Reform of the Fonds Commun Santé to accelerate universal health coverage

Nigeria: cervical cancer prevention and treatment

Reform of the Fonds Commun Santé to accelerate universal health coverage

The reform reaffirms the importance of the Fonds Commun Santé (FCS) in health financing in Niger. The P4H country focal point has been entrusted with the task of considering the options for a redesign. A roadmap has been validated by the stakeholders and monitoring indicators have been established.

Created in 2006 on the initiative of the Ministry of Public Health (MSP), the World Bank and the French Development Agency, the Fonds Commun Santé (FCS) aims to operationalize the principles of the Paris Declaration on Aid Effectiveness and the Accra Agenda for Action. Housed in the General Secretariat (GS) of the MSP, the FCS contributes to the implementation of health development plans (PDSS) and constitutes a technical response to the fragmentation of health financing in Niger.

The FCS has become an essential coordination mechanism, both financially and operationally, and has supported the MSP’s reforms (program budgeting, results-based management, operationalization of the new districts, etc.). It has served as an incubator for reform ideas and practices (80% of committed funds earmarked for front-line players, internal audit feedback, decentralized management, performance contracts, etc.). By providing a framework and financial and technical support for the review and programming processes, it has contributed to the development of a planning culture within the MSP. The multiplicity of its contributors and its governance model have enabled it to act as a shock absorber for financing cycles and as a lender of last resort. In so doing, it contributes to improving the continuity, predictability and equity of funding.

Gradually, from 2016 onwards, under the combined influence of a weakening of its strategic steering and changes in the funding logics of technical and financial partners (TFPs), notably via the arrival of projects housed within the FCS, the dynamic that had made it a success began to disintegrate.

Reforming the FCS: initial arbitration and definition of modalities

To prevent the FSC from turning from a strategic funding system into a a management tool focused on fiduciary accountabilityAt the end of 2021, the SG decided, at the cost of a significant reduction in available resources, to exclude vertical financing from the FSC, and to exclude players who use the FSC as a project management unit.

The P4H country focal point has been entrusted with the task of reflecting on the options and modalities for redesigning the FCS. The collegial work he led with the Ministry’s executives and the PTFs led to a reminder, clarification and reaffirmation of the core values of the FCS (coordination and rationalization, strategic continuity, subsidiarity, equalization, fungibility, etc.). These were set out in a reform strategy and catalytic financial measures (creation of an emergency response line, for the single supply chain, technical assistance, etc.) and strategic reforms (scorecards, target contracts, etc.), themselves set out in a roadmap validated by the stakeholders.

The choices made and the impetus given to reform have reaffirmed the centrality of the FCS in health financing in Niger, and this was reaffirmed in early 2023 in the validated PDSS and new health financing strategy. These were embodied in monitoring indicators and targets endorsed by the MSP, and primarily by the SG.

Reform as part of the Dutch contribution

This dynamic of work and reform has been reinforced by the arrival of new contributors to the FCS. The contribution of the Kingdom of the Netherlands, for example, provided an opportunity to develop new approaches and frames of reference. The reformed FCS framework and the flexibility of these new TFPs have made it possible to define new ways of aligning the partner’s thematic priorities with the objectives of the SSDP, while guaranteeing decisive support for its key reforms.

Expected results in terms of reform (deployment of dashboards and support for bottom-up reforms), process improvement (quality and veracity of health data) and public health indicators (particularly around sexual and reproductive health issues) have thus been formulated in a joint performance framework, incorporating the indicators and annual targets of the SSDP.

The financing structure chosen, jointly drawn up by the MSP and the donor, consolidates the gains already made and guarantees the predictability of FSC funds (50% of last year’s contribution is acquired), while ensuring that they are performance-oriented (50% of support is conditional on the achievement of annual performance targets), helping to further fuel the processes and reforms planned within the framework of the FSC and to strategically finance the SSDP.

Published On

10 May 2024

Case Study