Academic journal article Bulletin of the World Health Organization

How Can Health Ministries Present Persuasive Investment Plans for Women's, Children's and Adolescents' Health?/ Comment Les Ministeres De la Sante Peuvent-Ils Presenter Des Plans D'investissements Persuasifs En Matiere De Sante De la Femme, De L'enfant et De L'adolescent?/ ?Como Pueden Los Ministerios De Salud Presentar Planes Convincentes De Inversion Para la Salud De Mujeres, Ninos Y Adolescentes?

Academic journal article Bulletin of the World Health Organization

How Can Health Ministries Present Persuasive Investment Plans for Women's, Children's and Adolescents' Health?/ Comment Les Ministeres De la Sante Peuvent-Ils Presenter Des Plans D'investissements Persuasifs En Matiere De Sante De la Femme, De L'enfant et De L'adolescent?/ ?Como Pueden Los Ministerios De Salud Presentar Planes Convincentes De Inversion Para la Salud De Mujeres, Ninos Y Adolescentes?

Article excerpt

Introduction

Most low-and middle-income countries face financing pressures if they are to adequately address global goals for improving the health of women, children and adolescents. Only six of the 75 priority countries achieved the 5.5% annual rate of reduction in maternal mortality needed to achieve the United Nations (UN) millennium development goal 5. (1) Now further investments are required to meet the sustainable development goals for 2030 and implement the recommendations in the updated UN Global Strategy for Women's, Children's and Adolescents' Health (2016-2030). (2) According to the strategy, "existing financing falls far short of the sums needed to fund all the measures envisioned in this strategy. To scale up from current coverage to the targets for 2030 requires 33.3 billion United States dollars (US$) in 2015 alone across 63 high-burden, low-income and lower-middle-income countries, equivalent to US$ 10 per capita".

How much low-and middle-income countries spend from their own resources, and how well they spend them, is a key determinant of the outputs and outcomes of womens, children's and adolescents' health. There is no consensus about the amount or proportion of national income to spend on health; (3) good outcomes for maternal health, for example, can be achieved even in low-income settings. (4) Nevertheless, government expenditure on health is often low in absolute and relative terms in many low-and middle-income countries. This is important, because governments are usually the principal provider of public goods -worthwhile interventions that the private sector tend not to supply because they cannot easily charge a price for it, such as disease surveillance, vector control and other public-wide interventions against infectious diseases. Government expenditure is also a potentially key instrument for addressing health-related poverty and inequity and for preventing impoverishment due to out-of-pocket private expenditure. Sixty-three high-burden, low-and lower-middle-income countries are eligible for support under the recently launched global financing facility in sup port of the UN Secretary-General's Every Woman Every Child global strategy. (2) Yet in 48 of these countries the government's expenditure on health in 2013 was less than US$ 50 per capita, with eight countries spending less than US$ 10 per capita, and as low as US$ 4 per capita in Myanmar. (5) Fig. 1 shows that only nine countries have achieved the target of allocating 15% of national budget to the health sector which was agreed to by many low-income governments in 2001. (6) Eight countries, including highly populated India and Pakistan, allocated less than 5% of total government expenditure to health.

The share of government expenditure being allocated to women's and children's health, and the health sector more broadly, is also important because it reveals the political priority given to health compared with other sectors and priorities. An analysis of national health accounts for this article showed that the one lower-middle income and nine low-income countries for which data were available allocated on average just 22.6% of government health expenditure to reproductive, maternal, newborn and child health (expenditure on adolescents was not captured), despite that group normally comprising more than 50% of the population.

Governments in low-and middle-income countries already spend on average US$ 19.8 of their own resources on health for every dollar they receive in external assistance, (8) but virtually all such countries face significant pressures for additional government expenditure in coming years. Population growth will put additional demands on already under-funded public health systems. (9) Almost all low-and middle-income countries are seeking to achieve universal health coverage, yet most are also experiencing increased financial pressures as a result of rising rates of often expensive-to-treat and chronic noncommunicable diseases. …

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