Reconciling devolution with health financing and public financial management: challenges and policy options for the health sector

Effective devolution, health financing, and public financial management are crucial for advancing universal health coverage, and targeted policy solutions can address existing challenges in these areas across seven Asian and African countries.

This paper published in BMJ Global Health investigates the impact of devolution, health financing, and public financial management processes on universal health coverage in seven Asian and African countries: Burkina Faso, Kenya, Mozambique, Nigeria, Uganda, Indonesia, and the Philippines. It identifies key challenges, such as subnational governments’ reliance on central transfers without mandated health budget allocations, fragmentation of funding pools, weak budget planning, delayed and complex funding procedures, and inefficient service purchasing practices.

The paper proposes policy solutions, including conditional grants, improved revenue sharing, enhanced budget coordination, simplified processes, and strategic purchasing linked to health needs and facility performance.

Reference

Nirmala Ravishankar, Inke Mathauer, Hélène Barroy, Ileana Vîlcu, Michael Chaitkin, Marie Jeanne Offosse, Pura Angela Co, Angellah Nakyanzi, Boniface Mbuthia, Salomão Lourenço, Halimah Mardani, Joseph Kutzin, Reconciling devolution with health financing and public financial management: challenges and policy options for the health sector , BMJ Global Health

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