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The global movement toward universal health coverage (UHC) is accompanied by requests for large increases in government health spending in some countries. This combined with the global economic situation and stagnant economic growth across many low- and middle-income countries make it more critical than ever to place health financing discussions firmly in the context of macroeconomic and fiscal realities. Unfortunately, there is often a disconnect in decision making, with key fiscal decisions made in the absence of a clear understanding on the one hand of the potential consequences for the health sector, and on the other, the consequences for the country’s macroeconomic and fiscal position of increasing or reallocating government spending. Constructive health financing policy dialogue aims to reach a common understanding between health sector leaders and central budget authorities about policy objectives for the health sector and the resources needed to achieve those objectives, how much priority will be given to health in the government budget, and how the health sector will be held accountable for using funds effectively. This common understanding should be built on a realistic picture of the country’s macroeconomic and fiscal context, the constraints and competing priorities in the budget-setting process. When ministries of health and ministries of finance have a common understanding of macroeconomic and fiscal constraints, discussions can focus productively on using funds within the potential health resource envelope in the most effective way to achieve health system objectives. This guidance note outlines the key components of the macroeconomic, fiscal, and public financial management context that need to be considered for an informed health financing discussion at the country level. The guidance note is organized around four sets of questions that are key to placing the health financing dialogue in the context of a country’s macroeconomic and fiscal context. Each section points to measures, resources, and analytical tools that are available to assist in answering these questions for a specific country. The guidance note draws on case studies from 11 countries moving toward or sustaining universal health coverage conducted as part of the Japan†“World Bank Partnership Program on UHC as well as from other country examples.

"In recent years, many countries have committed to universal health coverage (UHC) as a national policy priority. Since public funds are the cornerstone of sustainable financing for UHC in most countries, the public financial management (PFM) system--the institutions, policies and processes that govern the use of public funds--plays a key role. A strong PFM system can ensure higher and more predictable budget allocations, reduced fragmentation in revenue streams and funding flows, timely budget execution, and better financial accountability and transparency. But the health sector faces some specific challenges that require more flexibility than PFM systems sometimes offer, including the ability to direct funds to where interventions and services are needed and ensure equity while creating incentives for efficiency and quality. PFM systems do not always align with these health financing objectives. Even when PFM reforms support health financing objectives, misalignments can occur due to operational issues or challenges in implementing PFM improvements. 'Aligning public financial management and health financing: sustaining progress toward universal health coverage' outlines areas where the PFM system and PFM rules are crucial for the effective implementation of health financing policy in support of UHC and offers guidance for improving alignment. Many of the steps toward improving alignment between the PFM system and health financing policy are considered good PFM practices in general. But specific measures may be called for to address the particular needs of health budgeting. The main objective is to support productive dialogue between health and finance authorities of finance to better harmonize the PFM system with health financing policy and thereby achieve UHC goals according to principles of good public-sector management. The paper was commissioned by World Health Organization (WHO) and jointly prepared by Results for Development Institute (R4D) and WHO under the auspices of WHO's Department of Health Systems Governance and Financing, Health Financing Unit. It is part of the Collaborative Agenda on Fiscal Space, Public Financial Management and Health Financing Policy."--

The book synthesizes the experiences from Bangladesh, Brazil, France, Ethiopia, Ghana, Indonesia, Japan, Peru, Thailand, Turkey and Vietnam in implementing policies to achieve and sustain Universal Health Coverage. The study focuses on three aspects of UHC reforms: political economy, health financing, and human resources for health.

This volume analyzes Ghana s National Health Insurance Scheme and highlights the range of policy options needed to assure its financially sustainable transition to universal coverage.

The goals of universal health coverage (UHC) are to ensure that all people can access quality health services, to safeguard all people from public health risks, and to protect all people from impoverishment due to illness, whether from out-of-pocket payments for health care or loss of income when a household member falls sick. Countries as diverse as Brazil, France, Japan, Thailand, and Turkey have shown how UHC can serve as vital mechanisms for improving the health and welfare of their citizens, and lay the foundation for economic growth and competitiveness grounded in the principles of equity and sustainability. Ensuring universal access to affordable, quality health services will be an important contribution to ending extreme poverty by 2030 and boosting shared prosperity in low-income and middle-income countries (LMICs), where most of the world's poor live. The book synthesizes the experiences from 11 countries Bangladesh, Brazil, France, Ethiopia, Ghana, Indonesia, Japan, Peru, Thailand, Turkey and Vietnam in implementing policies and strategies to achieve and sustain UHC. These countries represent diverse geographic and economic conditions, but all have committed to UHC as a key national aspiration and are approaching it in different ways. The study examined the UHC policies for each country around three common themes: (i) the political economy and policy process for adopting, achieving, and sustaining UHC; (ii) health financing policies to enhance health coverage; and (iii) human resources for health policies for achieving UHC. The findings from these country studies are intended to provide lessons that can be used by countries aspiring to adopt, achieve, and sustain UHC. Although the path to UHC is specific to each country, countries can benefit from the experiences of others in learning about different approaches and avoiding potential risks.

The purpose of this study is to document the approaches of the World Bank and the Global Fund to monitoring and evaluation (M&E), and to systematically and objectively compare the principles and objectives of the M&E systems and how these systems are implemented and used in practice at the country level. The report also discusses the relationship of the M&E systems to the two different business models of the World Bank and the Global Fund. The first goal is to identify whether and how the conclusions that emerge from their M&E systems on the effectiveness of their respective global health activities can be compared. The second goal is to contribute to the ongoing process of identifying good practices for developing M&E policies for global health programs, setting up M&E frameworks, planning and programming evaluations, and using M&E results more effectively to manage programs and strengthen the health policy process in partner countries. The report is organized as follows. Section two summarizes the World Bank's stated policies and approach to monitoring and evaluation. Each element of standard M&E systems framework; system of indicators and performance measurement; data collection and analysis; feedback and use of monitoring findings; and evaluation is described for the World Bank's approach in this section. Section three summarizes the Global Fund's stated M&E approach and policies according to the same structure. Section four compares the application of the approach to M&E of the two agencies in Burkina Faso, Lesotho and Russia. Section five provides a summary of the comparison between the two approaches to M&E. Section six identifies conclusions and lessons learned.