Health budget

                                  Overview

                                  Raising domestic public funds is essential for universal health coverage (UHC). No country has made significant progress toward UHC without increasing reliance on public revenues. Therefore, domestic tax systems that are essential to support country’s fiscal space expansion are central to the UHC agenda. 

                                  While the level of revenues matter, the allocation and use of these revenues are two crucial elements in supporting effective progress toward UHC. Public Financial Management (PFM) systems are key enabling factors to support appropriate formulation, execution and accounting of government expenditure. 

                                  In health, countries face challenges at all stages of the PFM cycle. Key questions include:

                                  • How to align budget allocations with sector needs?
                                  • How to ensure effective disbursement?
                                  • How to make the budget system more accountable and transparent? 

                                  As part of the Montreux Collaborative Agenda on Fiscal Space, PFM and Health Financing, WHO is supporting countries and partners in fostering dialogue between health and finance authorities, with the aim to strengthen domestic PFM systems and make budget practices more effective toward UHC.

                                   

                                  Good practices

                                  Generally, the key features of a well-functioning budgeting system typically include:

                                  • Multi-year planning and budgeting
                                  • Policy or output-oriented allocation
                                  • Realistic and credible estimates of costs
                                  • Open and transparent consultation processes. 

                                  In health, proactive engagement of health ministries in the budgeting process can facilitate alignment of budget allocations with sector priorities, as laid out in national health strategies and plans. The development of multi-year plans and budgets is likely to improve predictability in the sector’s resources. If the health budget is formulated according to sector goals or outputs and the execution rules align with this logic, it will make budgets more responsive to sector needs than if the formulation follows an input-based approach. A quality performance framework of budgets will also facilitate financial and operational accountability in health.

                                   

                                  Nearly 50%

                                  of African countries

                                  introduced programme budgets in health enhancing accountability and transparency

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                                  Many countries

                                  spend less than 80% of their annual budget allocation for health

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                                  Publications

                                  Uganda program based budgeting cover

                                  Many countries have initiated transitions to programme-based budgeting (PBB) to better align budgets to public policy priorities and to enhance accountability...

                                  Blue cover with the word "budget" in a globe

                                  There is no universal health coverage (UHC) without public financing, making public budgeting a central piece of UHC reforms. Peru has made significant...

                                  Gabon case study

                                  Despite significant efforts, health financing reforms in Gabon have not been fully implemented. Public funding as a share of total health expenditure increased...

                                  Publication budget matter cover

                                  Robust public budgeting in the health sector is a necessary condition to enable the effective implementation of health financing reforms towards universal...