[et_pb_section fb_built=”1″ admin_label=”!! PLEASE DO NOT EDIT !!!” _builder_version=”4.19.5″ _module_preset=”default” global_colors_info=”{}”][et_pb_row use_custom_gutter=”on” gutter_width=”1″ admin_label=”!!! PLEASE DO NOT EDIT !!!” _builder_version=”4.20.4″ _module_preset=”default” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.19.5″ _module_preset=”default” global_colors_info=”{}”][et_pb_text admin_label=”SUMMARY – Click on the WHEEL icon to open the textarea where you can paste or type your summary. Summary should be in bold and 250-300 characters. The counter at the bottom can help.” _builder_version=”4.21.0″ _module_preset=”default” custom_padding=”10px||20px||false|false” global_colors_info=”{}”]<\/p>\n
The 6th meeting of the WHO Montreux Collaborative on Fiscal Space, Public Financial Management and Health Financing[1]<\/a><\/sup> was held in Montreux, Switzerland from 14-16 November 2023.\u00a0<\/strong><\/p>\n [\/et_pb_text][et_pb_text admin_label=”TEXT – BLOCK 1 ” _builder_version=”4.21.0″ _module_preset=”default” custom_padding=”||1em||false|false” global_colors_info=”{}”]High-level finance and health-ministry representatives, development partners, and subject-matter experts met to identify how to more effectively strengthen public finance systems to support progress toward universal health coverage (UHC). In this blog post, we summarize the meeting\u2019s key messages and conclusions, and suggest ways for countries to accelerate their implementation of reforms. [\/et_pb_text][et_pb_text admin_label=”TEXT – BLOCK 10″ _builder_version=”4.21.0″ _module_preset=”default” custom_padding=”||1em||false|false” global_colors_info=”{}”]In 2024-2025, WHO, the World Bank, and UNICEF will strengthen their collaboration to support countries in adopting this Agenda. This renewed partnership aims to accelerate and better coordinate technical assistance provided to countries, to harmonize guidance, and accelerate the development of capabilities. The three organizations will organize the next Montreux meeting in November 2025. We look forward to working with all of you on this Agenda to contribute to the 2030 Sustainable Development Goals! [1]<\/span> https:\/\/www.pfm4health.net\/<\/a><\/span><\/p>\n
\n[\/et_pb_text][ba_gradient_heading title=”Background on the Montreux Collaborative” html_tag=”h3″ primary_color=”#455A64″ secondary_color=”#455A64″ admin_label=”HEADING (50-60 characters)” _builder_version=”4.21.0″ _module_preset=”default” title_font=”||||||||” title_font_size=”24px” title_line_height=”1em” custom_padding=”15px||10px||false|false” global_colors_info=”{}”][\/ba_gradient_heading][et_pb_text admin_label=”TEXT – BLOCK 1 ” _builder_version=”4.21.0″ _module_preset=”default” custom_padding=”||1em||false|false” global_colors_info=”{}”]The Montreux Collaborative meeting[2]<\/a><\/sup>, convened biennially by WHO since 2014, brings together country representatives, partners, and experts to discuss the relationship between fiscal space, public financial management (PFM), and health financing. These meetings highlight the critical role of public financing and of PFM systems in supporting progress toward UHC, and serve as fora for sharing evidence on reforms to address bottlenecks in PFM that affect public expenditure on health.[\/et_pb_text][et_pb_text admin_label=”TEXT – BLOCK 2 ” _builder_version=”4.21.0″ _module_preset=”default” custom_padding=”||1em||false|false” global_colors_info=”{}”]The Montreux Agenda focuses on the role of domestic budgets in expanding health coverage and assuring financial protection for the public. The Agenda builds on WHO-led research into the \u201cmechanics\u201d of public finance systems in health, conducted in collaboration with partners including the World Bank, the International Monetary Fund (IMF), the Organisation for Economic Co-operation and Development (OECD), UNICEF, Gavi, The Vaccine Alliance (Gavi), and the Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund). WHO also collaborates frequently with CABRI, International Budget Partnership, the Overseas Development Institute, Results for Development, ThinkWell, and P4H in this area of work.
\n[\/et_pb_text][et_pb_text admin_label=”TEXT – BLOCK 3″ _builder_version=”4.21.0″ _module_preset=”default” custom_padding=”||1em||false|false” global_colors_info=”{}”]The 2023 meeting focused on learning from the COVID-19 pandemic to identify adjustments to PFM that can improve systems\u2019 resilience to withstand shocks; clarifying what is needed from PFM to finance primary healthcare (PHC) more effectively; and unpacking the chronic underspending of health budgets, with discussion of joint solutions between finance and health actors.
\n[\/et_pb_text][ba_gradient_heading title=”Key takeaways” html_tag=”h3″ primary_color=”#455A64″ secondary_color=”#455A64″ admin_label=”HEADING (50-60 characters)” _builder_version=”4.21.0″ _module_preset=”default” title_font=”||||||||” title_font_size=”24px” title_line_height=”1em” custom_padding=”15px||10px||false|false” global_colors_info=”{}”][\/ba_gradient_heading][et_pb_text admin_label=”TEXT – BLOCK 4 ” _builder_version=”4.21.0″ _module_preset=”default” custom_padding=”||1em||false|false” global_colors_info=”{}”]The meeting\u2019s discussion of COVID-19 highlighted the role played by PFM systems in providing an adequate budgetary response to pandemics. Participants reached consensus on key parameters for making PFM more responsive to shocks, including using and expanding budget allocation flexibilities, streamlining budget spending protocols, and providing greater spending discretion to health service providers, while increasing accountability for outputs through robust financial information systems. There was clear recognition that the pandemic increased the need for cross-sectoral collaboration; and of the challenges in implementing budgetary and accountability mechanisms that bridge health and non-health sectors.
\n[\/et_pb_text][et_pb_text admin_label=”TEXT – BLOCK 5″ _builder_version=”4.21.0″ _module_preset=”default” custom_padding=”||1em||false|false” global_colors_info=”{}”]Discussions of PHC financing emphasized the role of public finance arrangements, channels, and incentives in ensuring effective delivery of primary care services. Programme-based budgeting (PBB) was presented as a tool to better align budgetary resources with primary care providers\u2019 needs. Evidence reviewed suggested that countries have yet to realize PBB\u2019s potential to this end, due to design issues and ongoing use of input-based control. In addition, participants agreed on the need to grant service providers more autonomy, including the ability to retain generated funds, to influence budgeting, and to more flexibility manage operating costs. To optimize the strategic purchasing of health services, the role of subnational authorities (e.g., districts and provinces) also needs to be clarified, given the decentralization processes which are ongoing in many countries.
\n[\/et_pb_text][et_pb_text admin_label=”TEXT – BLOCK 6″ _builder_version=”4.21.0″ _module_preset=”default” custom_padding=”||1em||false|false” global_colors_info=”{}”]The discussion of health budget execution highlighted chronic challenges in low-income countries, in which health budget execution has been poor, with deterioration since 2010 according to the WHO\/World Bank\u2019s most recent review of the data. This situation has resulted both from low absorptive capacities in the health sector, and systemic PFM bottlenecks, such as rigidly structured budgets, which impede capacity to spend at each stage of the budget cycle. Participants agreed to encourage countries to examine PFM bottlenecks by budget-cycle stage and by actor (health, finance, subnational level), as a means of identifying priority solutions.
\n[\/et_pb_text][et_pb_text admin_label=”TEXT – BLOCK 7″ _builder_version=”4.21.0″ _module_preset=”default” custom_padding=”||1em||false|false” global_colors_info=”{}”]Pre-and post-event workshops offered deep-dive discussions of two complementary topics. In the first workshop, experts discussed practicalities of scaling up \u201cdirect facility financing,\u201d a promising arrangement for financing primary care using domestic financing and country public finance systems and institutions for delivery. The post-event workshop focused on arrangements for external aid to the health sector, focusing on how to ensure better complementary between foreign and domestic resources. With the launch of the Lusaka Agenda on the Future of Global Health Initiatives (FGHI) one month after the Montreux Collaborative meeting, there is momentum for stronger alignment between Global Health Initiatives and countries\u2019 domestic PFM arrangements.
\n[\/et_pb_text][ba_gradient_heading title=”Moving forward” html_tag=”h3″ primary_color=”#455A64″ secondary_color=”#455A64″ admin_label=”HEADING (50-60 characters) Moving forward” _builder_version=”4.21.0″ _module_preset=”default” title_font=”||||||||” title_font_size=”24px” title_line_height=”1em” custom_padding=”15px||10px||false|false” global_colors_info=”{}”][\/ba_gradient_heading][et_pb_text admin_label=”TEXT – BLOCK 8″ _builder_version=”4.21.0″ _module_preset=”default” custom_padding=”||1em||false|false” global_colors_info=”{}”]Given current tight fiscal contexts, countries should prioritize reform of PFM as a means of increasing the agility and maximizing the value of public spending on health. PFM reforms are not necessarily \u201cbig bang\u201d reforms \u2013 they can be done incrementally but require sustained political commitment. The experience of responding to the COVID-19 pandemic has shown how PFM can become more responsive to shocks; these lessons should be incorporated into routine systems.
\n[\/et_pb_text][et_pb_text admin_label=”TEXT – BLOCK 9″ _builder_version=”4.21.0″ _module_preset=”default” custom_padding=”||1em||false|false” global_colors_info=”{}”]<\/p>\n\n
\n[\/et_pb_text][et_pb_text admin_label=”TEXT – BLOCK 9 – FOOTNOTES” _builder_version=”4.21.0″ _module_preset=”default” text_font_size=”13px” custom_margin=”20px||||false|false” custom_padding=”||||false|false” global_colors_info=”{}”]References<\/strong><\/p>\n