Finance for health

We all want to receive the health services we need. No matter who you are, where you come from, or what your financial status is. But many countries – especially low- and middle-income countries – don’t have enough public resources to meet everyone’s health needs. Their health service delivery relies heavily on people’s out-of-pocket spending and external funding.

Wemos aims to increase the quality and quantity of external and domestic funding for health in low- and middle-income countries. We collaborate with civil society partners in these countries and with global networks to ensure that global policies respond to the needs of the countries. We aim to convince global health donors and other global actors who influence public health budgets to improve their mutual coordination and their alignment with country priorities. Because that advances universal and equitable access to health services that leave no one behind.

“When I had Covid, I went to a private hospital. There I could get the medicines I needed. My sister went to a public hospital and had to pick up her medication herself. That is very difficult for many people.”
Chikondi, Malawi

Several global health funds aim to strengthen systems for health at country, regional and/or global level. For example, the Global Financing Facility, the Global Fund, Gavi, and the Pandemic Fund. Collectively, they provide a source of finance for health that is currently indispensable for low- and middle-income countries. However, if external funding is not well-aligned with national plans and systems, it can challenge national leadership, cause fragmentation and disrupt policy implementation in recipient countries.

To prevent this, global funding for health needs to be channeled via a harmonized and transparent system that facilitates democratic accountability and ownership at country level. Moreover, it should be predictable and not have undue restrictions, such as limiting its use for recurrent expenditures like health worker salaries.

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Many low- and middle-income countries struggle to raise sufficient public funds to achieve universal health coverage and depend on development finance to fill gaps. However, development finance has increasingly been focused on private-for-profit solutions, for instance by de-risking private investments and subsidizing public-private partnerships. In the health sector, this approach risks commercialization of health services, exacerbating inequalities in access to health services instead of closing inequality gaps. For example, it can lead to more pay-for-service systems, creating financial barriers for people with low incomes.

Universal and equitable public healthcare systems require public financing. And public resources for health should be used wisely, avoiding diversion into commercial solutions that do more harm than good. We ask global health actors to be critical when it comes to private sector solutions, and to support public health systems in the first place. Also, we aim to raise awareness of alternatives for increasing those scarce public resources.

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Although development assistance fills important financing gaps, it pales in comparison with structural drains on the public purse in many countries. The outflow of finances from low- and middle-income countries through unfair global tax rules, illicit financial flows, and debt servicing is almost double the inflow of official development assistance. Ultimately, a profound change is needed in the global financial and health architecture and the ways in which financial resources are raised and allocated. We need reforms to reverse the net flow of resources from low- and middle-income countries to high-income countries, not only enlarging countries’ public purse, but also increasing national sovereignty and self-sufficiency.

Wemos strives to connect the work of economic justice movements to the global health financing discussion. We aim for global health actors to become vocal on these issues, acknowledge the need for and support calls for reforms of the international financial architecture to expand the public purse of low- and middle-income countries.  

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The Covid-19 pandemic has shown that prevention, preparedness, response and recovery from the impact of infectious disease require unified pro-public action. After all, ‘no one is safe until everyone is safe’. Health systemsunderfunded in many countries – were ill-prepared to cope with a pandemic, and are still suffering from the impact of Covid-19. The global funding challenge is vast, and responses so far grossly insufficient. 

In line with our vision on equitable finance for health, Wemos advocates for this funding to be mobilised progressively (according to the ability to pay), allocated according to needs, and governed democratically. Considering the already large funding gaps for health, funding for pandemic PPR should not go to the detriment of existing funding flows for global health. In addition. pandemic PPR is a global responsibility that benefits all countries, and hence should not be funded from Official Development Assistance. On the basis of these principles, we analyse the different proposals and advocate for solutions that are equitable, inclusive and sustainable.

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Most low- and middle-income countries face severe health workforce shortages. Not enough health workers are trained, and for those who are, there are no steady jobs because there is no funding for their salaries. As a consequence, those health workers who are employed are overburdened and unable to give proper attention and care. While donors and governments agree that expanding the health workforce is urgent, domestic funding often runs short and external funding is too volatile or comes with restrictions that prohibits its use for recurring expenditures like salaries.

In the short to medium term, we advocate continued co-investment and improved quality of funding – predictable, long-term budget-support – from global health actors in low-and middle-income countries’ health workforce. This can boost the quantity and quality of health workers and provide the best conditions for their retention. Within the European Union, we advocate that Member States invest in training, job satisfaction and professional development of health workers, to increase their numbers and improve retention. In some cases, this can be done using existing EU funding instruments. Ultimately, all countries should raise their domestic resources in line with global targets, invest in long-term planning and forecasting, and in the recruitment, development, training, retention and management of their health workforce. For low- and middle-income countries, this will require an overall expansion of their public budgets (see also our section on reforms of the international financial architecture).

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