Seventh Annual Health Financing Forum: Investing in Health in the post-COVID era

Universal Health Coverage (UHC) is a Sustainable Development Goal that aims to ensure quality health services for all without financial hardship. High out-of-pocket spending in low- and middle-income countries exacerbates financial risk and impedes care for vulnerable populations. This session will examine the "Tracking Universal Health Coverage: 2023 Global Monitoring Report," focusing on global and regional financial hardship trends and their policy implications. This session will discuss results from the “Tracking Universal Health Coverage: 2023 Global Monitoring Report”, highlighting global and regional trends in financial hardship in health and policy implications.

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Aligning external aid with national plans and systems is essential for governance and financing mechanisms in health. This panel will feature Ministers of Health and Finance and donor community leaders discussing aid alignment, Public Financial Management reforms, and visions for success in reproductive, maternal, newborn, child, and adolescent health and nutrition outcomes.

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Climate change is a critical health issue, especially for developing countries that bear the brunt of its impacts. Although all countries contribute to global warming, it is low-income countries that bear the largest burden in terms of the increase the risk of heat-related illnesses as well as infectious diseases and malnutrition, among others.  With an increase in the incidence, severity and distribution of climate-driven health outcomes, there is an increase in demand for essential health services. At the same time, climate change affects the ability of health systems and infrastructure to deliver services effectively.  This session will particularly delve into the challenges faced by health systems in adapting to effects of climate change. The session will discuss the need for urgent action to scale-up investments and mobilize funding to support countries in implementing climate-health initiatives focused on adaptation to these challenges. And it will also examine opportunities for making health systems more resilient and sustainable to climate-related health shocks, while at the same time mitigating any avoidable action that contributes to greenhouse gas emissions and the global carbon footprint.

The financial sustainability of the HIV response is multifaceted, involving political, service delivery, and system factors. Panelists will share country-level actions and reforms to sustain HIV response gains, contextualized by trends in donor funding and health expenditures.

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The increasing global refugee population places a strain on health systems in host countries. This session aims to reflect on the initial global cost estimates of refugee inclusion in host countries’ health systems and discuss what the inclusion would mean for host countries? Additionally, the session will discuss the existing financing mechanisms for refugee health care and what other innovative financing instruments could be developed.

Health financing is crucial for achieving universal health coverage, especially in low and middle-income countries (LMICs), which face common challenges such as stakeholder engagement, fiscal constraints, and capacity gaps in policymaking. These challenges have been exacerbated by the COVID-19 pandemic. This session highlights efforts to improve healthcare financing in Africa. The session aims to highlight the benefits of south-south learning for impactful health financing reforms across the continent.

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This session will discuss the use of capitation-based payment systems in Latin America and the Caribbean, with experiences from Chile and Argentina. It will also present progress on regional collaborative initiatives between the World Bank, the IDB, and PAHO on primary health care financing.

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Health budget formulation and execution decisions are often made through opaque processes and are commonly based on weak evidence and participation, with limited oversight. Processes that fail to duly consider the perspectives of all those whose interests are at stake can lead to inequitable decisions driven by the interests of the powerful. This workshop examines how every element of the budget cycle can be rendered fairer and explores how greater openness and inclusivity throughout the health budget cycle might assist. Engage participants in reflection on how elements of the budget cycle in countries with which they have experience could be improved in terms of openness and inclusivity. Participants will be encouraged to discuss targeted and specific measures and their practicality. Discussion will focus on the potential benefits and costs of such measures, as well as on potential barriers to and enablers of fairer decision-making. 

Health taxes can generate fiscal and health benefits without adverse economic impacts. This session will focus on the design, implementation, and evaluation of health taxes, and how revenue can be directed towards health sector priorities.

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Efficient and accountable budget execution is crucial for UHC progress. This session will explore trends, causes, and solutions for budget execution issues, and discuss the roles of ministries of finance, health, and local government in reform efforts.

Health systems in many countries collect vast amounts of data, which can inform policymaking. This session will teach participants how to analyze healthcare claims data for health system policy analysis, focusing on predictive analytics for utilization episodes.

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It has been made before, but making the economic case for health remains critically important. While there is a need to update this case, to account for factors not previously included (COVID-19 and climate change), it is also important to consider and make the political case. Investing more in health and moving it up the policy agenda is ultimately a political decision. Moving health up the policy agenda requires understanding the perception of health by finance ministers and heads of state among competing policy priorities, and how they navigate the delicate balance between investing in health and other sectors.

In this session, participants will collectively explore the reasoning, incentives and enabling factors behind finance ministers' and senior officials' choices to prioritize or not prioritize investments in health over other sectors.

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Health budgets - one of two major entry points to increase the prioritization of health in government spending - are often seen as the result of an annual, formalized negotiation process between MoF and MoH, eventually with some influence of local and global advocacy efforts. However, this narrow view has multiple caveats. The political economy of the budget process is often much more complex and remains poorly understood.

In this session, participants will strengthen collective understanding of the budget process, the key challenges in prioritizing health, and emerging strategies to secure more budgetary funding for health. Participants will share latest evidence and country examples to address the key questions: What is the political economy of budget processes, and what are the institutional and structural factors impacting health-sector allocation? How have some countries managed to increase the priority for health in government spending? How can the budgeting process be influenced to secure adequate funding for health, including the role of non-governmental actors and donors?

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Aligning government health expenditures with sector priorities to improve the efficiency and fairness of spending is particularly difficult, with budget constraints currently dominating the macro-fiscal outlook in many countries. A key concern is the method of redistributing funds across programs, which depends on the complexities of public financial management systems and the intricacies of budgetary procedures. Additionally, the role of health sector entities and other interested parties in guaranteeing that funds are directed to programs where they will have the most impact is a critical consideration.

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This Special Session will explore the potential for strategic interaction between ministries of health and finance beyond regulated yearly interactions. The African Economic Research Consortium (AERC) will present their experience in Kenya, followed by a facilitated discussion with MoH and MoF officials sharing experiences and actionable steps for enhanced dialogue.

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Since 2020 the AHFF has held a Memorial Lecture in honor of Adam Wagstaff, research manager at the World Bank, professor of economics, mentor, and associate editor of the Journal of Health Economics.  This year’s session will also honor the awardee of the Adam Wagstaff Award (AWA) for Outstanding Research on the Economics of Healthcare Financing and Delivery in Low- and Middle-Income Countries, established by IHEA.

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Development Assistance for Health (DAH) is and will continue to be an important source of funding for LICs and LMICs. However, DAH and, more broadly, overall development assistance for all sectors stagnated before COVID-19, and their future is uncertain as the economic performance of some of the major bilateral aid providers weakens. Further, in the post-COVID-19 era, emerging development priorities, might mean that an increasing share of the available development assistance is used to create global public goods rather than arriving in countries in a form that boosts government health expenditure.

In this environment, recipient countries will need to make better use of the available development assistance to boost its impact on government health spending.

This session aims to shed light on the prospects for overall development assistance and DAH over the coming years. Participants will share their experiences of how overall development assistance and any component earmarked for health impact on country sectoral allocations and spending on priority programs within the health budget. The objective is to understand how development assistance can better boost government health spending.

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The challenge of aligning health-related government expenditures with the strategic imperatives of HEPPR to boost both the efficiency and fairness of funding is exacerbated in the recent period by concurrent crises, and a bleak macro-fiscal outlook. It is vital to understand the role that different stakeholders can play in ensuring that HEPPR priorities are funded, given their significant impact on health system outcomes. Beyond stakeholders and their political economy interests, it is also crucial to understand the institutional, public financial management and contextual factors affecting HEPPR government financing.

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The second major entry point to increasing the prioritization of health in government spending is through obligatory social health insurance (SHI) contributions - Despite controversies about its advisability, many LIC and LMIC governments have been experimenting with forms of SHI. For those governments that have already introduced SHI, the ongoing debate over the when and where is not all too helpful. Once in place, SHI arrangements are difficult to abolish. The SHI debate may shift the attention of health policymakers away from health financing challenges that are far more critical for progress toward UHC. What governments of LICs and LMICs do need to know today is the existing evidence and country examples on the additional revenue that SHI arrangements can realistically generate, and what are better SHI design options to mitigate or avoid the negative consequences on financing, equity and labor markets.

In this session participants will therefore address: How can we increase resources from mandatory SHI contributions and what factors influence this (e.g., size of the informal sector, enforcement and collection capacity, etc.): what is the political economy of expanding SHI to the poor and informal non-poor: what are policy options to reduce the impact of SHI on informality and on equity of access? How do the drawbacks of SHI compare to the benefits of raising additional revenues for health? How can existing SHI models evolve into more sustainable approaches and what has been the path followed by successful models of SHI?

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