Department of Economics, Makerere University School of Public Health, Kampala, Uganda.
Department of Economics, University of Dar Es Salaam, Dar Es Salaam, Tanzania.
Health Syst Reform. 2022 Mar 1;8(2):2082020. doi: 10.1080/23288604.2022.2082020.
The most effective way to finance universal health coverage (UHC) is through compulsory prepaid funds that flow through the government budget. Public funds-including on-budget donor resources-allow for pooling and allocation of resources to providers in a way that aligns with population health needs. This is particularly important for low-income settings with fiscal constraints. While much attention is paid to innovative sources of additional financing for UHC and to implementing strategic purchasing approaches, the government budget will continue to be the main source of health financing in most countries-and the most stable mechanism for channeling additional funds. The government budget should therefore be front and center on the strategic purchasing agenda. This commentary uses lessons from Tanzania and Uganda to demonstrate that more can be done to use the government budget as a vehicle for making health purchasing more strategic, across all phases of the budget cycle, and for making greater progress toward UHC. Actions need to be accompanied by measures to address bottlenecks in the public financial management system.
实现全民健康覆盖（UHC）最有效的融资方式是通过强制性的预付费资金，这些资金通过政府预算流动。公共资金——包括预算内的捐助资源——允许以符合人口健康需求的方式向提供者进行资源的汇集和分配。对于财政拮据的低收入国家来说，这一点尤为重要。虽然人们对全民健康覆盖的额外融资创新来源和实施战略采购方法给予了很大关注，但政府预算仍将是大多数国家卫生融资的主要来源，也是为额外资金提供渠道的最稳定机制。因此，政府预算应成为战略采购议程的核心。本评论以坦桑尼亚和乌干达的经验教训为例，表明可以采取更多措施，在预算周期的所有阶段，将政府预算作为一种手段，使卫生采购更具战略性，并在实现全民健康覆盖方面取得更大进展。这些行动需要辅以解决公共财政管理系统瓶颈的措施。
