Public financial management for universal health coverage: why and how it matters

UHC2030 launches policy note: ‘Public financial management for universal health coverage: why and how it matters’.

At the UN High-Level Meeting (UN HLM) on Universal Health Coverage in September 2019 country leaders reconfirmed universal health coverage (UHC) as a national policy priority and committed to directing government funds towards that goal. The move to UHC often means increasing public spending or redirecting existing resources. Strategic allocation and efficient spending of public funds are therefore important.

The COVID-19 pandemic has brought unprecedented challenges to country economies and population health. The pandemic also brings to focus the importance of prioritizing health system reforms towards UHC, as a key strategy that can address both health security and financial security.

Public financial management (PFM) systems, through which government’s fiscal and health policies are implemented, play a key role in how well countries manage the impact of the pandemic. There is increased emphasis on making larger and more timely investments into the health sector, as well as ensuring that resources flow smoothly to service delivery units and are spent efficiently. This places greater pressure on PFM systems.

The policy note Public financial management for universal health coverage: why and how it matters is intended as a primer on why public financial management in the health sector matters for supporting progress towards UHC and is key to preventing future pandemics.

The note was produced under the auspices of the UHC2030 Technical Working Group on Public Financial Management which comprises countries and development partners including partners who are members of the Sustainable Financing for Health Accelerator under the SDG3 Global Action Plan, who provided valuable comments that contributed to the finalization of this policy brief.

At a broad level there is consensus that PFM systems can facilitate improved health outcomes if they are configured with the right balance of control and flexibility required for the health sector. However, practitioners working within development partners and governments often have divergent expectations of PFM systems, and are not aligned internally, leading to sub-optimal reform efforts. Furthermore, there is lack of clarity on the role of PFM in health sector, and this can affect the ability to obtain the required support from senior leadership.

This note seeks to fill these gaps and articulate the commonly agreed broad expectations from PFM systems. This will support health and PFM experts to raise awareness and build momentum for a more focused approach on PFM for health in the pursuit of UHC and wider health security.