A research paper published in the December 2023 Issue of the Lancet Global Health on how 15 countries responded to the COVID-19 pandemic through their health financing policies. The paper has been co-authored by Aungsumalee Pholpark, Community Facilitator for the Asia Region at the P4H Coordination Desk from Bangkok, Thailand.
The COVID-19 pandemic was a health emergency requiring rapid fiscal resource mobilisation to support national responses. The use of effective health financing mechanisms and policies, or lack thereof, affected the impact of the pandemic on the population, particularly vulnerable groups and individuals. The paper provides an overview and illustrative examples of health financing policies adopted in 15 countries during the pandemic, develops a framework for resilient health financing, and uses this pandemic to argue a case to move towards universal health coverage (UHC).
This case study examined the national health financing policy responses of 15 countries (Brazil, China, Germany, India, Indonesia, Iran, Mexico, Nigeria, Singapore, Spain, South Africa, Thailand, UK, USA, and Vietnam) which were purposefully selected countries to represent all WHO regions and have a range of income levels, UHC index scores, and health system typologies. The authors did a systematic literature review of peer-reviewed articles, policy documents, technical reports, and publicly available data on policy measures in response to the pandemic and complemented the data obtained with 61 in-depth interviews with health systems and health financing experts. They also did a thematic analysis of our data and organised key themes into a conceptual framework for resilient health financing.
Resilient health financing for health emergencies is characterised by two main phases: (1) absorb and recover, where health systems are required to absorb the initial and subsequent shocks brought about by the pandemic and restabilise from them; and (2) sustain, where health systems need to expand and maintain fiscal space for health to move towards UHC while building on resilient health financing structures that can better prepare health systems for future health emergencies. The researchers observed that five key financing policies were implemented across the countries—namely, use of extra-budgetary funds for a swift initial response, repurposing of existing funds, efficient fund disbursement mechanisms to ensure rapid channelisation to the intended personnel and general population, mobilisation of the private sector to mitigate the gaps in public settings, and expansion of service coverage to enhance the protection of vulnerable groups. Accountability and monitoring are needed at every stage to ensure efficient and accountable movement and use of funds, which can be achieved through strong governance and coordination, information technology, and community engagement.
The findings suggest that health systems need to leverage the COVID-19 pandemic as a window of opportunity to make health financing policies robust and need to politically commit to public financing mechanisms that work to prepare for future emergencies and as a lever for UHC.