1. L'OMS en Afrique
  2. Health Financing

Health Financing

Health Financing

    Overview

    Health financing is a core function of health systems that can enable progress towards universal health coverage by improving effective service coverage and financial protection. Today, more than half of the population in the WHO African Region cannot access the health services they need, with cost being one of the main barriers. Many are pushed into poverty as a result of paying for services out-of-pocket. Others receive poor quality of services even when they are able to pay out-of-pocket. 

    Carefully designed and implemented health financing policies can help to address these issues. For instance, the way health care providers are contracted and paid for services can incentivize care coordination and improved quality of care. Further, sufficient and timely disbursement of funds to providers can help to ensure adequate staffing and medical products to treat patients.

    WHO’s approach to health financing focuses on the following core functions:

    • Revenue raising (sources of funds, including government budgets, compulsory or voluntary prepaid insurance schemes, direct out-of-pocket payments by users, and external aid)
    • Pooling of funds (the accumulation of prepaid funds on behalf of some or all of the population)
    • Purchasing of services (the payment or allocation of resources to health service providers)

    WHO Response

    • Strategic policy engagements: WHO facilitates policy dialogue and engagements at national and regional levels to develop health financing policy and strategies to tackle the key drivers of financial hardship, and provides guidance in health prioritization to improve efficiency and equity. This includes facilitating policy dialogue between health ministries and other ministries, such as finance and planning. 
    • Evidence generation: WHO gathers quantitative and qualitative information sources to generate regional evidence to monitor the status of health financing and progress in financial protection in the Region. WHO also uses this to develop policy options and recommendations for resource mobilization, financial protection mechanisms, strategic purchasing, benefit design and public finance management. WHO also provides expertise to countries to generate national and subnational information on health financing and financial protection and inform national level decision making. 
    • Targeted country support: WHO provides targeted technical assistance and expertise based on need and demand to countries on developing policy and legislative options on the core functions of health financing, addressing implementation challenges and initiating new reforms. This includes efforts to mobilise resources for health from traditional and new sources, strengthening resource pooling and addressing bottlenecks in purchasing of health services. It also includes support for better utilization of current funds through improved public financial management.
    • Capacity-building: WHO focuses on building capacity of national authorities for health financing across policy concepts and practice, economic analyses for monitoring and evidence generation to inform budget negotiations, resource allocation decisions, and business cases for investing in health and social protection. WHO also builds institutional capacity in countries and regional entities for policy dialogue and advocacy, evidence generation and purchasing of health services. 
    • Collaboration and partnership: WHO facilitates internal collaboration among technical teams to ensure synergies and internal coherence in policy advice and technical support provided to countries. In line with the Paris declaration and, more recently, the Lusaka Agenda, WHO works in partnership with other stakeholders for joint technical support to countries, and to leverage additional financing. This also ensures that financing for health is responsive to the national priorities and plans related to health system inputs, service organisation and service coverage targets. 
    Main Health issues

    Countries in the African Region are facing many challenges in financing their health systems and health services.

    • The level of financing for health in many countries remains inadequate compared to resource requirements to provide essential services and make progress towards UHC. In particular, public financing for health is significantly less than what national government have committed to, such as the Abuja target to allocate at least 15% of national budgets to health.
    • Progress in increasing financial protection remains suboptimal, and out-of-pocket expenditures remain a significant source of health spending in many countries. Millions are pushed into poverty annually due to health expenses and out-of-pocket direct spending accounts for 25% or more of current health expenditure in more than half of countries in the Region.
    • With the Region having the largest number of low-income countries, there is continued reliance on external funding which threatens sustainability of health outcomes 
    • Despite the tight fiscal space, many health systems still function inefficiently, with health outcomes that are not commensurate with the levels of funding.

    The capacity of many countries to expand fiscal space is limited, hence the need for a greater focus on improving efficiency and to explore innovative funding mechanisms

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