Domestic Financing for Health
Parliamentarian Round Table
25-26 March 2014,Joburg, SA
Linda Mafu, Head Political Advocacy and Civil
Society Department, External Relations
Global Fund
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BACKGROUND
Global Health Agenda
• Unprecedented funding for health from 2002 to present for
health and in particularly for AIDS, TB and Malaria through
Global Fund
• International Development Assistance is changing
• New trends to watch for particularly in area of support for
health
• Major progress and achievements in improving peoples lives
• Key MDG targets are on track to be achieved in number of
African countries and need to protect and sustain progress
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BACKGROUND
Why invest in health?
• Economic, social and political benefits from having a healthy
nations ; citizens have the potential to be more productive and
it can lead to demographic dividend
• According to the Lancet Commission: “Reductions in mortality
account for about 11% of recent economic growth in low and
middle-income countries as measured in their national income
account”
• Governments have an obligation to provide health care-
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Key Challenges
• Value for Money: major improvements are needed in health
programme efficiency and effectiveness
• Domestic Advocacy: a large part of any increase in public
funding for health will need to come from government,
therefore need to develop a convincing business and
advocacy case for increased public commitment in programs
of proven effectiveness
• Sustainability: Domestic public spending is set to continue as
economic growth continues, however it will not be sufficient to
address all the health needs. Therefore still a need for external
resources in the short to medium term. Hence the need to
explore innovative domestic financing mechanisms
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What is needed for ATM 2014-2016
Estimated funding required $87 billion
Mind the gap: 2.8 billion out of 15 billion just for 2014-2016.
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Global Priorities Changing: Post 2015 MDG High
Level Panel Report
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Africa has made commitments
• Abuja Declaration on HIV/AIDS, Tuberculosis and Other Related
Infectious Diseases, 2001: Heads of State commit to spend at least 15
% of budgets on Health
• Addis Ababa, African Union roadmap on shared responsibility and
global solidarity for AIDS, TB and malaria response, 2012 Endorsed
Roadmap on Shared Responsibility and Global Solidarity for HIV, TB
and Malaria, Pharmaceutical Manufacturing Plan
• Tunis Declaration on value for money, sustainability and accountability
in the health sector, 2012 Enhance value for money, increase
accountability improve sustainability of health resources
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Domestic Investment 2011: % of total
government expenditure
Rwanda
Malawi
Zambia
Togo
Tanzania
South Africa
Botswana
Nigeria
Kenya
Source:
23.7%
18.5%
16.0%
15.4%
11.1%
10.0%
8.7%
7.5%
5.9%
UNAIDS, Oxford Policy Management, Et al.
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How to sustain an ATM and HSS Response?
1. Increase donor support: getting more from
existing donors or involving new donors
2. Increase domestic financing
•
•
Public or government
Private sector
3. Decrease the cost of the current response by
improving efficiencies in existing programs
But prevent new infections!
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Criteria for Investment in Health and ATM
•
Level of national income, GDP or GNI. An approximation of
resources available within a country
•
Degree to which the Government is able to raise revenue
through taxes, levies, domestic borrowing, or other means.
•
Proportion of Government budget devoted to debt
•
Pre-existing pattern of disbursement to different sectors. For
health if historical allocations have been low, infrastructure may
be poor reducing the short-run capacity to absorb rapid
increases and convert to service delivery.
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Plan for analyzing “Fiscal Space”
Macroeconomic analysis
• Evaluating potential resource needs and resource availability,
identifying future resource gaps and potential ways of
eliminating such financial gaps.
Microeconomic analysis- for eg.
• Assessing potential opportunities to make the 3 largest
interventions efficient:
– ART
– PMTCT
– OVC
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Areas where we are working on with countries
and partners
•
Need for better data to better under which organization is spending what. This is true
of both domestic and international funding-data needs to be improved and
accessible
•
Political leadership is critical, and we have been working are developing advocacy
messages to ensure that health continues to be a priority
•
Revisit the economic arguments for health, including the macro-economic ones
•
Address rigid budgeting practices making it hard to reallocate revenues toward
health
•
Empower Health officials to talk to finance and finance to understand health
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Areas where we are working on with countries
and partners
•
Recognize and improve the role of civil society
•
Address the core question: it is possible to define the “right” mix of domestic and
international investment in any country-will vary country by country.
•
Establish on a country by country basis an acceptable “benchmark” for countries to
invest from their own resources.
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Conclusion
•
No single blueprint for a country’s domestic funding
•
Health expenditure should keep pace with economic growth
•
Need to learn from each other and share best practices
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Thank you.
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