Strained government budgets and reductions in external funding mean that developing countries must find new and innovative ways to finance their health systems and cover healthcare costs. As countries move from low- to middle-income status and increase their tax revenues, they are being asked to shoulder greater financial responsibility for financing health services. This shared responsibility for funding health is reinforced by financing mechanisms such as the Global Financing Facility and PEPFAR, both of which emphasize the increasing role of domestic resource mobilization—a process by which countries raise and spend their own funds in order to finance public services like healthcare.
HP+ provides technical support to governments in low- and middle-income countries, assisting them to effectively engage in domestic resource mobilization, put in place sustainable financing mechanisms that will go beyond meeting the short-term needs of specific disease programs, and make progress toward universal health coverage (UHC) goals. HP+ also provides support to private sector players to help them effectively contribute to a sustainable health financing agenda; and to civil society to help them identify effective platforms from which to advocate for adequate and sustained health funding. Taken together, these efforts increase healthcare access, deepen the scale and depth of services, and increase financial protections for the most vulnerable.
The project’s health financing work falls into seven main categories:
Reforming Health Financing for Universal Health Coverage
To help countries reform their health financing and make progress toward UHC, HP+ is providing technical assistance to governments to develop and implement national health financing strategies to improve and sustain the quality, availability, and equity of health service delivery, while also protecting the poor.
Advancing Health Insurance
HP+ supports the scale up of health insurance mechanisms as a way to mobilize additional, sustainable revenue, promote cross-subsidization through risk pooling, and incentivize high-quality service delivery of essential health services through appropriate provider payment mechanisms.
Increasing Domestic Resources for Health
Under the USAID-led PEPFAR Sustainable Financing Initiative, HP+ is building evidence and working with country stakeholders to increase health funding, mobilize domestic resources, promote program based budgeting, and explore a range of innovate financing mechanisms. Other activities include developing the investment case for the Global Financing Facility for Reproductive, Maternal, Newborn, Child, and Adolescent Health; providing analytics on national health insurance systems; program-based budgeting; and crafting frameworks to determine appropriate levels of domestic health funding.
Improving Technical Efficiency
To help countries achieve technical efficiency and generate savings, HP+ is identifying bottlenecks that impact service delivery; harmonizing supply chains and reducing wastage; and supporting public financial management initiatives that promote better planning and budgeting.
Engaging the Private Sector
To achieve UHC and ensure healthcare is both affordable and sustainable, HP+ is supporting governments’ engagement with the private sector by generating evidence, building government stewardship capacity, and acting as a neutral convener.
Mainstreaming Vertical Health Programs
To achieve equitable and improved health outcomes and UHC, countries are now considering how they can allocate scarce health resources across various health areas instead of to vertical health programs (HIV and AIDS, family planning, etc.). To support this shift, HP+ is using policy models to generate evidence, inform strategic decisions, and build the capacity of ministries of health to advocate for increased health funding in the face of competing priorities.
Generating Evidence
To help mobilize resources, determine economic benefits, and inform policy and programmatic decision-making and priorities, HP+ is costing national strategic plans and program operational plans and conducting cost-effectiveness analyses.
In 2014, Nigeria established the Basic Healthcare Provision Fund with the aim to remove financial barriers to accessing heath coverage, especially amongst the poor.
HP+ is examining how countries with near UHC have made progress; how social health insurance mechanisms are working in those countries and to what extent they cover FP services; and what drives variations in coverage between countries to help lessen disparities and make progress toward universal access to family planning.
The Family Planning Financing Roadmap allows family planning stakeholders to learn more about health financing concepts and how they relate to family planning and understand options for financing family planning given a particular country’s context.
HP+ partnered with the National Team for Accelerating Poverty Reduction, known as TNP2K, and other actors within the Government of Indonesia to conduct a comprehensive assessment of JKN. The assessment considers the impact of JKN from four perspectives—the payer, patient, provider, and private sector.
Government of Nigeria Approves Measures to Strengthen and Sustain HIV Financing
July 2022 —
In May 2022, the Government of Nigeria approved two memos, presented by HP+ at the 6th National Council on AIDS Conference. The memos call for sustainable HIV health financing reforms, including implementation of Nigeria’s HIV domestic resource mobilization and sustainability strategy—developed and launched with HP+ support in 2021—and the strengthening of public financial management. Nigeria's National Agency for the Control of AIDS will now work in close collaboration with state AIDS control agencies, the Ministry of Health, domestic resource mobilization multisectoral technical working groups, civil society organizations, and HIV implementing partners to implement the domestic resource mobilization strategy and strengthen public financial management and budget advocacy efforts. This work will take place across Nigeria’s 36 states and the Federal Capital Territory to improve government financing, reduce funding gaps, and ensure improved HIV outcomes and sustainability of Nigeria’s HIV response. Read our news story for more on this accomplishment.
Kenya Ministry of Health Posts National and Country Health Budget Analysis
June 2022 —
The Kenya Ministry of Health, for the first time, published the National and County Health Budget Analysis, FY 2020/21 to its public website, demonstrating the importance of this report in providing evidence for the country’s health sector resource mobilization and health planning and budgeting efforts. HP+ supported Kenya’s Ministry of Health to develop the analysis report, which examines how public health sector financial resources were allocated for the 2020/21 fiscal year in comparison to the allocation patterns of the preceding two years. Findings show that while Kenya has not yet attained the recommended allocation to health contained in the Abuja Declaration, the government has made significant progress, increasing allocation to 11 percent of the total government budget in 2020/21, from 7.5 percent allocated in 2014/15. Continuing this trend will help Kenya progress toward achieving sustainable financing for health and reduce dependence on external assistance. Other findings show that county governments spend the majority of their funds on the payment of staff salaries, which can limit funds available for other key inputs such as drugs. Further, county governments allocate more funding to curative care than to preventive and promotive care. These and other findings in the report provide evidence for national and county policymakers and decisionmakers to inform public health budget allocation planning at both the national and county level. The report is also available on the HP+ website.
Gonzalez-Pier Joins Panels on Primary Healthcare and Universal Health Coverage at World Bank Forum
June 2022 —
Health Policy Plus’s health financing lead, Eduardo Gonzalez-Pier, participated in the Annual Health Financing Forum (AHFF) on June 14–16 in Washington, DC. The annual event was co-hosted by the World Bank, USAID, and the Global Financing Facility. This year’s meeting, which assembled government officials, policy experts, and donor agencies from the health and financing sectors focused on mobilizing and pooling funds to pay for primary healthcare. Dr Gonzalez-Pier joined three deep-dive panels that explored how to protect primary healthcare resources through the frontline, building trust in health financing decisions for universal health coverage, and the role of taxes to promote health and increase funding. The meeting agenda was designed around the new “Lancet Global Health Commission on Financing Primary Health Care: Putting People at the Centre,” which promotes the vision that healthcare needs to be more effective, responsive, equitable, comprehensive, and primary healthcare-centered to be fully aligned with the objectives of universal health coverage. The forum discussions made evident that spending more and spending better on primary healthcare requires a balanced technical and political approach that needs to be supported by data-driven collaborative research, adoption of implementation science, and a deep understanding of political economy considerations. Promoting increased and open cross-country dialogue on lessons learned from locally relevant universal health coverage experiences is essential as countries emerge from the pandemic and set health systems back on track to meet the 2030 agenda.
HP+ Hosts End-of-Project Event in Mali
June 2022 —
For seven years, HP+ has worked with government and partners across Mali’s health system. Results and accomplishments were highlighted Thursday, June 9 with an end-of-project event in Bamako. Over the last two years, HP+ in Mali focused on health financing, health system strengthening, and health equity. Representatives of Mali’s National Health Insurance Fund and Devolution and Decentralization Support Team emphasized the importance of the in-depth health financing analyses HP+ conducted to support Mali’s health system. Analyses have focused on provider payment systems, health finance flows, and efficiency and equity at all levels, and were completed in collaboration with key partners. Also noted at the event was HP+’s role in advancing advocacy for community health worker (CHW) rights and legal status. These efforts led to the recent adoption of a decree enshrining the formal status and rights of CHWs, marking a transformative step toward making essential community healthcare sustainable and accessible for all Malians. In closing her remarks at the ceremony, Director of Health at USAID/Mali Julia Henn emphasized, “Although HP+ is coming to a close, we are still with you and will continue to support the Malian population.”
Seven Years Catalyzing Universal Health Coverage Reforms in Nigeria
May 2022 —
On May 19, Nigeria marked seven years of work between the government, local stakeholders, and the Health Policy Plus (HP+) project with an in-person event, streamed live. The event focused on sharing knowledge and discussing how to sustain gains in locally led development, equity for health services, and improved access to care in family planning and reproductive health, maternal and child health, HIV, and tuberculosis across Nigeria. As Dr. Ngozi Azodoh, director of the Planning, Research and Statistics Department, of Nigeria’s Federal Ministry of Health (FMOH) told the gathering: “Like Oliver Twist, the FMOH wants more. [More] support from the HP+ team and the project director and an expansion of the scope of work in Nigeria … to help the Ministry of Health build a stronger health system and work towards meeting the country’s health goals.” Project director, Suneeta Sharma, attended the event and spoke to the more than 70 attendees present, including representatives of the FMOH, the National Agency for Control of AIDS, the National Health Insurance Scheme, the National Primary Health Care Development Board, the chairman of the Senate Committee on Primary Health Care and Communicable Diseases, implementing partners, civil society and private sector organizations, USAID Nigeria, and the media.
Budgeting Process for Madagascar’s Health Sector Strategic Plan Reduces Financing Gaps
April 2022 —
Government stakeholders collaborated with HP+ to reduce the resource need gap and ensure efficient and needs-based resource prioritization for the health sector. Using the OneHealth Tool and other classification methodologies, stakeholders reached consensus on the essential health programs, interventions, and inputs for the strategic plan. Presenting key challenges, lessons learned, and recommendations for the future, this brief can be used to advocate for increasing domestic resources for Madagascar’s health system and to inform the Malagasy government, as well as a wider audience beyond Madagascar, about best practices and potential pitfalls with the financial planning process for a health sector strategic plan.
Kenya Launches HP+-Supported Health Financing Strategy
February 2022 —
President Uhuru Kenyatta launched the 2020–2030 Kenya Health Financing Strategy during the Annual Universal Healthcare Conference on February 7, 2022. The launch signals the government’s commitment to reform the health sector and achieve sustainable, high-quality services for all Kenyans. Among other priorities, the strategy recommends instituting mandatory pre-payment revenue generation from health insurance premiums, replacing out-of-pocket payment at the point of service, guided by fairness and affordability for different income levels. (This recommendation was adopted in a 2022 amendment to the National Health Insurance Fund Act, which has made membership in the fund mandatory for all Kenyans 18 years of age and above.) HP+ provided technical assistance to the Ministry of Health to develop and finalize the strategy, including facilitating stakeholder engagement and advocacy, generating evidence to inform policy priorities, and assisting with drafting the document. HP+ also supported the ministry to develop a communications and advocacy plan, an abridged version of the strategy, frequently asked questions, and a poster to facilitate dissemination. Read more about HP+’s support, lessons learned, and recommendations, including an interview with HP+ Kenya staff Stephen Muchiri and David Khaoya.
Workshop Validates Madagascar’s National Health Financing Strategy
January 2022 —
HP+ Madagascar has been supporting the Ministry of Public Health to draft a national health financing strategy to advance universal health coverage in the country. In December 2021, the ministry’s Secretary General led a workshop to validate the strategy with participants from technical and financial partners, civil society organizations, and the private sector. Throughout the strategy development process, HP+ supported staff to assess the country’s existing health financing mechanisms, develop national health financing goals, and define the strategy’s vision, objectives, and strategic axes. HP+ also played a role in supporting government partners to understand the purpose and importance of the strategy while facilitating dialogue between government actors, parliamentarians, donors, partners, and civil society representatives to ensure collective ownership of the strategy through a participatory, collaborative, and inclusive process. HP+ will now integrate stakeholder input into the strategy, coordinate finalization and dissemination, and support the development of an implementation plan and monitoring, evaluation, and governance frameworks.
Webinar Explores Whether Blended Financing Can Help Catalyze Commercial Engagement in Health
December 2021 —
On November 30, 2021, HP+ hosted a thought-provoking webinar discussion on the challenges and opportunities in catalyzing the private sector’s investment in health, including for family planning commodities. The speakers, including Denise Harrison from USAID’s Commercial, Security and Logistics division of PRH and Monisha Ashok of the Center for Innovation and Impact joined with Palladium and Salient Advisory representatives and Caspian, an Indian venture debt company investing in health, to discuss findings of recent studies of commercial engagement in the family planning and health products space in India and four countries in Africa. The studies found challenges to attracting commercial sector investment in each region were similar and include financing, regulatory, and pricing constraints. However, discussions highlighted innovations that could be applied and supported by patient and risk tolerant capital provided by donors to mitigate risk for investors such as development impact bonds, credit funds, and multistakeholder grant-making mechanisms to support innovation and scale up. The speakers noted that rapid advances of digital innovations necessitated by the COVID-19 pandemic are demonstrating that capacity and opportunities exist. Speakers challenged listeners and one another to be bold and risk-averse in pursuing and financing innovations as this field of blended financing advances.
Madagascar Public Financial Protection Law to Improve Health Sector Funding Championed by Parliament
October 2021 —
A significant policy win was achieved as HP+ Madagascar supported the development of the Public Financial Protection Law, which is intended to create a more favorable legal environment in support of universal health coverage. At a meeting with parliamentarians that HP+ helped organize in May 2021—a rare collaboration between the Ministry of Health and parliamentarians—the parliamentarians accepted the importance of the law and proposed to be part of the process of carrying it forward to advance equitable healthcare access. The president of the National Assembly’s Public Health Commission was particularly engaged and volunteered to personally carry forward the Public Financial Protection Law. The law includes the creation of a new National Health Solidarity Fund, which will be financed through direct transfers from the national budget, private donations, and external funding and will cover contributions for poor and vulnerable populations. Now that the parliament has bought in, they are developing both the law and the national strategy for health financing alongside partners such as the Ministry of Finance and Budget and Ministry of Decentralization. Next steps include establishing a coordination mechanism between the National Assembly and the Ministry of Health and conducting further advocacy in favor of increasing the state budget for the health sector.
HP+ Supports Kenya to Secure More Than US$440 Million from Global Fund
August 2021 —
The government of Kenya and the Global Fund to Fight AIDS, Tuberculosis and Malaria recently kicked off a three-year, US$440-million project to combat these diseases over the next three years. The Global Fund grant, executed in July, will enable Kenya to implement activities in HIV, tuberculosis, and malaria, as well as cross-cutting areas such as integrated service delivery and quality improvement, human resources for health, financial management systems, and health sector governance and planning. HP+ developed and implemented methodologies to cost the proposed interventions and identify counties that meet the co-financing requirement. HP+ also conducted the HIV funding landscape analyses and developed the malaria program’s plans for sustainability, transitioning, and health financing. With the Global Fund grant, Kenya will bring more HIV-positive clients into antiretroviral treatment with a goal of reaching 90 percent coverage by June 2025 and expand distribution of insecticide-treated nets, benefitting 21.6 million people. It will increase intermittent preventive treatment of malaria in pregnancy, and enhance community-based systems for service delivery, among other interventions. The government of Kenya and partners AMREF Health and Kenya Red Cross will implement grant activities and pursue a transition to sustainable financing.
Staff and Partners Share HP+ Results and Lessons Learned at the International Health Economics Association Meeting
July 2021 —
Sessions on presenting evidence and ideas on public financial management, the health impacts of COVID-19, and health insurance financing were among those delivered by HP+ researchers at this year’s International Health Economics Association (iHEA) online congress. Representatives from HP+ Kenya, Malawi, and Nigeria hosted an organized session on the need for a strong public financial management system and the challenges faced by many countries in delivering better spending in their journeys toward universal health coverage. HP+’s Rebecca Ross collaborated with the London School of Hygiene and Tropical Medicine to convene an organized session, presenting results from a mixed method study on the impact of Indonesia’s national health insurance scheme on the competitive landscape of public and private healthcare providers. View HP+’s sessions.
Policy Action in Kenya Encourages Local Malaria Control Funding
May 2021 —
At a meeting of the Lake Region Economic Bloc (LREB) last week, representatives proposed progressively increasing malaria control county budget allocations to procure at least 10% of their malaria commodities and supplies. This reflects a key HP+ health financing recommendation for malaria control in the eight bloc counties that are a focus of the President’s Malaria Initiative. In Busia, Bungoma, Vihiga, Homa Bay, Kakamega, Kisumu, Migori, and Siaya counties, HP+ analysis showed that underfunding for malaria control has persisted even as overall county health budgets have increased. HP+ data further showed that over the years in these eight counties, there has been low absorption—actual spending—of malaria control funds coupled with heavy reliance on donor funding for key malaria commodities. The evidence on funding will be used to inform county priority-setting in these counties, which are located in an endemic malaria zone and participate in the LREB.
HP+ Identifies 3 Potential Pathways for Blended Finance for Family Planning
April 2021 —
HP+ is exploring three new areas for implementing blended finance in family planning as the first step in developing financing models for USAID consideration. In December HP+ virtually convened 27 experts—USAID representatives, implementing partners in family planning, development finance experts, and impact investors—to explore how stakeholders can use blended finance to help expand modern contraceptive use. Three areas for opportunity came into focus: (1) market introduction/shaping and market access, (2) innovation in distribution channels and point-of-sale, and (3) new direct-to-consumer technologies. Blended finance is the strategic use of public and donor resources to mobilize private capital to achieve development outcomes, including addressing health. Such arrangements have been used to address climate change, access to clean water, and other economic development issues.
Online Policy Forum Unpacks Policy and Financing Challenges to Reduce Maternal Mortality
March 2021 —
How best to improve maternal health access and quality in resource-constrained settings was the focus of an online policy forum convened by HP+ on March 23. The session—Quality v. Coverage: Is There a Trade-off in Financing Maternal Health?—highlighted the continued high level of maternal mortality despite increases in facility-based births. It explored the push and pull that policymakers must face when planning and allocating resources aimed at increasing access and quality. Led by Elena Ateva, HP+’s maternal health lead, the discussion featured Alison Morgan of the Global Financing Facility, Nana Twum-Danso of the Rockefeller Foundation, and Aparajita Gogoi of the White Ribbon Alliance/India. In addition, HP+’s Dorit Stein shared recommendations from a research study on strategic health purchasing reforms for maternal and neonatal health services and Aparajita Gogoi shared results from the What Women Want campaign and accompanying dashboard of women’s responses
Community Health Workers in Mali: HP+ Explains How to Lower Costs and Maintain Quality
March 2021 —
A recent peer-reviewed journal article by HP+ staff and consultants explains how Mali can reduce its spending on community health workers without sacrificing quality. The article in Global Health Science and Practice concludes that US$13.01 million expended in 2015 for a package of 23 services, including contraceptive injections and oral contraceptives, could have been reduced to US$8.36 million, if standard care protocols were followed. The article also notes that geographic targeting in rural areas is a particularly productive strategy for optimizing service delivery. The analysis appears at a time when 88 percent of funding for Mali’s community health workers is derived from donors and is thus vulnerable to declines in international funding. The publication is part of a 15-article supplement Communities as the Cornerstone of Primary Health Care: Learning, Policy, and Practice, which explores how countries are reinvigorating primary healthcare systems with communities across diverse settings. The supplement’s editorial notes HP+’s innovation in finding efficiencies and geographic targeting to reach underserved communities.
Malawi Youth Leverages USAID Training into Budget Advocacy
March 2021 —
A Malawi youth is using skills acquired at a recent USAID-funded training to advocate for youth-friendly health services (YFHS) in his home district of Mwanza. He is one of 15 Malawi youth leaders HP+ trained in health budget advocacy with the goal of increasing young people’s engagement in health budget processes. After the training in November, the youth developed an advocacy action plan focused on increased budget allocations for YFHS and presented it to representatives of the Mwanza CSO Network in December. The CSO Network pledged its support, committing to engage a member of Parliament as a strategic partner to strengthen the advocacy community in Mwanza. HP+ will be monitoring the implementation of this action plan for the next nine months.
Mali Finalizes its Global Financing Facility Investment Case and a Monitoring Plan for the Country’s 2018-2023 Health and Social Development Plan
February 2021 —
Mali has joined the Global Financing Facility (GFF), giving the country potential access to development funding from the World Bank and other donors worldwide, and helping to improve financing efficiencies for health. The country took the final step in unlocking access to GFF funding at a December workshop, when it completed its investment case for reproductive, maternal, newborn, child, and adolescent health (RMNCAH). At the same time, Mali finished development of a monitoring framework for its Health and Social Development Plan, which is tied to the RMNCAH investment case. Finalization of these key strategic documents is essential for the social health sectors and Mali’s intention to achieve the Sustainable Development Goals. The country’s GFF investment case seeks an improvement in health outcomes, including a reduction in maternal mortality from 325 to 146 per 100,000 births by 2023 and a reduction of the proportion of women 15-49 years who have experienced gender-based violence from 10.8 percent in 2018 to 2 percent in 2023. HP+ organized the December workshop with the Ministry of Health and other stakeholders to finalize the document and facilitated remote participation of some partners.
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.
