WHO Symposium on Health Financing for UHC

4th Meeting of the Collaborative Agenda on Fiscal Space, Public Financial Management and Health Financing

Background information

Public revenues are central to financing progress towards universal health coverage (UHC). Mobilizing fiscal space through domestic revenues has therefore gained importance in the post-2015 global health agenda. However, weaknesses and rigidities in public financial management (PFM) systems often constrain the efficient use of such revenues, making PFM reform central to the UHC agenda. Motivated by this, WHO’s Department of Health Systems Governance and Financing convened a series of meetings in Montreux, Switzerland, on Fiscal space, PFM and Health Financing policy since 2014 to share knowledge and provide guidance to country related reforms. The first meeting was held in December 2014, building on existing work and dialog on these issues with partner agencies. A follow-up was held in April 2016, to discuss key issues aimed at enhancing productive dialog as countries seek to move towards UHC. In November 2017, the third meeting centred on the practical issues countries face in implementing PFM policies and reforms to institutionalize and sustain progress towards UHC.

Meeting dates and objectives

The fourth meeting was held again in Montreux (Switzerland) on 12-14, November 2019. In addition to WHO colleagues, participants included representatives from Member states, multilateral and bilateral partners, as well as from foundations, civil society organization and academia. The meeting was financially supported by DFID. This fourth meeting took  a more granular approach towards specific health sector PFM and fiscal space issues, including unpacking the links between generic fiscal space and health-specific measures, budget formulation and execution issues in health, and their interrelations with payment systems for health service providers. The specific objectives of the meeting were:

• Provide participants with an update on conceptual developments on fiscal space
• Offer a deep-dive on budget formulation and execution issues for the health sector
• Look at PFM reform from a health service provider perspective
• Define the future PFM/health work agenda with partners

Presentations

• Strengthening social spending in developing countries (D. Coady)

• Assessing fiscal space in the SDG era (S. Gupta) 
• Fiscal space for health:  considerations for implementation (H. Barroy (with S. Gupta and S. Sapatnekar) and J. Cylus))

• Fiscal decentralization and health (S. Yilmaz)

Day 2 - Addressing challenges in health budget formulation and execution

• Design of budgetary programs: key questions for health (H. Barroy, with J. Lakin, E. Dale and L. Mills)

• Implementing programme budgeting in health – links to payment methods (L. Hawkins)

• Budget Execution in Health (M. Piatti-Fünfkirchen and H. Barroy) 

Day 3 – Budget accountability in health

• Accountability for (health) budgets (J. Lakin)
• Improving budget accountability in health through government-civil society collaboration: Insights from Mexico (D. Rajan)
• Performance frameworks for programme budgets friend or foe for better accountability in health? (M. de Jong)

• A few conclusions and reflections on future directions (J. Kutzin)