Towards a coherent global framework for health financing: recommendations and recent developments

Abstract

The articles in this special issue have demonstrated how unprecedented transitions have come with both challenges and opportunities for health financing.

Time to abandon amateurism and volunteerism: addressing tensions between the Alma-Ata principle of community participation and the effectiveness of community-based health insurance in Africa

“…Obviously, our reflection is based on a premise: the obligation for states to increase public funding for the health sector. This is an essential condition for UHC that many experts have been emphasising for a very long time,23 including recently for CBHI schemes,21 24 25 and which our case studies confirm.…”

“…As WHO suggests in its analysis of CBHI schemes, ‘mandatory enrolment of the population’ has become necessary,4 as has the professionalisation of their management, which is not synonymous with privatisation. Moreover, mandatory enrolment and professionalisation can only be achieved effectively if African states commit themselves to taking seriously their citizens’ health by substantially increasing (as did Rwanda) public financing of the health system and subsidising members’ contributions 21 23. African states could draw inspiration from the current examples of Thailand and some Indonesian provinces, where the government gave everyone in the informal sector free membership, financed through taxes.…”

Setting performance-based financing in the health sector agenda: a case study in Cameroon

“…Financing is at the centre of efforts to improve health and health systems. It is only when resources are adequately, efficiently and equitably mobilised, pooled and spent that all people can enjoy sustained progress towards universal health coverage (UHC) [ 4 ]. The Third UN Financing for Development Conference in 2015 let to the adoption of the Addis Ababa Action Agenda (AAAA) [ 5 ].…”

Defining the concept of fair pricing for medicines

“…For governments, financial hardship depends on need, available budget, and the ability to sustainably increase a budget 24. A key challenge is that government spending on health, and medicines, in particular, varies widely by country 25. Several targets have been proposed to provide guidance for a fair level of collective health spending: a minimum of 5% of GDP26 or 15% of government budgets on health,27 a maximum of 1% of government health expenditure on vaccines,28 or a threshold for each quality adjusted life year provided by a medicine.…”