.
Domestic Resource Mobilization (DRM) collaborative
Since 2017, the DRM collaborative has partnered with the Global Financing Facility (GFF) for a jointly offered learning platform on DRM. With more than 100 participants from 19 JLN and GFF countries the collaborative has facilitated discussions, and shared cross-country knowledge and expertise on pressing questions on DRM for health. The collaborative has worked on co-producing five knowledge products:
- Making the Case for Health: A Messaging Guide
- Dynamic Inventory of DRM Resources and Efforts
- On Prioritizing Health: A Background Analysis
- Policy Dialogue Toolkit
- Narrative Summaries on Public Expenditure for Health
- Central Government Budgetary Spending on Health in Indonesia
- Ministry of Health & Family Welfare Spending in Bangladesh
The collaborative is also now in its second phase of work and will be fostering a community of practice aimed at supporting adaptation and implementation of the knowledge products of the collaborative. The DRM collaborative is also partnering with the Global Financing Facility (GFF) and the Global Fund (GF) to support in-country application of the knowledge emerging from the
Fiscal Policy for Public Health Learning Exchange
This learning exchange was held in February 2018, in Nairobi, Kenya co-located with the third in-person meeting of the Efficiency collaborative – attended by 36 participants from 11 JLN countries. The Fiscal Policy for Public Health Learning Exchange considered positive health outcomes that can be achieved through fiscal policy measures. The overarching objective of this learning exchange was to discuss the use of fiscal policy such as sin taxes for tobacco to discourage consumption and lead to positive health outcomes. This included understanding country experience in feasibility, implementation, achievements and challenges in using fiscal policy for public health, diagnostic tools for evaluating and strengthening tax policies for public health and benefits, political economy, and ease of introduction of tobacco tax. Discussions and key take away messages from the learning exchange were captured in a blog which was published on the JLN website shortly after the event. A report on the learning exchange can be downloaded.
Annual Health Financing Forum (AHFF) Series. The JLN’s Health Financing Technical Initiative partners annually on the AHFF. This year, AHFF is focused on health financing resilience during COVID-19 and is happening in two parts. The first part occurred in July 2020. Registration for the second part, which will be held from November is now open.
In order to extend the reach and impact of the JLN’s Health Financing Technical Initiative, especially during the COVID-19 pandemic, the World Bank facilitation team leveraged and intensified its existing longstanding collaborations with the World Bank’s Health Financing Global Solutions Group, the Global Financing Facility, and other partners to form a COVID-19 Health Financing Resilience Program.
COVID-19 Health Financing Resilience Program (ongoing). The Program supports decision-makers to shape health financing policies based on best evidence and emerging lessons by forecasting crisis impact, facilitating knowledge exchange, documenting and analyzing policy responses through a monitoring questionnaire, developing a global research agenda, and revisiting widely accepted policies. A virtual collaboration space has been made available through a community of practice for practitioners to discuss health financing policy responses and their impact and to share country experiences and lessons learned. Launched at this years’ AHFF, a variety of learning exchanges will include webinars, roundtables, virtual working groups and facilitated Q&A. Additional resources will also include a curated repository of technical materials. The JLN Domestic Resource Mobilization (DRM) and Efficiency Collaborative (EC) teams will continue to be coordinated by the Health Financing Technical Initiative and are invited as active participants in this expanded community of practice. Additionally, the Health Financing Technical Initiative will cross-collaborate as part of the JLN’s new COVID-19 Network for Open Dialogue and Exchange (NODE) amplifying the important intersection of health financing and pandemic response and recovery.
Joint Event with Provider Payment Mechanisms Initiative on Provider Payment in Indonesia. A facilitated half day learning exchange meeting in 2017 with the Provider Payment Mechanisms Initiative provided Indonesia with access to peer countries’ experiences in building effective models of strategic health purchasing and financial risk-sharing in decentralized contexts.
1 Summarized from Tandon, A. (2020) Global Landscape: Fiscal Space for Health