FINANCE FOR HEALTH

Evidence shows that public resources and country-specific health financing strategies are key to realising the right to health. It is a public responsibility to ensure equitable access to essential health services for all.

However, in many low- and middle-income countries (LMICs), health budgets are not sufficient to achieve Universal Health Coverage (UHC), or recruit and retain the necessary number of health workers. Health expenditure often relies too heavily on out-of-pocket spending, pushing many people into poverty and exacerbating inequalities.

If we aim to achieve sustainable results in strengthening countries’ health systems – which is a prerequisite for sexual and reproductive health and rights –including the health workforce, it is crucial to expand countries’ fiscal space for health. Yet, this should not be left to individual countries alone; many countries still depend on official development assistance (ODA) for health to co-finance their health systems. However, this type of ODA is decreasing. Instead, World Bank and donor countries – the Netherlands included – spend relatively more ODA to engage and strengthen the private-for-profit sector, also in health.

Wemos believes that the international community can and should contribute more to the strengthening of countries’ health budgets. This can be done by increasing and better aligning development assistance for health with country-specific strategies on the one hand, and by reducing practices that needlessly limit government budget (for health) on the other hand.

Health financing, gender and other cross-cutting issues

When we talk about financial access to health services, we see that women are disadvantaged. Both national policies on health financing and macroeconomic policies can contribute to these gender inequalities.  In countries with high out-of-pocket spending, women face extra barriers to essential health services. This is because women suffer more from constrained cash flow, and because out-of-pocket spending is often required in sexual and reproductive health services – including family planning methods – that particularly affect women, their health, career and household income.

International financing institutions, such as the World Bank and the International Monetary Fund (IMF), also have a large impact on health policies and fiscal space for health through their advice and conditions related to loans. Wage bill ceilings in the public health sector and restrictions on the use of ODA for health worker salaries negatively affect women, who form the grand majority of health care professionals.

Therefore, we incorporate gender and equity into our analyses and evidence-building, and join up with partners to effectively advocate gender equality in health policies.

We also address cross-cutting issues like the accountability of multilateral organisations and high-income countries towards LMICs, and meaningful civil society engagement in decision-making within this programme.

Change needed

In our Finance for health programme, we wish to contribute to the following:

• Bilateral and multilateral development partners increase and align their ODA to co-finance UHC strategies in countries that cannot raise sufficient domestic public resources.
• International financial institutions and development partners actively support the efforts of LMICs to increase their fiscal space for health, by strengthening national and international tax justice measures and by phasing out harmful policy conditionalities that unduly limit a country’s spending options for social services.
• Where development partners use ODA to promote business involvement in health in LMICs, they apply criteria to ensure that this: 1) helps the countries in question to attain health-specific development goals, and does not cause harm, and 2) respects aid effectiveness principles.
• Civil society organisations have both the capacity and opportunity to effectively monitor and influence finance for health at both national and international levels, and to advocate alternative financing models where appropriate.

Read more

• On our Aid for Trade work
• Blog: ‘Are UHC kidding me? 5 alternatives to equitably fund health for all’
• Discussion paper: Best public value for public money? The case of match-funded multi-hospital infrastructure development in Tanzania
• Factsheet: Fiscal space for health and ways to increase it
• Factsheet: Public finance targets for UHC
• Infographic: Pooling resources for health system strengthening
• Country reports: Human resources for health in Malawi, Fiscal space for health in Uganda
• Our work on the Global Financing Facility (GFF):
  – GFF country analyses (Kenya, Malawi, Tanzania, Uganda)
  – Interactive document: Connecting voices: creating space for civil society engagement in the GFF
  – Our joint open letter to GFF
  – Blog: ‘After the GFF replenishment: how is GFF addressing civil society’s concerns?