Moving from ideas to action - developing health financing systems towards universal coverage in Africa

Abstract

BackgroundAccelerating progress towards universal coverage in African countries calls for concrete actions that reinforce social health protection through establishment of sustainable health financing mechanisms. In order to explore possible pathways for moving past the existing obstacles, panel discussions were organized on health financing bringing together Ministers of health and Ministers of finance with the objective of creating a discussion space where the different perspectives on key issues and needed actions could meet. This article presents a synthesis of panel discussions focusing on the identified challenges and the possible solutions. The overview of this paper is based on the objectives and proceedings of the panel discussions and relies on the observation and study of the interaction between the panelists and on the discourse used.SummaryThe discussion highlighted that a large proportion of the African population has no access to needed health services with significant reliance on direct out of pocket payments. There are multiple obstacles in making prepayment and pooling mechanisms operational. The relatively strong political commitment to health has not always translated into more public spending for health. Donor investment in health in low income countries still falls below commitments. There is need to explore innovative domestic revenue collection mechanisms. Although inadequate funding for health is a fundamental problem, inefficient use of resources is of great concern. There is need to generate robust evidence focusing on issues of importance to ministry of finance. The current unsatisfactory state of health financing was mainly attributed to lack of clear vision; evidence based plans and costed strategies.DiscussionBased on the analysis of discussion made, there are points of convergence and divergence in the discourse and positions of the two ministries. The current blockage points holding back budget allocations for health can be solved with a more evidence based approach and dialogue based on a clear vision and costed strategic plan articulated by the ministry of health. Improving health in Africa is a driver for long-term economic growth and development and this is the reason why the ministries of health and finance will need to find common ground on how to create policy coherence and how to articulate their respective objectives.

Does expanding fiscal space lead to improved funding of the health sector in developing countries?: lessons from Kenya, Lagos State (Nigeria) and South Africa

“…The only other literature commenting on these issues in the African context that could be located is a paper based on a series of panel discussions between Ministries of Finance and Health [31]. The key message from these panel discussions was the need for Ministries of Health to build an evidence base on the need for investment in the health sector and to demonstrate efficient use of resources within the health sector.…”

The path to longer and healthier lives for all Africans by 2030: the Lancet Commission on the future of health in sub-Saharan Africa

“…75 The consequences of inefficiency are anything but trivial: it has been estimated for OECD countries that improving efficiency to the standard of best performing countries would bring, on average, an increase of 2 years in life expectancy, compared with 4 months brought by a 10% increase in public health expenditure per capita. 167 Investing in efficiency and demonstrating value can strengthen the dialogue between African Ministries of Health and Ministries of Finance 168 and help convince Ministers of Finance of the returns associated with allocating much needed resources for health.…”

Moving towards universal health coverage: The need for a strengthened planning process

“…In this respect, the weakness in planning is twofold, firstly, the lack of costed strategic plans to inform resource mobilisation efforts and secondly, the limited funding posing a challenge to planning. A panel discussion between ministers of health and ministers of finance from African countries concluded that the lack of clearly articulated priorities detailed in evidence‐based and costed plans explained the prevailing unsatisfactory financing for health . Relatedly, Namibial et al argue that the limited funding in itself is a challenge to good planning.…”

“…Past efforts in resource mobilisation have yielded varied results, and in majority of cases, not much success has been registered. Cited challenges include poor prioritisation, contradictions in the policy direction, inefficiencies in resource allocation and use, and inadequacies in the consultative processes . These are partially attributed to flaws in the planning processes.…”