1.Support government commitment and build technical and information capacity to be able to inform health priorities and spending by:
- Supporting countries through capacity building in standardized monitoring of total health expenditures (e.g., National Health Accounts), with attention to serving the needs of the poor and
- Expanding training in client countries in collaboration with local Institutions to build knowledge and technical capacity through health financing learning platforms.
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Whether Bank support to health financing reforms is sustained depends on government commitments and local technical capacity.
Technical capacity has facilitated understanding for health financing reforms and can be built in collaboration with local Institutions.
WB: Agree. The HNP GP will continue and expand support to build capacity to monitor public and private sector spending, and to prioritize the use of public subsidies based on evidence.
Training in the HOW and the WHAT of health financing will be expanded through various learning and knowledge management vehicles.
Action 1: Build capacity to monitor public and private sector spending and target public subsidies.
Indicator: % of active operations and TA activities with the development objective to strengthen HF that include activities to improve the capacity to monitor public and private sector spending and/or to target public subsidies.
Baseline: TBD, FY2015
Target: TBD
Action 2: Expand HF training and other learning in client countries in collaboration with local institutions.
Indicator: Number of HF training and learning activities delivered for clients in collaboration with local institutions.
Baseline: FY2015
Target: TBD
Frequency of reporting: Annually
Data source: Annual GP KM review
IEG confirms the overall progress made in FY17 in supporting client countries to build technical and information capacity to inform health priorities and spending.
Action 1: build capacity to monitor public and private sector spending and target public subsidies.
The FY17 portfolio review showed a sustained increase in "the share of active World Bank projects and ASAs comprising health financing activities directed to improve the capacity to monitor public and private sector spending and/or to target public subsidies," which is the indicator chosen to monitor progress on Action 1. The indicator was at 45% in FY15 (baseline), 45% in FY16 and 52% in FY17 (surpassing the target of 50% for FY18).
Action 2: expand health financing (HF) training and other learning in client countries in collaboration with local institutions.
Sustained improvements were also recorded in the "number of health financing (HF) training and learning activities delivered for clients in collaboration with local institutions", the indicator used to monitor progress on Action 2. According to a survey of client-serving teams affiliated with the Health Financing Global Solutions Group (HF GSG), the indicator progressed from 14 in FY15 (baseline), to 31 in FY16 and 80 in FY17 (which surpasses the target of 35 set for FY18). The FY17 survey identifies three main categories of HF training and learning activities provided in client countries: (i) workshops and events, (ii) trainings, and (iii) formal Flagship courses. Local institutions had significant involvement in the development, implementation, and delivery of the training and learning activities.
The key drivers of the improved support to client countries in building technical and information capacity to inform health priorities and spending were: (i) the establishment of clear technical priorities under the overall coordination of the HF GSG (ii) increased focus of the Health Financing Multi-Donor Trust Fund (HF MDTF) toward building country-level capacity (iii) the support provided by the Global Financing Facility for Every Woman and Every Child (GFF), which builds on the experience of the Health Results Innovation Trust Fund (HRITF) in supporting results-based financing (RBF) health operations and (iv) collaborations with global partnerships programs that are active in health financing.
[Action 1: Build capacity to monitor public and private sector spending and target public subsidies. Indicator: % of active operations and TA activities with the development objective to strengthen HF that include activities to improve the capacity to monitor public and private sector spending and/or to target public subsidies. FY15 (baseline): 45% FY16: 45% FY17: 52% FY18 (target): 50%]
[Action 2: Expand HF training and other learning in client countries in collaboration with local institutions. Indicator: Number of HF training and learning activities delivered for clients in collaboration with local institutions. FY15 (baseline): 14 FY16: 31 FY17: 80 FY18 (target): 35]
Since the initial Health Financing Management Action Record (HF MAR) for FY15, the World Bank Group's (WBG) Health, Nutrition and Population Global Practice (HNP GP) and its Health Financing Global Solutions Group (HF GSG) led a significant expansion of health financing activities, with an emphasis on client impact. As a key capability required to make progress toward the Universal Health Coverage (UHC) targets by 2030, health financing is a priority area for the HNP GP, and the focus of an increasing number of HF GSG, HNP GP and WBG activities, including contributions to global initiatives. The FY17 MAR reflects the overall growth and strengthening of health financing capabilities in service to our clients. This growth was achieved through the establishment of clear technical priorities (overview of priorities under reference/action area 0310), resource mobilization, extension of health financing collaborations and partnerships, and improved overall coordination through the HF GSG.
Results for Action 1 reveal a sustained focus on boosting the capacity of client countries to monitor public and private sector spending and/or target public subsidies. The share of activities supporting this focus has risen to 52% in FY17 from 45% in FY16. This growth is linked to expanded funding for health financing capacity development, including financing through the Health Financing Multi-Donor Trust Fund (MDTF) to integrate externally-financed health programs.
The HF MDTF funding impacts capacity-building for spend monitoring and targeting for public subsidies through 4 pillars of activity: (1) comprehensive health financing and institutional assessments (2) technical assistance and capacity building (3) knowledge generation and exchange activities and (4) implementation of health systems integration/strengthening interventions. At its inception, the MDTF focused largely on pillar (1) through its support of the execution of the Health Financing System Assessment (HFSA) in client countries. The focus of MDTF has since shifted toward pillar (2) and building country-level capacity.
The MDTF's support of HFSA has strengthened expending analysis and triggered demand by client countries for activities to build analytical capacities. The HFSA aims to identify critical constraints and opportunities to develop health financing systems that accelerate and sustain progress towards UHC. The HFSA has been administered in 35 countries to date as a combination of a standard core assessment and deep-dive modules tailored to the needs of the client country. The core assessment is a holistic health financing system review, including health and UHC outcomes, health financing functions, health system inputs and the country's macro-fiscal, demographic, organizational and poverty context.
The HFSA is designed to monitor public and private spending, but also to review local institutions and their capacity to carry out health financing functions, including expenditure analyses. The HFSA is used for diagnosing capacity constraints at the country level and identifying where countries can further strengthen their systems and build capacity. The HFSA's standards of practice (SOP) suggests an assessment of the client country's data collection and analytical capacity. The assessment reviews how to resolve capacity constraints and institutionalize the monitoring of public and private expenditures. This work, supported by the MDTF financing, directly impacts how countries shape their agendas to improve monitoring capabilities, as well as how WBG supports them in making progress.
In addition to MDTF, financing support from the Global Financing Facility for Every Woman and Every Child (GFF), also prioritizes capacity-building for health financing activities in client countries. The GFF is a multi-stakeholder partnership (involving WBG, Gavi, the Global Fund, United Nations agencies and other organizations), that focuses on identifying and financing interventions to support the expansion of health coverage for reproductive, maternal, newborn, child, and adolescent health (RMNCAH) as a part of the goal to achieve UHC by 2030. The GFF Trust Fund (Trust Fund) is a central component of the GFF and housed at the World Bank. This multi-donor trust fund has been established at the World Bank to provide additional financing for RMNCAH by linking grant funding to IDA or IBRD projects. The Trust Fund mobilizes the expertise of the entire World Bank Group, including the IFC through its private sector window. It builds on the experience of the Health Results Innovation Trust Fund (HRITF) in providing results-focused financing to support countries to achieve RMNCAH results. As of April 2016, the Trust Fund had received US$815 million in commitments from the governments of Norway and Canada and from the Bill and Melinda Gates Foundation. As of FY17, GFF supports financing for interventions to support expansion of coverage for RMNCAH, as well as helping support health systems strengthening, in 16 lower- and middle income countries of 62 that are eligible. The activities are managed from the HNP GP and strengthening of health systems is accomplished through a GFF mandate for the review of country systems, support for HFSA assessments, and funding for the development of health financing strategies.
Analysis of the results indicators for Action 2 shows a significant expansion of health financing training and learning activities in client countries executed in collaboration with local institutions (e.g., government, academia). The driving force for this growth is also MDTF financing and the end-to-end support the MDTF financing and the HF GSG provide for the implementation of the HFSAs and follow-up learning activities in client countries. Through the HFSA, for which MDTF provides financing, countries develop an understanding of their own capacity constraints. Countries then request training and learning activities to fill these capacity gaps. MDTF helps finance both the initial HFSA and the subsequent training activities brought to countries and co-developed with local institutions. The number of these activities has significantly increased from 31 to 80 between FY16 and FY17, according to a survey of client-serving teams affiliated with the HNP GP Health Financing GSG. This FY17 TTL survey helped identify three categories of training and learning activities: (i) workshops and events, (ii) trainings, and (iii) formal Flagship courses. Local institutions in client countries are involved in each with significant participation in development, implementation, collaboration, and delivery. For each activity, local institutions are directly involved in planning, developing content, hosting, presenting or leading content discussions, depending on the context of the event.
Examples of workshops conducted in FY17 include: (1) a strategic purchasing workshop with a focus on externally-financed programs, held in Jakarta in collaboration with DJSN (Social Safety Net Board) and Gajah Mada University (2) a two-day workshop in Bangkok with presentations and discussions led by the Ministries of Health and Finance on integrating externally-financed health programs while building sustainable and inclusive health financing systems (held in the run up to the Prince Mahidol Award Conference, P155137) (3) a thematic week on UHC for the 20-year Anniversary of the Mandatory Health Insurance Fund organized by the Government of Kyrgyzstan with support from development partners (September 27-30, 2016) and (4) health benefit package design and costing workshops led in collaboration with the Ministries of Health, Labor, Finance and Social Affairs of the Republic of Congo (P143849).
Examples of FY17 trainings include: (1) a training in Papua New Guinea entitled "Health Infrastructure Project Management and Cost-Benefit Analysis", conducted in collaboration with the National Department of Health in March 2017 (2) a training on provider payment reform evaluation, "Impact Evaluation of Provider Payment Reforms on Advancing China's Health (APPROACH): An Evaluation of County Hospitals", delivered in collaboration with Fudan University, Peking University Health Science Center, Sun Yat-sen University, and Sichuan University and (3) a training on capitation-based performance payments in Kosovo, prepared in collaboration with the Ministry of Health, municipalities, and local health facilities, and executed by the Kosovo Ministry of Health consultants.
These activities complement the ongoing HNP GP Flagship courses conducted in collaboration with client countries, which include health financing components. In FY17, the Flagship course was delivered in collaboration with five country teams and their counterparts, including Timor-Leste, Lao PDR, Cambodia, Bangladesh and Ethiopia. Two regional courses with health financing content were also held in Thailand and Sri Lanka.
Further, in April 2017, the HNP GP and HF GSG held the Second Annual UHC Financing Forum (the Forum), established as the WBG's flagship knowledge exchange and learning event for health financing in FY16. The Forum, held concurrently with the Spring Meetings, brought together more than 400 experts from across the WBG and over 50 countries (representatives of the Ministries of Health and Finance) and partner organizations (IMF, WHO, multilateral financing agencies). Local institutions were represented on the Forum Steering Committee and Working Group leading preparation for the event, including the Estonian Health Insurance Fund, the Ghana National Health Insurance Scheme, the Ministry of Health of Nigeria, the Thailand International Health Policy Program, and the Budget Transparency Initiative (a network of country-level institutions). Discussions focused on efficiency in health financing and were supported by a strong leadership and convening role played by the HF GSG. Preparations for the Forum included a systematic review of available evidence on the Forum topic under the guidance of the Technical Working Group and steering Committee, as well as broad and inclusive consultations with WBG staff and external experts/partners. Outputs developed for the Forum have been widely disseminated in response to demand from participants and can be found at these links:
(1) http://globalpractices.worldbank.org/gsg/Financing/Pages/News%20Article…
(2) http://www.worldbank.org/en/events/2017/04/20/second-annual-universal-h…
The portfolio review shows that in FY15 and FY16 around 45% of active operations and TAs had the development objective to strengthen health financing and set up for FY18 the target of 50%. HNP GP provided health financing support to client countries through: (i) the Global Financing Facility for Every Woman and Every Child (GFF) and (ii) the Health Financing Transition MDTF. HNP GP is also collaborating with DEC to enhance the consistency of health financing household data under the WBG Data for Goals Initiative, and with WHO/OECD to improve the frequency, relevance and ownership of national health accounts (NHA). Health financing training and learning opportunities offered to client countries has more than doubled between FY15 (14) and FY16 (31) (FY18 target: 35) according to the survey of client-serving teams affiliated with the HNP GP Health Financing Global Solutions Area (GSA).
The portfolio review shows a significant and steady trend at 45% in FY15 and FY16 of active operations and TA activities with the development objective to strengthen health financing including activities to improve the capacity to monitor public and private sector spending and/or to target public subsidies. The Health, Nutrition and Population Global Practice (HNP GP) has been bolstering this trend by supporting initiatives to strengthen capacity for health financing reform in client countries. Through the Global Financing Facility for Every Woman and Every Child (GFF), the WBG is currently providing support to strengthen health financing systems in 12 lower- and middle income countries of the 63 that are eligible for support. Gradual expansion is planned in FY17 and beyond as more resources are mobilized. As indicated in earlier updates, this support mandates the review of data and information systems, and increasingly assists countries in closing health financing capacity gaps. The Health Financing Transition MDTF has been scaled-up to more than US$50 million, providing support to more than 20 countries in comprehensively assessing their health financing systems and developing transition plans, including the review of health financing data and information systems as well as support to strengthen them. Further, the HNP GP has been working closely with DEC to enhance the consistency of health financing household data under the WBG Data for Goals Initiative. Under the leadership of WHO/OECD, the HNP GP is working closely with partners on a joint strategy to improve the frequency, relevance and ownership of national health accounts (NHA), including the involvement of local institutions in the process of collecting, vetting and analyzing data. Finally, the data shows steady expansion of health financing training and other learning opportunities in client countries and in collaboration with local institutions, such as governments and academia. According to the survey of client-serving teams affiliated with the HNP GP Health Financing Global Solutions Area (GSA), the number of such activities has more than doubled between FY15 (14) and FY16 (31), and the teams are encouraged to continue this trend both by the Health Financing Global Solutions Group and the HNP GP overall leadership.
[Action 1: Build capacity to monitor public and private sector spending and target public subsidies. Indicator: % of active operations and TA activities with the development objective to strengthen HF that include activities to improve the capacity to monitor public and private sector spending and/or to target public subsidies. FY15 (baseline): 45% FY16: 45% FY18 (target): 50%]
[Action 2: Expand HF training and other learning in client countries in collaboration with local institutions. Indicator: Number of HF training and learning activities delivered for clients in collaboration with local institutions.
FY15 (baseline): 14 FY16: 31 FY18 (target): 35
Frequency of reporting: annual
Data source: TTL survey]
The HNP Global Practice (GP) has strengthened the incorporation of health financing into several new country-level initiatives.
Of particular importance is the new Global Financial Facility (GFF) for Every Woman and Every Child, which was launched in July 2015 at the Third International Conference for Financing Development Development. In addition to the GFF's support to fill the financing support for basic child, adolescence, and maternal health, the fund will also requires eligible countries to improve the tracking of health resources. Effectively, this will lead to better capacity to monitor financing in most or all IDA countries. The GFF will be hosted at the World Bank and the Gates Foundation is providing support to improve data collection and analysis.
The World Bank has a trust fund that is supporting the development of health financing strategies in 12 countries. This will support the analysis of existing data and provide capacity building to improve the quality of data collection and analysis.
These initiatives, along with proposals to strengthen country capacity in the collection and analysis of data, are promising and should supports efforts to implement the recommendation. The Global Practice has not set the baseline or targets for this indicator.
The HNP GP is exploring/has launched several initiatives to strengthen and expand WBG support to building country commitment/capacity for resource tracking to inform health financing policy making and implementation in member countries:
1. The recently launched, WBG-hosted Global Financing Facility (GFF) for Every Woman and Every Child makes investment in resource tracking de-facto mandatory for every future IDA operation (including in the health sector of GFF countries) moreover, it aligns financing from development partners to improve information management systems in health. The GFF supports countries in developing and financing Investment Cases for Woman and Child Health and Health Financing Strategies for Universal Health Coverage. The development of both Investment Cases and Heath Financing Strategies includes an in-depth review of information systems (including NHA), data gaps, and plans to strengthen national systems. Investment Cases and Health Financing Strategies have been or are being developed in 12 out of the 63 countries eligible for GFF financing support (TF, IDA and IBRD).
2. A roughly $30 million MDTF supports the development and implementation of health financing transition strategies in a dozen member countries, which includes the review of health financing information strategies and activities to improve local capacities to track resources, analyze data, and use information for policy-making. The activities include training in collaboration with local institutions.
3. The HNP explores options to expand support to countries in building capacity to monitor health financing, in particular household data, through the soon to be launched WBG Data for Goals initiative.
4. The HNP GP is working toward an enhanced peer review process to strengthen and better align ASA / operations with GP and corporate priorities, such as statistical capacity building.
The portfolio review to assess support under operations and ASA active in FY15 is ongoing, the baseline and target for the performance indicator are therefore pending.