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Summary

With support from the World Health Organization (WHO), ThinkWell conducted a six-part webinar series from May to November 2019 on how to ensure that public financial management (PFM) provides an enabling environment for sustainable health financing policies. Webinar topics included budget formulation issues, budget execution issues, links between budget reforms and provider payment systems, budget accountability, and budgeting in devolved settings. The series aimed to enhance technical knowledge and capacity among health sector stakeholders and stimulate peer exchange on the implementation of budget reforms in health. To learn please visit the WHO’s page on the series here.

Session 1: Role of PFM functions and reforms from a health sector perspective

Many countries place public funds at the core of health financing to progress towards universal health coverage (UHC). A strong PFM system is key for sustainable financing for UHC, and as a result, many countries have initiated long-term PFM reforms. In this session, we discussed the importance of compulsory public funding for UHC and the main PFM challenges in the health sector. We provided examples of successful PFM reforms in African countries to illustrate points.

Session 2: Budget formulation issues in the health sector: key issues for policy makers

An increasing number of countries recognize that budget formulation influences health sector spending and performance. Countries have modified the way that budgets are formulated to ensure better alignment of sector priorities. This session provided an overview of budget formulation issues in the health sector and reforms from OECD countries. As case study examples, we presented key insights on budget formulation and dived into South Africa’s program structure.

Session 3: Budget execution issues in the health sector: challenges and policy responses

Budget execution poses many challenges in the health sector in several low and middle-income countries (LMICs). One of the main challenges in LMICs are underspent health budgets. In this session, we discussed the role of budget execution in the health sector. We also provided an overview of budget execution in LMICs, with a focus on Mozambique.

Session 4: Links between budget reforms and provider payment systems: what is at stake?

The way public budgets are formed, allocated, disbursed, and accounted influences how service providers are paid in the health sector. In this session, we focused on how to align autonomy, incentives and objectives as well as budget classifications and their links with provider payment methods.

Session 5: Budget accountability: financial transparency and accountability towards sector outputs

Comprehensive information about public finance needs to be publicly accessible so governments can be held accountable and to promote an informed dialogue around policy priorities. Health spending is typically characterized by poor transparency and accountability. In this session, we focused on the road to budget transparency and accountability in health, the role of government-civil society collaboration in improving budget accountability, and performance frameworks for program budgets.

Session 6: Budgeting for health in devolved settings

The budgeting process in devolved settings can prove to be very complex, particularly in the context of weak governance systems. In this session, we discussed implications of fiscal decentralization for the health sector and we shared country experiences from Argentina and Kenya.

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