Is sufficient increase spending on health only?

The current financing methods of health system in the low- and middle-income countries do not generate enough resources to produce the requested health care levels for the whole population, many of the available resources are not pooled to provide support against household expenditure variance or channeled through some sort of prepayment mechanisms, and the scarce resources that are mobilized often do not lead to value for money in terms of the health care on which it is spent. Furthermore, health financing system is an exacerbating factor and a cause of the challenges of health inequity, unequal access, limited availability and capacity, and poor-quality health care services (1).

         Most of the middle-income countries have started on reforms to deal with these problems by improving the efficiency of health care spending. But increase spending alone will not lead to improve the health status of people unless the international community faces the challenge of supporting the implementation capacity of health systems, so that spending translate into better health outcomes for the poor (2). The challenge for health authorities is to ensure that financing mechanisms guarantee healthcare access and financial protection for patients while assuring the quality of services through sufficient supplies and human resources (3). There is no single plan for achieving these goals. In addition to that, the development of health delivery and financing systems will continue to be influenced by highly variable political, cultural, demographic, economic, and epidemiological contexts (2).

        Simultaneous steps are needed to improve efficiency, performance, and accountability in the public and private sectors. Introduction and strengthening of health management information systems, third-party assessments of service guarantee and quality, public disclosure, social audits, community supervision, and accreditation of facilities could help to improve accountability and effectiveness. Mechanisms are also needed to help with the flow of public funds, enhance the absorption capacity of the public health system, minimize unspent balances, and ensure improved monitoring and assessment (4). 



1. Valéry R, Aïssa D, Mahaman M, “User fees abolition policy in Niger: Comparing the under five years exemption implementation in two districts”, Health Policy 99 (2011) 219–225.

2.  Pablo Gottret, George Schieber, “Health Financing Revisited A Practioner’s Guide Overview”, The World Bank, 2006, 1-23.

3. Gilson L, McIntyre D., “Removing user fees for primary care in Africa: the need for careful action”, BMJ 2005; 331:762–5.

4. A K Shiva K, Lincoln C , Mita C, Shiban G, Vijay M, Amarjeet S, Abhijit S, “India: Towards Universal Health Coverage 6 Financing health care for all: challenges and opportunities”, Vol 377, Lancet 2011; 668–79.


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