From Stumbling Block to Enabler: The Role of Public Financial Management in Health Service Delivery in Tanzania and Zambia

The way governments manage resources through the budget cycle has important implications for health policy and whether governments achieve societal objectives such as efficiency, equity, quality, and accountability. Studies found a positive association between health service delivery outcomes and good governance of public finance, however the mechanisms through which public financial management affects service delivery remains underexplored. This article maps the three stages of the budget cycle to common performance criteria used in health service delivery. It applies this approach to experiences in Tanzania and Zambia.

Towards universal health coverage and sustainable financing in Afghanistan: progress and challenges

Afghanistan has made impressive progress in introducing primary health care across the country over the last fifteen years. In the face of the diverse challenges ranging from persistent insecurity, conservative social norms, weak public financing, and reducing donor aid, Afghanistan is arguably among one of the most challenging contexts to achieve universal health coverage (UHC). Therefore, it is important to consider additional avenues towards UHC while building on the progress in coverage and financing of primary health care to date.
The right to health is considered a fundamental human right and UHC has gained prominence globally as a goal for countries in the Sustainable Development Goals (SDGs). UHC is defined by the World Health Organization (WHO) as: “access to key promotive, preventive, curative and rehabilitative health
interventions for all at an affordable cost, thereby achieving equity in access.

An assertive, practical, and substantive agenda to catalyse meaningful change

The Lancet Global Health Commission on financing primary health care combines a shared vision with practical guidance on how to align health financing with overall reform strategies that place primary care service delivery at the core. The Commission reinforces key messages that WHO has put forward on health financing reforms to enable progress towards universal health coverage. It then extends these by application to primary care as a critical service delivery element for the progressive realisation of UHC.

WHO's guidance on health financing is crystallised into a framework for regular country assessment to inform policy dialogue. The alignment of the Commission with this guidance is clear, as reflected in the table. While the decision to limit the operational definition of primary health care to service delivery platforms was made for the purposes of the Commission, certain key financing issues merit further attention. We point to these towards the end ...