Frameworks help countries rally policy makers and shape social health protection and health financing systems. Fundamental to developing and implementing frameworks is a shared understanding of key terms. Framework development and implementation also depends on collaborations across sectors and on stakeholders having ready access to relevant and accessible knowledge resources.
Social health protection and health financing frameworks and references
Some key vocabulary
A health financing (HF) framework is determined by four health financing system functions: revenue raising, pooling, purchasing and benefit design. An HF framework helps to define country specific HF arrangements, governance and reform policies and strategies that can advance universal health coverage (UHC). Embedded in the health financing framework of the World Health Organization is the belief that advancing equity in delivery of health services people need requires financial protection and service of sufficient quality. These requirements drive HF reforms in countries to improve equity in the distribution of health system resources, efficiency, transparency and accountability.
UHC is an overarching goal: to strengthen health systems and SHP to ensure that all people access health care services without financial hardship or income insecurity in case of sickness. The objectives, functions and principles of SHP are grounded in international social security standards developed by the International Labour Organization.
Global goods that facilitate collaborations
Developing and implementing SHP and HF frameworks furthers national reforms. Frameworks help countries provide comprehensive health services of sufficient quality to all while assuring financial protection for those who need it. The P4H Network supports the twin goals countries have to develop and implement frameworks by facilitating the exchange of knowledge, sharing best practices and country experiences, facilitating dialogues, organizing events at global, regional, and country levels, and promoting partnerships across different sectors engaged in SHP and HF reforms to advance UHC.
Low- and middle-income countries often cite lack of good governance as causing scarce government revenue and inadequate levels of public spending on health and SHP, inequity, inefficiency, over-reliance on out-of-pocket payments, and lack of explicitly defined benefits. No single solution or model addresses these challenges. However, SHP and HF frameworks, as well as guiding principles and standards, can help countries effectively address their individual challenges. Some key declarations, conventions, resolutions and reports, guidelines and tools, as well as training opportunities for SHP and HF – examples of global goods – can certainly be of use.
Key Declarations and Conventions
- 2012 – ILO Social Protection Floors Recommendation, R202
It was adopted by ILO constituents in the aftermath of the 2008 financial and economic crisis, to ensure that all members of society enjoy at least a basic level of social protection throughout their lives. On healthcare, it established a nationally defined set of goods and services constituting essential health care, including maternity care, that meet the criteria of availability, accessibility, acceptability & quality. - 2000 – ILO Maternity Protection Convention, C183
Provides rules for the adoption of national legislation for the promotion of health and safety of the mother and child, notably concerning the protection during pregnancy, the right to a maternity leave, maternity benefits and the right to return to work. - 1977 – ILO Nursing Personnel Convention, C 149
Recognizing the vital role played by nursing personnel, together with other workers in the field of health, in the protection and improvement of the health and welfare of the population. This convention focused on setting decent standards of work, to boost the professional and political profile of nursing personnel and provide incentive for retention of nursing personnel. - 1969 – ILO Medical Care and Sickness Benefits Convention, C130
The Convention provides rules governing national legislations protecting employees through the provision of medical care of curative or preventive nature and through the provision of sickness benefits. - 1962 – ILO Equality of treatment (Social Security) convention, C118
This convention establishes the rules on the equality of treatment of nationals and non-nationals in social security, covering its nine branches including health care. It applies also for refugees and stateless persons without any condition of reciprocity. - 1952 – ILO Social Security (Minimum Standards) Convention, C 102
It is the flagship of all ILO social security Conventions, as it is the only international instrument, based on basic social security principles, that establishes worldwide-agreed minimum standards for all nine branches of social security, including healthcare. - 1944 – ILO Medical Care Recommendation, R069
This ILO recommendations established the need for universality of protection. It is an instrument that provides comprehensive guidance on the provision, organisation, financing and administration of medical care, mandating a comprehensive preventive and curative care available for all members of the community at any time and place.
Key Resolutions and Reports
- 2023 – Open and inclusive: Fair Processes for Financing Universal Health Coverage
The report offers decision support on fair processes for policy choices relating to health financing for universal health coverage (UHC). It opens by making the case for why fair processes matter for health financing. The report describes key health financing decisions with an impact on equity in service coverage and financial protection and related country experiences. - 2023 – From Double Shock to Double Recovery
The WBG report analyses health financing in a time of global shocks due to the COVID 19 pandemic. It recommends governments to take rapid action to prioritize health spending and put their countries and the world on a pandemic-resilient, sustainable development trajectory. - 2023 – Global spending on health: Coping with the pandemic
The report shows global health spending in 2021, the second year of the pandemic. It found that the increase in spending was driven by higher government spending and out-of-pocket payments. - 2022 – Global spending on health: Rising to the pandemic’s challenges
The Report presents the years dominated by the emergence of COVID-19 and its associated health and economic crises, governments around the world rose to the challenge. - 2021 – Domestic Resource Mobilization for Increased Health Sector Fiscal Space and Universal Health Coverage: A Health Financing System Assessment Drill-Down Guidance Note
This report provides guidance on how to examine domestic resource mobilization for increased health sector fiscal space to ensure progress towards universal health coverage (UHC). It is best used as a complementary tool to broaden health financing systems assessment focusing on public financing as a key constraint. - 2021 – Global expenditure on health: Public spending on the rise?
The Report examines country health spending patterns and trends over the past 20 years, before the COVID-19 pandemic, with greater focus on public spending on health. - 2021 – Extending social health protection: Accelerating progress towards Universal Health Coverage in Asia and the Pacific
This publication provides important insights to practitioners on concrete ways to adapt and extend social health protection, including through adapted design features building on the principles laid out in ILO standards. The report provided experiences across countries of the Asia and the Pacific region on the extension of social health protection based on shared values of global solidarity and fair financing. - 2021 – Tracking Universal Health Coverage: 2021 Global monitoring report
This report tracks and monitors UHC progress with health service coverage and financial protection indicators. - 2021 – World Social protection report 2020-2022
Provides a global overview of recent developments in social protection systems and examines the impact of the COVID-19 pandemic. The section on social health protection focused on monitoring the global progress in the extension of social health protection across countries. - 2020 – Social Protection Spotlight Brief ‘Towards Universal Health Coverage: Social Health Protection Principles’
The brief presents the international social health protection principles. These principles reflects international consensus forged by governments, employers’ and workers’ organizations that emphasis the social health protection as a right-based approach to achieve UHC. - 2020 – Handbook on Social Health Protection for Refugees
This document provides guidance on considerations and practical steps required to assess options for the inclusion of refugees in the national social health protection systems. It is developed jointly between the ILO and UNHCR and takes stock of approaches, successes, potential pitfalls, and lessons learned for the extension of social health protection coverage to refugees. - 2020 – Global spending on health: Weathering the storm
The Report analyses global health spending for 190 countries from 2000 to 2018 and provides insights as to the health spending trajectory from the MDG era to the SDG era prior to the crisis of 2020. - 2019 – High-Performance Health Financing for Universal Health Coverage (Vol. 2) : Driving Sustainable, Inclusive Growth in the 21st Century
This WBG report identifies critical health financing constraints. It says that the majority of developing countries have yet to seize the growth and development opportunities offered by high-performing health financing. Major coverage gaps for essential health services persist; for those who receive services, coverage is too often ineffective, as the quality of services is low. - 2019 – WHO Resolutions on UHC
Health financing, strengthening health workforces, building sustainable and resilient people-centered health systems, and investing in and strengthening primary health care were set as key priorities. They urged governments to involve in coordinating work across all sectors to achieve UHC with a focus on poor, vulnerable and the marginalized. - 2019 – Global Spending on Health: A World in Transition
This 2019 report Global health spending: A world in transition examines how countries progress towards financing UHC in a world in transition. - 2018 – Annual Health Financing Forum: Greater Equity for Better Health and Financial Protection
This paper is prepared for the “Third Annual UHC Financing Forum: Greater Equity for Better Health and Financial Protection”. This paper was prepared under the guidance of the Forum Technical Working Group. - 2018 – Public Spending on Health: A Closer Look at Global Trends
The 2018 global health financing report presents health spending data for all WHO Member States between 2000 and 2016 based on the SHA 2011 methodology. - 2017 – Annual Health Financing Forum: Greater Efficiency for Better Health and Financial Protection
This is paper is prepared for the “Second Annual UHC Financing Forum: Greater Efficiency for Better Health and Financial Protection”. - 2017 – New Perspectives on Global Health Spending for Universal Health Coverage
This WHO global report summarizes the internationally comparable data on health spending in all WHO Member States between 2000 and 2015. - 2016 – Annual Health Financing Forum: Domestic Resource Mobilization
This paper summarizes discussions held at the first UHC Health Financing Forum that will take place in Washington from 14-15 April 2016. It reflects comments from experts of the World Bank Group, USAID, Technical Working Group that included experts from academia, government, the Bill and Melinda Gates Foundation, GAVI, the Global Fund, IMF and WHO. - 2012 – ILO Social Protection Floor Recommendation
ILO Social Protection Floor Recommendation 2012, No 202 guides building of comprehensive social security systems and extending social security coverage by prioritizing the establishment of national floors of social protection accessible to all in need. - 2010 – World Health Report: Health Systems Financing: The Path to Universal Coverage
The report outlines how countries can modify their financing systems to move quickly towards universal coverage and to sustain those achievements based on available data and evidence. - 2005 – WHO Resolution on Sustainable Health Financing, Universal Coverage and Social Health Insurance
WHA 58.33. It called on Member States to increase prepayment and pooling of resources as basic principles in health financing and social health protection for UHC.
Key Guidelines and Tools
- 2024 – ILO toolkit on Social Health Protection
This toolkit provides a gateway to resources on social health protection that are important for practitioners. The resources include relevant standards, statistical tools, thematic technical areas, management, administration and actuarial tool as well as country profiles on efforts to build sustainable and effective social health protection systems. - 2024 – ADB Regional : Using Digital Technology to Improve National Health Financing in Asia and the Pacific
It aims to support technical assistance to help the developing member countries to achieve universal health coverage by supporting the development and adoption of digital national health insurance (NHI) information systems within ADB’s Strategy 2023 to reduce poverty and inequalities and enhance human capital and social protection for all. - 2023 – Resource Guide on the Use of Health Technology Assessment in Health Benefit Package Design Processes
Many countries around the world use health benefit packages as a key element in their health systems, and they are increasingly recognized as important elements on the path to universal health coverage (UHC). Health benefit packages require processes to inform their design, meaning the decisions of what to include or exclude. These processes may be referred to as health technology assessment (HTA), or by similar terms along the lines of evidence-supported priority-setting. This resource guide is intended to point users to the resources available for health benefit package design, describing available frameworks, guidance, data, and tools. While the focus is on materials produced by the World Health Organization (WHO), there are other key references highlighted as well. - 2023 – Assessing the effects of digital technologies on health financing and UHC universal health coverage objectives – A guide with key questions
This WHO guide aims to support the generation of evidence digital technologies influence on health financing functions and progress towards. - 2021 – HTA and Health Benefit Package Survey Page
In response to the World Health Assembly Resolution 67.23, the WHO Secretariat conducts a survey to assess the status of Health Technology Assessment (HTA) in member states. In 2021, a second round of this survey was conducted that also included an innovative module on country health benefit packages. The survey website features key results and interactive dashboards to examine the results of the different modules, or to explore a given country’s responses in-depth. Data is also downloadable and there are pdf profiles available as well. - 2020 – The Health Financing Data Visualization tool
This tool visualizes country specific health financing data selected from 5 income categories. - 2020 – Health Financing Progress Matrix
It guides assessment of country health financing systems with quantitative and qualitative indicators. - 2019 – Financing for Universal Coverage: Dos and Don’ts. Health Financing Guidance Note No 9
This guide aims to build understanding of key issues in financing for UHC. - 2017 – Health Financing Guidance No 3. Developing a National Health Financing Strategy: A Reference Guide
It provides the framework to analyze and develop a national health financing strategy for UHC. - 2015 – Assessing Health Provider Payment Systems. A practical guide for countries working toward UHC
It is a practical, step-by-step guide designed to help countries find answers to their provider payment policy questions. - Toolkit on ILO Social Security Standards
The Toolkit id developed to raise awareness about ILO social security standards that include medical care and sickness benefit, and their application and impact in national contexts.
Training courses
- WHO – The WHO offers e-learning course on health financing policy for universal health coverage comprising of 6 modules which cover the core functions of health financial policy as conceptualized by WHO.
- WHO – WHO launched e-Learning Course on Public Financial Management (who.int) which is a supplementary module to WHO’s “e-learning Course on Health Financing Policy for Universal Health Coverage.
- WHO – WHO offers e-Learning Course on Cross-Programmatic Efficiency Analysis (who.int) that provides an approach to analyzing efficiency across health programs within a health system.
- ILO – The International Training Centre of ILO in Turin annually offers e-learning on social health protection- addressing inequities in access to health.
- WBG – The World Bank Group opened the Health Systems Flagship Program to facilitate a strategic and systematic approach to health system and health financing reforms for UHC.