Thanzi researchers at the Centre for Health Economics (CHE, University of York) and the East, Central and Southern Africa Health Community (ECSA-HC) have been commissioned by The Global Fund to produce a comprehensive report which helps to inform and improve healthcare resource allocation in the region. Country-specific findings from this report will be presented during a series of National Dialogues scheduled to take place between October 2022 – April 2023.
Whilst progress has been made in increasing domestic health investment across Africa, the case for public healthcare spending is still a major concern across the ECSA region where resources are more constrained and access to essential healthcare services is most restricted. The need to address these concerns is therefore an urgent priority for countries across the region.
In response to these concerns, the Africa Leadership Meeting “Investing in Health” convened in 2019 saw health leaders across Africa unite with the aim of addressing existing inefficiencies in healthcare resource allocation, as part of the wider goal to achieve Universal Health Coverage. The meeting has been pivotal in highlighting the need for more strategic thinking around health financing to make sure that resources are used where they can have the greatest impact. The meeting resulted in the launch of a number of initiatives and commitments: calling upon all Heads of State and governments of African Union member states to put in place a series of actions to increase domestic resources for health and strengthen health systems.
In order to implement any changes to health financing allocation, national Ministries of Health (MOH) and Ministries of Finance (MOF) must have access to detailed evidence on how such a change could impact population health and the approach which would offer taxpayers the greatest value for money. In order to address this ‘gap’ in evidence, The Global Fund commissioned health economics researchers at CHE and ECSA-HC to develop a comprehensive report which aims to provide evidence to guide national deliberations on health financing in five ECSA focus countries (Eswatini, Malawi, Mauritius, Zambia, Zimbabwe); and ultimately help inform effective decision-making as part of the wider financing strategy for the health sector. There is a need for implementation research to be undertaken to assess the suitability of potential revenue generation techniques, before any actions or recommendations are put into practice.
The report is intended to guide national policymakers and stakeholders in the respective countries (including the MOF and MOH), providing a detailed summary of the current health sector in each of the five ECSA focus countries and presenting novel analyses, evidence-based policy tools and frameworks to inform health system-wide policies, with the overall aim of delivering (i) More money for health, (ii) More health for the money, (iii) Equity in health financing.
Key Findings and Recommendations from the Report
In order to meet the sustainable development goal of universal health coverage (UHC) in all five focus countries, the report sets-out a number of recommendations:
- The report cites a specific study on health spending in the ECSA region completed by researchers at the University of York, which shows a tight link between public health spending and health outcomes, even in the short run. The study also shows evidence of rivalry for fiscal capacity across components of public spending. Based on these findings, the report calls for a holistic approach that is paramount in the balance between increased resources for health alongside efficient, effective, and equitable use of those resources to achieve health sector objectives.
- Whilst improving health is a primary objective for health care expenditure, researchers also considered further effects, including how ‘productive’ spending commitments are likely to be, in terms of their impacts on improving population healthcare outcomes. Using analysis completed of health spending and health outcomes through time and across countries, the report includes a set of estimates showing how much ‘health’ is produced when a given budget is committed to healthcare. In all five countries, findings show that increasing health budgets is likely to lead to substantial improvements in population health. Researchers recommend refining these in-country estimates on the productivity of healthcare budgets in future.
- The report introduces a range of evidence-based priority-setting tools originally developed under the Thanzi la Onse (Health of All) project for the health contexts of Malawi and Uganda, which have the potential to be applied much more widely across the African continent. The report sets-out how such tools can be utilised by MOHs, MOFs and other stakeholders, to make explicit, accountable, and evidence-based decisions about how to make the best use of the resources available (i.e., achieve “more health for the money”), as well as determining the value of committing additional resources for healthcare within specific country settings.
- Looking specifically at the objective of better equity in healthcare, researchers list 10 key areas designed to assist countries in building their health systems in ways that reflect their own social value judgments. The report also outlines a plan for a pilot study with policy stakeholders in each of the focus countries, to address the ‘gaps’ in health equity in the context of overall health system priorities.
- Researchers also completed an ALM health financing tracker for Malawi and Zimbabwe. The report outlines how this practical tool can be used on an ongoing basis, to monitor the commitments and progress in health financing within member countries of the AU.
Future Plans for National Dialogues
This report provides a detailed assessment of how domestic health financing commitments and resource allocation within healthcare can be best informed. Analyses and findings from this report will be used to inform and support the coordination of health financing national dialogues between MOH and MOF, beginning with Malawi (24th – 26th October 2022) and followed by Zimbabwe, Mauritius, Eswatini and Zambia (scheduled to take place between November 2022 – April 2023).
Malawi Health Financing Dialogue (October 2022): The event was attended by the ministers of finance, health and local government, as well as senior representatives from the National Planning Commission, Parliamentary Health Group, the SADC Secretariat and African Union.
Malawi Health Financing Dialogue (October 2022): Deputy Director of Planning at the Ministry of Health, Dr Gerald Manthalu, presents the revised health benefits package and 8-year Health Sector Strategic Plan (HSSP-3).