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Sustainable Financing

HP+ More recent Sustainable Financing publications are available.

  • Tracking health budget allocations is critical in assessing whether resources allocated in the health sector are aligned to key policy objectives as articulated in policy documents. In Kenya, the Constitution requires that at least 15 percent of the national revenues should be allocated to the county governments to fund the devolved functions that include health. This study assessed the trends in allocations between 2013/14 and 2014/15, and sought to establish whether the allocations were aligned to sector priorities both at the national and county level.

  • As part of the USAID-led PEPFAR Sustainable Financing Initiative to increase domestic resources for HIV, the USAID- and PEPFAR-funded Health Policy Project created 31 macro-fiscal and health financing profiles for 18 countries that are transitioning to a higher income status, have high HIV burdens, and/or rely heavily on donor funding. These country profiles assess past trends and future projections in key indicators related to a country's ability to grow economically and dedicate more financial resources to health, including HIV.

    The macro-fiscal profiles provide overviews of each country's economic growth, political economy, and government revenue and expenditure. The health financing profiles analyze government, external, and out-of-pocket spending on health; health financing functions, including revenue contribution and collection, pooling, and purchasing; and HIV financing trends.

    You may download individual briefs on this page.

  • The USAID- and PEPFAR-funded Health Policy Project (HPP) in Kenya helped the Ministry of Health (MOH) secure an allocation of KSh 2.9 billion (approximately US$30 million) in the 2015/16 national budget to purchase HIV commodities and other strategic health commodities. Of this, US$21 to 23 million will go to purchase antiretroviral drugs (ARVs) and HIV testing kits. The remainder will supplement the purchase of malaria and tuberculosis commodities. HPP also helped secure the reinstatement of a line item for an annual allocation for HIV commodities in future national budgets. HPP is also working with private sector pharmacies and hospitals to stock ARVs that can be accessed by those who can afford them. As part of this initiative, the Kenya Medical Supplies Authority has already earmarked ARVs for 10,000 patients to help trigger sales. Innovative efforts, like increasing ARV sales in the commercial sector, can further enhance the sustainability of Kenya’s HIV program and increase access to ARVs and HIV services for those who cannot afford private care.

  • A high proportion of Tanzania’s total health spending comes from foreign donors and households (out-of-pocket), rather than from sustainable sources such as government tax-based revenue or health insurance. While the country has made enormous strides in improving its population’s health, the Government of Tanzania and its development partners recognize that the current health financing structure is not sustainable. The government is now considering several crucial changes to how healthcare in Tanzania is financed; as part of this effort, the country is finalizing a health financing strategy and scaling up new programs to accelerate service delivery coverage and improve quality.

    In support of building a sustainable structure, the USAID- and PEPFAR-funded Health Policy Project reviewed the country’s healthcare financing situation to provide a baseline against which innovation and policy change can be gauged. This report provides a broad overview of the health financing landscape in Tanzania as of 2014 and aims to highlight those aspects suggesting a greater reliance on domestic and sustainable resources to accomplish Tanzania’s health goals. 

  • While Tanzania has made significant progress on priority health indicators, the limited effectiveness of health financing constrains its ability to achieve more.Despite challenges Tanzania is making progress toward sustainable financing. This USAID and PEPFAR-funded Health Policy Project brief explores the country's prospects for sustainable financing and explores the linkages between financing and universal health coverage. 

  • Over the past decade, the performance of Tanzania’shealth system has been mixed. The country will achieve many of its 2015 targets for malaria, HIV and AIDS, tuberculosis, and child health, but progress in reproductive health is lagging. Currently, nearly half of the country’s health budget is covered by donor funding—the largest share in the world. This USAID and PEPFAR-funded Health Policy Project brief provides an overview of Tanzania's existing health system, including: human resources for health, health financing, commodities and supplies, and monitoring and evaluation and health management information systems.

  • In the past decade, PEPFAR has committed significant technical and financial resources to the fight against HIV, working with local partners in target countries to promote prevention programs, increase the number of patients receiving ART, and strengthen national coordination and monitoring of programs. As donor funding stagnates and developing economies grow, it is critical to identify long-term, sustainable sources of domestic funding for HIV to maintain and build upon the successes achieved by low- and middle-income-countries in partnership with PEPFAR.

    As part of PEPFAR’s Sustainable Financing Initiative to increase domestic resource for HIV, HPP created a baseline assessment of the current state of HIV financing in Uganda against which future achievements in domestic resource mobilization can be measured. The assessment analyzes current resource commitments against projected need, estimates future domestic resource needs, and examines efficiency and equity in the use of funds.

  • In the past decade, the President’s Emergency Plan for AIDS Relief (PEPFAR) has committed significant technical and financial resources to the fight against HIV, working with local partners in target countries to promote prevention programs, increase the number of patients receiving antiretroviral therapy (ART), and strengthen national coordination and monitoring of programs. As donor funding stagnates and developing economies grow, it is critical to identify long-term, sustainable sources of domestic funding for HIV to maintain and build upon the successes achieved by low- and middle-income-countries in partnership with PEPFAR.

    As part of PEPFAR’s Sustainable Financing Initiative to increase domestic resource for HIV, the Health Policy Project (HPP) has created a baseline assessment of the current state of HIV financing in Zambia against which future achievements in domestic resource mobilization can be measured. The assessment analyzes current resource commitments from all sources, both domestic and external, against projected resource need under UNAIDS’ 90-90-90 target, to determine future need for new domestic resources in each country, as well examines efficiency and equity in the use of funds, with the goal of maximizing the impact of financial commitments.