Health financing

Health financing is one of the six building blocks of health systems, and it is closely related to another building block – governance. Taken together, they have a huge impact on access to health and care services and our ability to meet the Sustainable Development Goals targets on universal health coverage. The area lends itself well both to systems thinking and policy analysis approaches, which are central to HPSR.

Why is this an important issue?

Who pays for care? Who is allowed to provide it? And what impact do the answers to these first two questions have on the quality and accessibility of health services? These are some of the key questions that inform this area of work. Different countries have vastly different approaches to these issues. And while there is no single answer, better understanding these dynamics can help countries to expand services and uncover and close gaps in coverage.

Alliance track record

The Alliance has collaborated closely with the Health Governance and Finance team at WHO Headquarters on a number of projects in this space, beginning with an 11-country research programme that examined how and why results-based financing programmes had or not been scaled up and integrated into national health systems. Based on the success of this work, two other research programmes have been developed: one that examines initiatives in LMICs on making health insurance programmes more responsive to the needs of those they cover, and one looking at transitions from external funding to national funding for health services in six.

Using an embedded research approach, the Alliance has also been working with policy-makers and researchers in two countries to support the role out of national health insurance schemes. In India, we worked with the WHO country office and the South East Asia Regional Office (SEARO) to support a series of research projects to inform the early implementation of India’s new National Health Insurance Scheme (PM-JAY). Based on priorities identified by senior policy-makers within India’s National Health Authority (NHA) – the scheme’s implementing agency – and engaging the NHA throughout the research process, three teams shared findings with the NHA leadership. Based on the success of these studies and responding to the national policy-makers’ request for more research, a second round of studies is underway. In Pakistan, we are working with the Sehat Sahulat National Health Insurance Programme and national research teams to develop research that directly responds to challenges faced by programme implementers.