FINANCE FOR HEALTH

Wemos aims to increase the quality and quantity of external and domestic funding for health in low- and middle-income countries. We collaborate with civil society partners in these countries and global networks, to ensure that global advocacy reflects ‘local realities’, and jointly advocate for global policies that respond to these countries’ needs. We push global health donors and other global actors that exert influence on public health budgets, to improve coordination with each other and alignment with country priorities, and to better ensure universal and equitable access to health services that leave no one behind.

Read about our work on the following topics: 

• Public finance for public purpose in health
• Coordination and alignment of donor strategies to strengthen health systems
• Mobilising resources for the health workforce
• Countering austerity to expand the budget for public (health) services
• Funding for pandemic preparedness and response
   

Public finance for public purpose in health

Situation
The World Bank Group, with its Maximizing Finance for Development (or ‘private first’) approach, prioritises the role of private-for-profit actors in development, and so do many other multilateral and bilateral institutions. Official (public) resources have increasingly been used to de-risk private investments, facilitate public-private partnerships and otherwise support commercial enterprises in diverse sectors of development in low- and middle-income countries.

In the health sector, however, this development approach risks to miss its purpose, exacerbating inequalities in access to health services instead of closing inequality gaps. For example, when it leads to more reliance on pay-for-service systems, this maintains or creates financial barriers for those who can’t afford to pay.

Solution
The international financial institutions, global health initiatives and other development actors, through their financial and technical assistance, can contribute better to health equity by helping countries to expand and strengthen the public purse for health systems that are inclusive by design. In our advocacy we aim to create critical awareness on how to use public resources for health wisely, avoiding diversion into commercial solutions that do more harm than good, and on alternatives for increasing those scarce public resources (see our work on ‘Countering austerity’).

Read more:

• ‘Improving healthcare, but for whom?’ Inventory study on the International Finance Corporation’s investments in healthcare (2022)
• ‘Health Security & Equity: a public priority’. Position paper on the IDA20 policy framework from a health perspective (2021)
• ‘Risky business’, position paper on the promotion of public-private partnerships in healthcare (2021)
• ‘In the interest of health for all?’ Discussion paper on the Dutch ‘Aid and Trade’ agenda as pursued in the African healthcare context (2020)
• ‘Best public value for public money?’ Discussion paper on the case of match-funded multi-hospital infrastructure development in Tanzania (2019)
• Summary brief on Dutch Aid & Trade in Health (2020) – a two-pager that summarises the two above-mentioned discussion papers  

Coordination and alignment of donor strategies to strengthen health systems

Situation
The Global Financing Facility (GFF), the Global Fund and Gavi – also referred to as ‘the 3Gs’ – are the three largest global health initiatives that raise and allocate funds for health in low- and middle-income countries. In addition to their objectives on specific diseases, target groups or interventions, they increasingly target health systems strengthening. To improve health most effectively, it is crucial that the strategies and interventions of the 3G’s are well aligned at global and country level. Weak coordination between the 3Gs and poor alignment with national health policies and plans may result in ineffective policies and practices that fail to improve health in an equitable way.

Solution
Wemos wishes to see that the 3Gs are coordinated, aligned with country systems, and strongly committed to health systems strengthening. Through collaborations and joint analysis with civil society in the Global South, we build knowledge on how global policies affect local realities. This shapes our policy recommendations and sharpens joint advocacy messages toward health actors at our respective national levels and at global level. By coordinating and aligning their policies, the 3Gs can be more effective, and strengthen their contribution to equitable access to health services.

Read more:

• Report with CEHURD ‘Tracking the progress and implications of the global financing facility (in this case results – based financing) in the healthcare sector in Uganda’ (2021)
• Various factsheets about the Global Financing Facility in Uganda: updated factsheet (2020) and others
• ‘Strengthening health systems strengthening, an analysis of coordination among the Global Fund, the Global Financing Facility and Gavi (3Gs)’ – a full report by Cordaid and Wemos and an accompanying policy brief (2021).
• Webinar (April 2021): How do the Global Fund, GFF, and Gavi coordinate their efforts to strengthen health systems? 
• Watch the GAP! webinars on the Global Action Plan for Healthy Lives and Well-Being for All: 1) ‘The GAP and civil society’ and 2) ‘The GAP and sustainable financing for health’ (October 2020)
• Report ‘Watch the GAP! A critical civil society perspective on the development, potential impact and implementation of the ‘Global Action Plan for Healthy Lives and Well-Being for All’’ (2020) 

Situation
Most low- and middle-income countries have severe health workforce shortages to meet the WHO minimum health workforce requirements needed for universal health coverage (UHC) and sexual and reproductive health services goals. While donors and governments agree that expanding the health workforce in many countries is urgent, there is a lack of donor commitment, because finance for health personnel is considered a matter of domestic resource mobilisation only. However, Covid-19 has put further stress on fiscal space for health overall and increased the debt burden for many low and middle-income countries, making it even harder for them to invest in their health workforce. 

Solution
To make health systems work properly, securing sufficient funding to fill gaps in additional health workforce is needed, in the short as well as the longer term. Both governments and donors should increase public financial resources for recruiting and retaining health workers.

Read more:

• Devex article ‘A review says ACT-A should continue. Experts say changes are needed.’ in which Amanda Banda (gobal health advocate at Wemos) explains why ACT-A must prioritise funding of health systems (October 2021) 
• Our engagement in the ACT-A Strategic Review report (October 2021) 
•  Our reaction to the Rome Declaration on Global Health; it does not mention concrete commitments to invest in the global health workforce (May 2021)
• Webinar on investing in health workers that Wemos held with partners of the Dutch Global Health Alliance (December 2020)
• Letter to major funders in global health calling on them to prioritise international funding that supports recruitment of health workers in resource-limited contexts (April 2020) 
• ‘Will investment in our health workforce continue beyond COVID-19?‘, article published by EPHA (April 2020)

Countering austerity to expand the budget for public (health) services 

Situation
To cope with the Covid-19 pandemic, high-income countries have put in place more expansionary fiscal and monetary policies and increased public spending on health and social security to support their economies. At the onset of the pandemic, the International Monetary Fund (IMF) advised low- and middle–income countries to do the same – thereby breaking with a long tradition of advising austerity and public budget cuts. However, this did not last. Country programmes and surveillance reports indicate that the IMF started advising governments to resume austerity measures. This return to austerity aggravates the impact of the pandemic on both the health sector and the wider economy.

Solution
There are alternatives, including in the poorest countries, to increase public resources and avoid cutting budgets for health or other essential public spending. These include reducing or restructuring debts, fighting illicit financial flows, increasing tax revenues in a progressive manner or implementing a more expansionary monetary policy. In Europe and the USA, for example, the European Central Bank and the Federal Reserve have been financing the public debt of governments to respond to the pandemic. Wemos is collaborating with partners to raise awareness around austerity, explore feasible alternatives, and advocate for policy options to increase fiscal space for public spending, including on health. 

Read more:

• A letter to the IMF, G20 and Central Bank governors calling for fair channelling of Special Drawing Rights (September 2021) 
• A letter to the IMF to stop calling for austerity measures during the Covid-19 recovery period (October 2020)
• Session on ‘Fiscal Space for Universal Health and Social Protection Post Covid-19 Pandemic: how to prevent austerity?’ (WB/IMF annual meetings Civil Society Policy Forum October 2020). 

Funding for pandemic preparedness and response 

Situation
Covid-19 has shown again that the containment of infectious disease requires unified pro-public action. After all, ‘no one is safe until everyone is safe’. Next to measures to achieve universal access to essential commodities and technologies, pandemic prevention, preparedness and response (PPR) at international and country level needs rigorous improvement. So far, funding for PPR has proven to be grossly insufficient.

Solution
In line with our vision on equitable finance for health, Wemos advocates for this funding to be predictable and sufficient, mobilised progressively (according to the ability to pay), allocated according to needs, and governed democratically. In addition, considering the already large funding gaps for health, this funding should not go to the detriment of ODA nor add to the debt burden of low- and middle-income countries. Against these principles, we analyse the different proposals and monitor the negotiations at the WHO about a new treaty to strengthen pandemic preparedness and response. 

Read more:

• Our online overview & review of international initiatives for access to medical products against Covid19: www.covid19response.org (February 2022)

Applying an intersectional lens to make sure no one is left behind

People – especially youth – with compounded vulnerable social identities often struggle with accessing the health services they need, including sexual and reproductive health and rights (SRHR). For example, girls living with a disability and in poverty, face higher barriers accessing the health services they want and need than an adult man with an average income. 

The majority of (global) policies cannot fulfil the promise of ‘leaving no one behind’ in many low- and middle-income countries. As a result, many people are stuck in a vicious cycle of poverty and exclusion. We must therefore apply an ‘intersectional lens’ that helps us understand how different social identities ‘intersect’ and affect health and SRHR.

Together with partners and youth panels, we develop and implement tools for intersectional policy analysis and lobby & advocacy.  We aim to raise awareness of the value of an intersectional approach among global and regional actors. Ultimately, we want them to support changes in SRHR-related and health financing policies, to improve the SRHR of youth and minoritised groups. 

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