Optimizing national health financing strategies to achieve Universal Health Coverage
As the world marks Universal Health Coverage (UHC) Day on December 12, my colleagues and I at the Global Financing Facility for Women, Children and Adolescents secretariat are focusing on the health and well-being of women, children and adolescents as a key entry point to help countries accelerate progress toward UHC by 2030. Although most of the poorest countries do face significant financing headwinds, our experience so far at the GFF shows that all countries can improve the efficiency and effectiveness of their health spending to help bring the goal of UHC within reach.
Our new annual report shows that many GFF-supported countries have begun transforming the way that national budgets are formulated and spent, using the country-led GFF investment case to prioritize the most cost-effective health and nutrition interventions and align domestic and international financing. In Mozambique, for example, the GFF and partners came together to support the government’s Primary Health Care Strengthening Program, which aims to increase both the coverage and quality of health and nutrition services for women, children and adolescents. Preliminary assessments show that in its first year of implementation, the Mozambique government increased the ratio of health spending to total domestic expenditures and exceeded most of its targets, including increasing the number, reach and capacity of community health workers and the share of technical health workers assigned to the PHC network. These systemic shifts are saving lives: in 42 lagging districts, the percentage of births taking place in a health care facility had jumped from 66 percent in 2017 to 80 percent as of December 2018.
In Nigeria, support from the GFF partnership helped jumpstart the implementation of the Basic Health Care Provision Fund (BHCPF), the financing mechanism established to operationalize the 2014 National Health Act, which guarantees all Nigerians a free, universal Basic Minimum Package of Health Services (BMPHS). Evidence from GFF-supported pilot initiatives in three Nigerian states convinced policymakers to increase the budget allocation for the fund, resulting in a pledge of US$180 million, or 1% of the annual federal budget, in domestic resources to support the BHCPF annually. The pilots showed the pathway for a gradual expansion of the package as the economy grows and as reforms to increase and diversify revenues are implemented, while a resource mapping exercise highlighted financing gaps and areas of duplication to guide where and how external financing should be budgeted.
Given the massive UHC financing gaps that exist today, it’s clear that most low- and lower-middle income countries won’t achieve UHC by 2030 without substantial increases in domestic resources for health. Getting there will require the alignment of all stakeholders and financial and technical instruments around a common vision. At the GFF, we are helping governments convene their in-country stakeholders as well as to foster cross-country learning about what works. The GFF’s partnership with the Joint Learning Network, for example, aims to build the capacity of ministries of health to engage more effectively in budget negotiations by learning from the experiences of other countries.
While leadership on health financing must start with the countries themselves, we know that getting to UHC by 2030 will also require international partners to optimize their support. By effectively linking financial incentives provided by multilateral and bilateral financiers—including bilateral donors, Gavi, and the Global Fund to Fight AIDS, Tuberculosis and Malaria, with support from technical partners such as the World Health Organization (WHO)—the GFF provides a powerful platform for supporting countries in implementing the necessary health financing reforms.
And now we are taking this international collaboration to the next level. As part of the Global Action Plan launched this past September, the GFF has teamed up with these multilateral partners and the World Bank around the GAP’s health financing accelerator. Together, we’ve pledged to ramp up joint advocacy and technical support to countries, and increase deployment of joint funding mechanisms. If we all stay true to our pledge, by UHC Day 2020 our GFF partner countries should be seeing the difference.
For many low and lower-middle-income countries, making progress toward UHC seems like a daunting task. Resources are scarce, and leaders must make difficult trade-offs between competing priorities. But I remain optimistic that if countries and their partners continue to follow the data, check their institutional interests and focus on optimizing spending to bring access to quality services to the most vulnerable populations, we will keep the promise of UHC by 2030.