Financing Health in Africa - Le blog
  • Home
  • Bloggers
  • Collaborative projects
  • Join our COPs
  • Resources
  • About Us
  • Contact Us

UHC: time for really "innovative" health financing!

12/12/2020

0 Commentaires

 
Myria Koutsoumpa, Rosana Lescrauwaet and Mariska Meurs*

​Ten years after the WHO’s report on Universal Health Coverage (UHC), most African low- and lower-middle income countries are not able to raise enough resources to achieve UHC. And however important, domestic efforts for resource mobilisation alone will not be enough to bring us there. The world has a collective responsibility to address tax injustices and high indebtedness, which have a huge potential to free resources for health.
Photo



​

Photo
Universal Health Coverage (UHC) means that everyone receives the health services they need without suffering financial hardship. This should include the full spectrum of essential, quality health services - from health promotion to prevention, treatment, rehabilitation, to palliative care. The 10th anniversary of the WHO Report on UHC coincided with a pandemic that aggravated funding gaps for health and brought to the forefront both the importance as well as the failures of public health systems. But the report also came with a strong global commitment, which was renewed at the high-level meeting on UHC at the United Nations General Assembly in September 2019 bringing together heads of state, political and health leaders, policymakers, and UHC champions.

While in the last ten years we have witnessed improvements in several health indicators, poverty and inequality remain core challenges. People living in poverty suffer many more health problems, have far less access to quality health services and, still, many people are driven into poverty each year because of health expenditures. An important step for many governments to take towards UHC is to not only redistribute but also raise more revenue to cater to their population’s health needs.  The global community increasingly emphasises governments’ responsibility for domestic resource mobilisation for health. However, most low- and lower-middle income countries (LMICs) in Africa are not raising, and in the short to medium term, will not be able to raise, enough domestic resources to achieve UHC. They remain far from achieving the twin health spending targets of at least USD 112 per capita per year and 5% of GDP. The reality is that even if they manage to allocate 5% of their GDP to health this amount will still be far from enough (figure 1). External sources will continue to be critically important for many LMICs health spending in the medium term.

Photo
Figure 1: Comparison between general government health expenditures and international benchmarks in 28 African LMICs

​The prospects for economic growth are not good for many of them and, in fact, many people are left behind by economic growth - as expressed and measured by countries’ GDP. GDP increases do not automatically translate to poverty reduction nor to increases in the countries’ health spending. Especially so when pathways towards economic growth do not pay sufficient attention to equal distribution of wealth and investing in social sectors, which has been the case for many years under the influence of policy advise or conditions put in place by the IMF and the World Bank. This has been the dominating directive and trend at least for the past couple of decades, while the achievement of equity and investment in UHC requires different approaches. The Covid-19 emergency has moved the dial towards more flexibility and introspection within these institutions, at least in their rhetoric. As recent findings from Eurodad, Oxfam and ActionAid demonstrate, practise is not following suit.
​
Even if economic growth accelerates considerably in the near future, domestic resource mobilisation alone will not be enough to realise SDG3 and UHC by 2030. To achieve the health-related SDGs, LMICs require an additional USD 371 billion per year. Furthermore, the annual funding gap would remain at USD 54 billion even with projected increases in their domestic health spending. Given these caveats, which are the leading strategies to increase a country’s fiscal space for health? The WHO and international financing institutions like the IMF are flagging three: 1) earmarked taxes, 2) reprioritisation of health in government budgets, and 3) public financial management (PFM) reforms and efficiency improvements.


1. Earmarked taxes for health, aka 'sin taxes', is a commonly suggested solution for raising resources, initially introduced though to reduce consumption of harmful products. However, the WHO’s own research has shown that sin taxes have a very limited potential in raising resources for health, they are not predictable, and they do not have the prospect of leading to sustained, long-term expansion in fiscal space for health.

2. Reprioritisation of health in government budgets is important but will bring limited amounts of resources in many LMICs due to the already constrained public purse.

3. As for the gains from PFM reforms and efficiency improvements, despite high potential, they will take time to materialise and still won’t come close to filling the massive funding gap.​

It is clear that the world needs alternative avenues to expand fiscal space in LMICs and allow for higher investments in the SDGs, including health. This is something for which organisations like the ILO and UN Women, among others, advocate. The alternatives are not new. They are just not yet actively explored because they challenge mainstream political and macroeconomic thinking. The latest UNCTAD report estimated that Africa is losing USD 89 billion per year in illicit financial flows such as tax evasion and theft, which amounts to more than it receives in development aid. The potential of this untapped source of revenue is clear when compared with the annual funding gap for the health-related SDGs previously mentioned.  At the same time, debt service repayment on average takes over almost 12% of African governments’ revenue, while the average domestic allocation to health is half of this.

To conclude, health, as well as other social goals, need far more public resources. Mainstream approaches to economic growth are not leading to higher well-being, equality and realisation of the SDGs. To meet the SDG3 targets, including UHC, a rethink is needed on how to get there, putting equity centre stage and challenging mainstream thinking on economics and finance.
​

 
*The authors are global health advocates from Wemos’ health financing team. Wemos is an independent civil-society organisation seeking to improve public health worldwide. It analyses Dutch, European and global policies that affect health and proposes changes in them. Wemos holds the Dutch government, the European Union, and multilateral organisations accountable for their responsibility for respecting, protecting and fulfilling the right to health.
0 Commentaires



Laisser un réponse.


    Our websites

    Photo
    Photo
    Photo

    We like them...

    SINA-Health
    International Health Policies
    CGD

    Archives

    Septembre 2019
    Juin 2019
    Avril 2019
    Mars 2019
    Mai 2018
    Avril 2018
    Mars 2018
    Février 2018
    Janvier 2018
    Décembre 2017
    Octobre 2017
    Septembre 2017
    Août 2017
    Juillet 2017
    Juin 2017
    Mai 2017
    Avril 2017
    Mars 2017
    Février 2017
    Janvier 2017
    Décembre 2016
    Novembre 2016
    Octobre 2016
    Septembre 2016
    Août 2016
    Juillet 2016
    Avril 2016
    Mars 2016
    Février 2016
    Janvier 2016
    Décembre 2015
    Novembre 2015
    Octobre 2015
    Septembre 2015
    Août 2015
    Juillet 2015
    Juin 2015
    Mai 2015
    Avril 2015
    Mars 2015
    Février 2015
    Janvier 2015
    Décembre 2014
    Octobre 2014
    Septembre 2014
    Juillet 2014
    Juin 2014
    Mai 2014
    Avril 2014
    Mars 2014
    Février 2014
    Janvier 2014
    Décembre 2013
    Novembre 2013
    Octobre 2013
    Septembre 2013
    Août 2013
    Juillet 2013
    Juin 2013
    Mai 2013
    Avril 2013
    Mars 2013
    Février 2013
    Janvier 2013
    Décembre 2012
    Novembre 2012
    Octobre 2012
    Septembre 2012
    Août 2012
    Juillet 2012
    Juin 2012
    Mai 2012
    Avril 2012
    Mars 2012
    Février 2012
    Janvier 2012
    Décembre 2011
    Novembre 2011
    Octobre 2011

    Tags

    Tout
    2012
    Accountability
    Aid
    Alex Ergo
    Assurance Maladie
    Bad
    Bamako Initiative
    Bénin
    Bruno Meessen
    Burkina Faso
    Burundi
    Civil Society
    Communauteacute-de-pratique
    Communauté De Pratique
    Community Of Practice
    Community Participation
    Conference
    Cop
    Course
    Couverture Universelle
    CSU
    Déclaration De Harare
    Divine Ikenwilo
    Dr Congo
    économie Politique
    élections
    équité
    Equity
    Fbp
    Financement Basé Sur Les Résultats
    Financement Public
    Fragilité
    Fragility
    Free Health Care
    Global Fund
    Global Health Governance
    Gratuité
    Gratuité
    Health Equity Fund
    Health Insurance
    ICT
    Identification Des Pauvres
    Isidore Sieleunou
    Jb Falisse
    Jurrien Toonen
    Kenya
    Knowledge-management
    Kouamé
    Leadership
    Mali
    Management
    Maroc
    Maternal And Child Health
    Médicaments
    Mise En Oeuvre
    Mutuelle
    National Health Accounts
    Ngo
    Niger
    Omd
    OMS
    Parlement
    Participation Communautaire
    Pba
    Pbf
    Plaidoyer
    Policy Process
    Politique
    Politique De Gratuité
    Politique De Gratuité
    Post Conflit
    Post-conflit
    Private Sector
    Processus Politique
    Qualité Des Soins
    Qualité Des Soins
    Quality Of Care
    Recherche
    Redevabilité
    Reform
    Réforme
    Research
    Results Based Financing
    Rwanda
    Santé Maternelle
    Secteur Privé
    Sénégal
    Société Civile
    Uganda
    Universal Health Coverage
    User Fee Removal
    Voeux 2012
    Voucher
    WHO

Powered by Create your own unique website with customizable templates.