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How come national resources for health are falling?

By Ariana Childs Graham, PAI, US
Lola Dare, Chestrad, Nigeria
Simon Wright, Save the Children, UK

As the High Level Political Forum discusses its health targets, this joint blog raises the concern that national resources for health are falling. We’re calling for this to be reversed quickly.

How healthcare causes poverty

The theme of this week’s High Level Political Forum on the Sustainable Development Goals (SDGs) is “Eradicating poverty and promoting prosperity in a changing world“. One of the causes of poverty – which is also a cause of fear and suffering – is the failure to ensure that all people have access to quality healthcare without being expected to pay large amounts of cash for it.

150 million people each year are pushed into poverty, or further into poverty, because they have to pay high out-of-pocket costs for healthcare. And 400 million people do not have access to essential health services. Universal health coverage (UHC), in Target 3.8 of the SDGs, suggests a framework for stopping these injustices.

But national investment is falling

Public investment in health is the key to genuine UHC. And there have been  many commitments to increase spending on health systems – which would lead to achieving UHC. Despite this, we’re finding that governments of low and middle-income countries are reducing, not increasing, their spending on health.

A recent report from the World Health Organization (WHO) shows that between 2000 and 2014, public funding for health from domestic source in low and middle-income countries stagnated. National budget prioritisation of health sharply declined and was highly volatile between 2000 and 2014 in lower income countries (LICs).

Despite the strong consensus, there is no evidence that the process of replacing private expenditure with public financing has started, especially in low-income countries. No country has achieved significant progress towards UHC without investing public money in the health system.

Progress takes time and with two years of the SDGs already behind us, governments urgently need to prioritise national health spending by committing at least 5% of GDP. This needs short-term action rather than vague aspirations for the future.

Primary healthcare first

As non-governmental organisations that are part of the UHC2030 civil society constituency, we want to see UHC reforms drive improvements in health systems so that all the SDG targets can be achieved. We are calling on this High Level Political Forum to confirm a bottom-up approach to UHC, establishing universal primary healthcare as the bedrock, and progressing towards resilient and secure national health systems.

While the priority is for governments to collect and spend 5% of their GDP on health, donors need to achieve their promise of 0.7% GNI to Official Development Assistance (ODA).

The WHO report shows that aid actually has a negative impact on domestic resources. This should make donors review whether the way they are giving aid is causing fragmentation and chaos, and undermining the will and capacity of national governments to build universal primary health care.

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