Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland.
Health Syst Reform. 2019;5(4):322-333. doi: 10.1080/23288604.2019.1659126. Epub 2019 Nov 4.
Collective financing, in the form of either public domestic revenues or pooled donor funding, at the country level is necessary to finance common goods for health, which are population-based functions or interventions that contribute to health and have the characteristics of public goods. Financing of common goods for health is an important part of policy efforts to move towards Universal Health Coverage (UHC). This paper builds from country experiences and budget documents to provide an evidence-based argument about how government and donor financing can be reorganized to enable more efficient delivery of common goods for health. Issues related to fragmentation of financing-within the health sector, across sectors, and across levels of government-emerge as key constraints. Effectively addressing fragmentation issues requires: (i) pooling funding and consolidating governance structures to repackage functions across programs; (ii) aligning budgets with efficient delivery strategies to enable intersectoral approaches and related accountability structures; and (iii) coordinating and incentivizing investments across levels of government. This policy response is both technical in nature and also highly political as it requires realigning budgets and organizational structures.
集体融资,无论是国内公共收入还是汇集的捐助资金,在国家层面上都是为了为卫生共同商品提供资金,这些共同商品是基于人口的功能或干预措施,有助于健康,具有公共物品的特点。为卫生共同商品提供资金是实现全民健康覆盖(UHC)政策努力的重要组成部分。本文借鉴国家经验和预算文件,从循证的角度论述了如何重新组织政府和捐助者的融资,以更有效地提供卫生共同商品。与融资碎片化相关的问题——在卫生部门内部、跨部门以及各级政府之间——成为关键的制约因素。有效解决碎片化问题需要:(i)汇集资金并整合治理结构,以跨计划重新包装职能;(ii)使预算与高效交付战略保持一致,以实现跨部门方法和相关问责结构;以及(iii)协调和激励各级政府的投资。这种政策应对既是技术性的,也是高度政治性的,因为它需要重新调整预算和组织结构。