As countries strive toward universal health coverage, they must meet mounting demands on their health systems by both mobilizing additional resources and using them as efficiently as possible.
Governments navigate continual changes in the health financing landscape, driven by economic growth, shifting political priorities at home and abroad, and citizens’ mounting expectations. Growth can increase resources available to pay for services, while policies and public tax and financial management systems determine how efficiently and equitably funds are pooled and spent.
Governments must also confront declines in external funding, which stem from rising incomes, improving coverage, and shifting donor priorities. Though few health systems rely predominantly on external resources, specific populations and programs are vulnerable to receding donor funds and may need to be integrated into the mainstream health system.
Those delivering services must also navigate the changing landscape. Siloed health programs have fostered specialized providers who often depend on revenue from donors and patients. As governments seek to more holistically purchase services, providers are exploring ways to access publicly pooled funds by diversifying offerings, forming provider networks, and investing in systems to monitor and improve quality.