Identifying Key Bottlenecks and Providing Recommendations to Improve the Health Budget in Kenya
November 2020 —
An analysis of Kenya’s national and county health budgets revealed that, while there has been a significant increase in resources allocated to health, gaps in implementation remain. HP+ conducted the study, which found that resources for health comprise just 9 percent of the total government budget; this falls short of the 15 percent recommended by the Abuja Declaration. Furthermore, county budgets continue to be dominated by recurrent expenditures—such as personnel salaries—raising concerns about resource allocation for effective and quality service delivery. The report provides evidence to support key recommendations for national and county governments to more effectively allocate resources to health.
Webinar Features Fiscal Space Analyses of Indonesia and the Philippines
August 2020 —
Since the emergence of COVID-19, the debate on whether health should be re-prioritized in government budgets with explicit allocations and earmarks has re-emerged. On July 27, an HP+ webinar featured recent analyses of fiscal space for health conducted by USAID’s ProtectHealth project in the Philippines and HP+ in Indonesia. In “Fiscal Space for Health in the Era of COVID-19: Constraints and Choices in Preserving Gains for Indonesia and the Philippines,” speakers—including high-level finance ministry officials from both countries—highlighted current fiscal constraints, government budgetary responses to the COVID-19 crunch on revenues, and possible avenues through which additional financing could be raised.
Indonesia Public-Private Partnership Technical Guidelines Move Forward
July 2020 —
Indonesia’s Secretary General of the Ministry of Health expressed support for the swift adoption of new technical guidelines on public-private partnerships (PPPs) and encouraged national and subnational stakeholders to engage in implementation and budgeting for the new guidelines. HP+ has been working with the Indonesian government to develop a blueprint for how to engage in PPPs in non-infrastructure endeavors, such as the training of healthcare workers, management of healthcare facilities, and community-based prevention and promotion activities. The guidelines, which apply to the whole health sector, will soon be finalized and presented to Ministry of Health leadership for adoption.
Legislative Committee Endorses HIV Financing and Sustainability Strategy for Ethiopia
March 2020 —
In January 2020, leadership of a key legislative committee endorsed Ethiopia’s first HIV Domestic Resource Mobilization and Sustainability Strategy, developed with support from HP+. Once approved by the Council of Ministers, the strategy will put in place groundbreaking HIV financing mechanisms, including a US$14 million increase in general government budget allocation to HIV programming and the earmarking of a 0.2 percent tax on the profits of all companies, public and private, with an annual revenue of approximately US$3 million. The strategy is estimated to mobilize US$93 million over five years, increasing from US$15 million in 2021 to US$23 million in 2025.
Mobilizing Government Funding for HIV from Non-Health Sectors in Cambodia
March 2020 —
In recent months, HP+ has supported Cambodia’s National AIDS Authority to identify and budget for HIV-related activities for the coming year in coordination with non-health line ministries. Using the National Strategic Plan for a Multi-Sectoral, Comprehensive HIV/AIDS Response (2019-2023) as guidance—a strategic plan for coordinating the country’s HIV response, produced with HP+ support—the ministries committed approximately US$500,000 to fund HIV-related activities in Cambodia. This commitment supports progress toward achieving the vision of government funding of 50% of the HIV response by 2023 (up from 24% in 2017).
Prime Minister Approves Financing Action for Cambodia’s Integrated HIV/AIDS Response
February 2020 —
Cambodia took a major policy implementation step in its national HIV/AIDS response this month when the Prime Minister approved a resolution directing operational funding for the response and other key advancements, notably the eligibility of all people living with HIV to receive a Health Equity Card and recognition of the important role played by civil society organizations. The resolution also guides the Ministry of Health to amend policies for health center and hospitals to use their own funds for HIV/AIDS activities, in addition to Ministry’s national budget. This achievement represents the culmination of an extensive effort by HP+ Cambodia and its health advisors, who are embedded at the National AIDS Authority (NAA), to advance health financing policy implementation for people living with HIV. This effort included sensitization and capacity building with the NAA leadership and ongoing support for the entire policy advocacy process including the drafting of the board resolutions and proposal to the Prime Minister’s office. Moving forward, the Prime Minister’s directive calls for the Supreme National Economic Council to further study the fiscal space to ensure implementation of the commitments and to sustainably mainstream the HIV/AIDS response through strengthened human resources, procurement, supply chain management, and health information systems. HP+ will continue to support the NAA in implementation of the new guidance.
HP+ Advocacy Prompts Increased Government Funding for ARVs in Cambodia
February 2020 —
As a result of HP+ advocacy support to Cambodia’s National AIDS Authority, the country’s Ministry of Economy and Finance (MEF) agreed to significantly increase funding for antiretroviral drugs (ARVs) over the next three years. The annual increases in funding—from the current allocation of US$1.5 million to US$5 million by 2023—will allow the Global Fund to reallocate resources to critical, underfunded HIV prevention activities. The MEF’s decision supports progress toward achieving the country’s national strategic plan directive that 50 percent of HIV response funding be derived from domestic sources by 2023 and sets a new contribution floor for government ARV funding.
Enhancing Domestic Resource Mobilization in Kenya Through Legal and Policy Analysis
February 2020 —
Kenya’s Public Financial Management Act requires that all funds collected at health facilities be channeled to a country revenue fund, blocking local health departments from control of revenue and compromising quality of care as a result. To address this challenge, HP+ supported the Kilifi Department of Health to assess the legal and policy environment and identify a strategy to redirect US$1.25 million in user fees back to the health sector to support purchase of commodities and cover operational costs. Returning control of domestic resources for health to the health sector is expected to improve quality of care and accessibility of commodities at health facilities.
HP+ Disseminates Subnational HIV Cost Results in Jakarta
November 2018 —
On October 10, in Jakarta, HP+ disseminated cost results from its subnational HIV activity to an audience of more than 50, composed of attendees from the Indonesian government, civil society, and development partners. HP+ collected primary cost data from 19 civil society organizations and “puskesmas” (community health clinics) in Jakarta to identify the unit costs of delivering critical HIV interventions, disaggregated by key population reached and service delivery model. Detailed, updated unit costs are needed to improve estimates of the total resources required to meet provincial HIV targets and to explore the feasibility of increased financing of the HIV response through local government and greater integration into the Jaminan Kesehatan Nasional benefits package—the country's single-payer national health insurance scheme. As a result, the Provincial Health Office for Jakarta, which presented at the dissemination event, committed to using HP+ cost results in its annual budgeting and planning for HIV activities.
HSR2018: Experts Explore Ways to Integrate HIV into Health Insurance in Liverpool
November 2018 —
The fifth Global Symposium on Health Systems Research (HSR2018) was held recently in Liverpool, England. PEPFAR’s Sustainable Financing Initiative (SFI), supported HP+ to co-host an independent side session on October 10, with panelists from HP+, SHOPS Plus, UNAIDS, and USAID. The well-received session, “Beyond Vertical: Sustaining HIV Service Delivery Through Health Insurance,” was moderated by USAID’s Susanna Baker with HP+’s Arin Dutta. Also at HSR2018, HP+ presented two posters at the main conference: one on total market approach and another on women’s leadership and accountability. The latter poster, presented by HP+/RTI’s Christin Stewart, was awarded a “high scorer” prize and was featured on the conference website.
Strengthening Financial Sustainability of Indonesia’s National Health Insurance Scheme
October 2018 —
Indonesia's MoF and other ministries have an interest in understanding whether Indonesia’s national health insurance scheme—Jaminan Kesehatan Nasional (JKN) - delivers a positive and equitable impact on Indonesian’s health and welfare. HP+ worked with the MoF to design a M&E framework for health and with the Government of Indonesia to conduct a comprehensive assessment of JKN. The assessment considers JKN’s long-term financial sustainability and the impact of JKN from various perspectives, including on private health providers' investment decisions, competitiveness, the efficiency of healthcare service delivery, and the impact on the private health market overall, including labor gains. These findings are being used to inform continued investment in JKN and changes to the legal framework for health in the country. In October, HP+ was recognized for ‘Excellence in the Use of Theory of Change’ by the USAID Mission in Indonesia for their work on the JKN comprehensive assessment.
Health Financing Assessment Guides Implementation of Madagascar’s UHC Strategy
May 2018 —
Madagascar’s National Universal Health Coverage (UHC) strategy includes a vision to develop a comprehensive health financing mechanism that will extend the reach of a high-quality essential package of services to more people, especially the poor. As part of this effort, the government is now piloting the National Health Solidarity Fund, a candidate mechanism, to advance the health system towards universal health coverage. To inform health reform decision-making, the USAID-funded Health Policy Plus project conducted an assessment of Madagascar’s current health financing arrangements. Findings from the assessment suggest that Madagascar has a low revenue base, and the health sector relies heavily on donors and out-of-pocket payments to fund key programs and health facility costs. Like many other low-income countries, use of health services is low, health financing pools are fragmented, and financing mechanisms cannot guarantee an essential package of services for most citizens. The assessment also identified opportunities to increase efficiency in budgetary allocation and execution. As the country pilots the National Health Solidarity Fund, this landmark assessment comes at a critical time to inform policies aimed at maximizing financial protection for the poor and vulnerable.
Budget Training Leads to Increased Health Allocations
November 2016 —
In 2015/16 health budgets, 12 of Kenya’s counties collectively committed US$2 million to HIV programs, enhancing these programs’ sustainability. These budget commitments come as a result of program-based budgeting (PBB) training provided to county health teams by USAID through the Health Policy Plus (HP+) project. Additionally, in Turkana county, the health department’s budget allocation increased in the 2016/2017 budget by 16 percent. These increases were informed through the PBB training and the USAID-supported county health accounts, which provided evidence to support the request. HP+ is now in the process of training a further 14 counties to improve program-based budgeting.
Study on HIV Financing Gap Highlights Funding Needs
August 2016 —
Palladium’s Catherine (Barker) Cantelmo and Thomas Fagan presented work conducted under the Health Policy Project at an oral session on health financing chaired by Michael Ruffner (PEPFAR) and David Wilson (World Bank) at the International AIDS Conference. One of the presentations was on a study published in Plos Medicine. This 97-country study estimates that the facility-level ART resource needs for test-and-start from 2016 to 2020 exceed the projected funding available, assuming flat external support yet ambitious domestic resource contribution, and that the five-year funding gap could be as large as $21 billion. The results of the study were cited in a Washington Post article that underscores the need for additional donor funding for HIV, including a fully-funded Global Fund, to sustain the progress made over the last 16 years.