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Transitioning from multilateral to domestic healthcare financing: The looming challenge

Posted by ACTION Secretariat, Washington, D.C. on Sep 19, 2017  | 

Throughout the human life cycle, the most critical variable for optimal living will always be good health. Without good health, it is difficult if not impossible for people to self-actualize, contribute to the financial growth and stability of families, and to the national and global economies, and lead generally productive lives. ACTION Global Health Partnership recognizes this, as it does the reality that globally, millions of people experience serious barriers to health. ACTION, therefore, has made it its mission to influence policy and mobilize domestic and multilateral funding to fight diseases of poverty and achieve equitable access to health for all people.

Lack of proper nutrition, particularly in the first 1000 days of life, and insufficient access to immunization against preventable childhood diseases; exposure to neglected diseases like tuberculosis (TB) and poor access to treatment in the event one falls victim to this and or other  contagious or non-communicable disease, are among the greatest barriers to health, particularly in the world’s poorest countries such as those in sub-Saharan Africa, South East Asia, and Haiti – the poorest in the Western Hemisphere.  A 2015 study by the World Health Organization and the World Bank estimates that 400 million people worldwide lack access to at least one of seven essential health services, ranging from pregnancy care to clean water. Despite much progress under the Millennium Development Goals (MDGs), from 2000 to 2015, therefore, much more needs to be done to improve the quality of life for these people. This means removing identifiable barriers, mobilizing resources and creating the policy framework to enable universal health coverage, providing a healthy start for every child, and fund research and care for diseases like TB.

ACTION’s position paper, Progress in Peril? The Changing Landscape of Global Health Financing, to be launched at the United Nations General Assembly today, is an examination of the global health landscape in the face of imminent funding withdrawal by multilateral organizations to developing countries.  With improved health, a major focus of the MDGs, new programs were created to fund improve standards and outcomes in low income countries.  The Global Fund to Fight AIDS, TB, and Malaria and Gavi, the Vaccine Alliance, emerged out of that period.  These funds mobilized billions of dollars for people in developing countries.  Official Development Assistance also improved dramatically since 2000. The increase funding resulted in dramatic improvements in many countries. These programs, however, are set to end in five to seven years for most countries, as the initial frameworks run their course.

With one exception, multilateral funding institutions determine aid eligibility partly by economic status; some considered disease burden or other health indicators as well. While economic growth is rendering some countries ineligible, it does not negate the challenge posed by transition. Because many of these countries were extremely poor to begin with, marginal or even substantive growth in GDP is not necessarily visible in the day to day life of those living in extreme poverty nor does it mean improved governance in most cases, which is a necessary part of the environment for better healthcare infrastructure. Multilaterals are transitioning, however, either because the programs have run their course or because donor countries, for political reasons, are cutting development aid. Regardless of the reasons, transition will significantly impact national budgets, health systems and healthy outcomes. Twenty -four countries will face transition from two or more programs in the next five to seven years.  Of these, eleven will transition out of three or more programs. ACTION’s policy paper, grounded in a case study of three countries finds them in varying stages of transition. 

The first, Côte d’Ivoire, has yet to transition from any mechanisms but anticipates increased co-financing payments and the beginning of the transition process from 2020. The health system’s fragility and low prioritization in the national budget pose additional risks during transition. It will be essential to have a strong, harmonized, and costed plan created by a partnership of all relevant stakeholders to address transition. The second, Nigeria, currently faces accelerated transition from Gavi, as well as transition from the GPEI, roughly in the next five years. In order to maintain the current low levels of health coverage, a dramatic increase in health financing at both the federal and state level must occur in the next 5–10 years to replace reduced external support.

Finally, Vietnam is poised to undertake simultaneous transition effectively, having achieved middle-income status, reduced income poverty significantly, and achieved improvements in health outcomes. Nonetheless, limitations in health service delivery and governance could cause problems in the transition process, notably in protecting access for key populations served by donor-financed health programs.

The study has found that governments in developing countries are not ready and other stakeholders are mostly unaware of the looming lost of funding or do not believe it will happen. This lack of preparedness has serious implications for gains made under the MDGs and the health outcomes for millions of people. 

Among a comprehensive list of recommendations, ACTION is urging a review of the transition process to slow down or stop withdrawal completely. Strategies to protect the health of specific populations could include joint cross-border/regional programming and helping non-governmental stakeholders diversify their sources of funding to directly provide services to key populations.

Without such a review and rethinking of transition, an unnecessary and crisis is likely to unfold in the global landscape in the next decade – just when the world should be consolidating gains under the SDGs.