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Financing arrangements in health sector under sector-wide management

Lo Veasnakiry Ministry of Health, Cambodia (2014) C3

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Health sector financing by centre and states/UTs in India, 2015 -16 to 2017-18

National Health Accounts Cell Ministry of Health & Family Welfare Government of India (2018)

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Towards Mapping the Fiscal Space: Health Sector Financing Strategy in Mozambique

N’weti, Wemos (2024) CC

This paper was commissioned by N´weti and Wemos as part of the project “Equitable health financing for a strong health system in Mozambique”. Its purpose is to contribute to the debate of the Mozambican Ministry of Health’s draft Health Sector Financing Strategy (HSFS) 2025 – 2034

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Africa’s Health Financing in a New Era

Africa Centres for Disease Control and Prevention (Africa CDC) (2025) CC

Africa’s health sector is facing an unprecedented financing crisis, driven by a sharp decline of 70% in Official Development Assistance (ODA) from 2021 to 2025 and deep-rooted structural vulnerabilities. This collapse is placing immense pressure on Africa’s already fragile health systems as ODA ...is seen as the backbone of critical health programs: pandemic preparedness, maternal and child health services, disease control programs are all at risk, threatening Sustainable Development Goal 3 and Universal Health Coverage. Compounding this is Africa’s spiraling debt, with countries expected to service USD 81 billion by 2025—surpassing anticipated external financing inflows—further eroding fiscal space for health investments. Level of domestic resources is low. TThe Abuja Declaration of 2001, a pivotal commitment made by African Union (AU) member states, aimed to reverse this trend by pledging to allocate at least 15% of national budgets to the health sector. However, more than two decades later, only three countries—Rwanda, Botswana, and Cabo Verde—have consistently met or exceeded this target (WHO, 2023). In contrast, over 30 AU member states remain well below the 10% benchmark, with some allocating as little as 5–7% of their national budgets to health. In addition, only 16 (29%) of African countries currently have updated versions of National Health Development Plan (NHDP) supported by a National Health Financing Plan (NHFP). These two documents play a critical role in driving internal resource mobilisation. At the same time, public health emergencies are surging, rising 41%—from 152 in 2022 to 213 in 2024—exposing severe under-resourcing of health infrastructure and workforce. Recurring outbreaks (Mpox, Ebola, cholera, measles, Marburg…) alongside effects of climate change and humanitarian crises in Eastern DRC, the Sahel, and Sudan, are overwhelming systems stretched by chronic underfunding. The situation is worsened by Africa’s heavy dependency with over 90% of vaccines, medicines, and diagnostics being externally sourced—leaving countries vulnerable to global supply chain shocks. Health worker shortages persist, with only 2.3 professionals per 1,000 people (below the WHO’s recommended 4.45), and fewer than 30% of systems are digitized, undermining disease surveillance and early warning. Without decisive action, Africa CDC projects the continent could reverse two decades of health progress, face 2 to 4 million additional preventable deaths annually, and a heightened risk of a pandemic emerging from within. Furthermore, 39 million more Africans could be pushed into poverty by 2030 due to intertwined health and economic shocks. This is not just a sectoral crisis—it is an existential threat to Africa’s political, social, and economic resilience, and global stability. In response, African leaders, under Africa CDC’s stewardship, are advancing a comprehensive three-pillar strategy centered on domestic resource mobilization, innovative financing, and blended finance. more

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Reforms in the Health Sector in Ukraine. Revolutionizing care: Ukraine's sectoral approach to anti-corruption health

Steingrüber, S. World Bank (2022) C2

Following the 2014 Euromaidan Revolution, Ukraine embarked on a national reform program to reduce widespread corruption within government. In the health sector, the government introduced several complementary reforms that aimed to improve the health outcomes of Ukrainian citizens, but designed in su... more

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Financing transformative health systems towards achievement of the health Sustainable Development Goals: a model for projected resource needs in 67 low-income and middle-income countries

Stenberg, K.; O. Hanssen; T. Tan-Torres Edejer et al. Lancet Glob Health (2017) C1

Background The ambitious development agenda of the Sustainable Development Goals (SDGs) requires substantial investments across several sectors, including for SDG 3 (healthy lives and wellbeing). No estimates of the additional resources needed to strengthen comprehensive health service delivery to... more

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Increasing equity in health service access and financing: Health strategy, policy achievements and new challenges

Annear, Peter Leslie; Veasnakiry, Lo; Momoe Takeuchi World Health Organization (WHO) (2016) C_WHO

Policy note: Cambodia Health Systems in Transition.
The health system includes a mix of public and private providers. The use of private providers is much greater among the wealthy, while the use of informal-sector health providers is greater among the poor. Due to these circumstances there is ... more

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Making Universal Health Coverage Effective in Low- and Middle-Income Countries: A Blueprint for Health Sector Reforms

Peter O. Otieno, Gershim Asiki IntechOpen (2020) CC

Health sector reforms not only require attention to specific components but also a supportive environment. In low- and middle-income countries (LMICs), there is still much to be done on ensuring that people receive prioritized healthcare services. Despite LIMCs spending an average of 6% of their GDP... more

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From Double Shock to Double Recovery – Implications and Options for Health Financing in the Time of COVID-19

Kurowski, C.; D. B. Evans; A. Tandon et al. The World Bank (2021) CC

The COVID-19 pandemic has resulted in a double shock - health and economic. As of March 1, 2021, COVID-19 has cost more than 2.5 million lives and triggered an economic recession surpassing any economic downturn since World War II. Part I of this paper explores the impact of this current macro-fisc... more

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Innovative financing for HIV response in sub–Saharan Africa

Atun, R.; Silva, S.; Ncube, M.; Vassall, A. Journal of global health (2016) CC

In 2015 around 15 million people living with HIV were receiving antiretroviral treatment (ART) in sub–Saharan Africa. Sustained provision of ART, though both prudent and necessary, creates substantial long–term fiscal obligations for countries affected by HIV/ AIDS. As donor assistance for healt... more

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Health sector spending and spending on HIV/AIDS, tuberculosis, and malaria, and development assistance for health: progress towards Sustainable Development Goal 3

Global Burden of Disease Health Financing Collaborator Network Lancet (2020) C1

Background: Sustainable Development Goal (SDG) 3 aims to “ensure healthy lives and promote well-being for all at all ages”. While a substantial effort has been made to quantify progress towards SDG3, less research has focused on tracking spending towards this goal. We used spending estimates to ... more

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Future and potential spending on health 2015–40: development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries

Global Burden of Disease Health Financing Collaborator Network Lancet (2017) C1

Background: The amount of resources, particularly prepaid resources, available for health can affect access to health care and health outcomes. Although health spending tends to increase with economic development, tremendous variation exists among health financing systems. Estimates of future spendi... more

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Impact of health systems strengthening on coverage of maternal health services in Rwanda, 2000–2010: a systematic review

Maurice Bucagu, Jean M. Kagubare, Paulin Basinga, Fidèle Ngabo, Barbara K Timmons & Angela C Lee Reproductive Health Matters (2012) CC

From 2000 to 2010, Rwanda implemented comprehensive health sector reforms to strengthen the public health system, with the aim of reducing maternal and newborn deaths in line with Millennium Development Goal 5, among many other improvements in national health. Based on a systematic review of the lit... more

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A review of health resource tracking in developing countries

Powell-Jackson T. and A. Mills Health Policy and Planning (2007) C2

Timely, reliable and complete information on financial resources in the health sector is critical for sound policy making and planning, particularly in developing countries where resources are both scarce and unpredictable. Health resource tracking has a long history and has seen renewed interest mo... more

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Rwanda: Health Sector Policy

Ministry of Health, Rwanda (2015) C2

The Health Sector Policy gives general orientations for the sector which are further developed in the various sub-sector policies guiding key health programs and departments. All health sub-sector policies will be updated in line with this new policy. The Health Sector Policy is the basis of nationa... more

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Rwanda Fourth Health Sector Strategic Plan (July 2018-June 2024)
recommended

Ministry of Health, Rwanda (2018) C2

Rwanda’s fourth health sector strategic plan (HSSP4) is meant to provide the health sector with a Strategic Plan that will highlight its commitments and priorities for the coming 6 years. It will be fully integrated in the overall economic development plan of the Government. HSSP4 will fulfill the... more

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Health Financing Progress Matrix assessment, Kenya 2023: summary of findings and recommendations

Kenya Ministry of Health, World Health Organization (WHO) (2024) CC

This comprehensive HPFM report thoroughly explores Kenya’s health financing landscape. It provides an in-depth analysis of the current state of affairs and sheds light on required strategic changes in health financing. The report points out the need to improve public financial management within th... more

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Transforming the health system in Uzbekistan: two-year implementation review

World Health Organisation (WHO) (2023) C_WHO

Uzbekistan has started a process of health system reform that includes fundamental changes in service delivery and health financing arrangements, as well as digitalization of the health care sector. The reform was initiated in 2018 by the adoption of high-level legislation, which was put into practi... more

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Mental health systems in selected low- and middle-income countries: a WHO-AIMS cross-national analysis

World Health Organization WHO WHO (2009) C_WHO

Data on the essential building blocks of mental health systems, including mental health governance, financing, service delivery, human resources and information, are reported. For mental health planning, it is important to know not only the level of resources in these six areas, but also how thos... more

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Public-private partnerships for health care infrastructure and services: considerations for policy makers in Ukraine

World Health Organization WHO, Regional Office of Europe (2022) C_WHO

ndependent of the current conflict, the health sector in Ukraine faces several critical shortcomings. In particular, the country has an oversupply of hospitals and an undersupply of primary care and diagnostic facilities. Addressing these limitations will require substantial amounts of capital inves... more

Rwanda Fourth Health Sector Strategic Plan (July 2018-June 2024) recommended

Rwanda Fourth Health Sector Strategic Plan (July 2018-June 2024)
recommended