KATE HAWKINS, Future Health Systems member

Day 2 of the Geneva Health Forum was characterised by discussions about the most appropriate mechanisms to finance functioning health systems and what changes in policy would be necessary to support this. Whilst development assistance overall is increasing the percentage share allocated to health is not rising at a commensurate rate. Most financing for health in developing countries is out of pocket expenditure. How do we protect the poor from the impoverishing effects of ill health? How do we secure greater investment in health? What are optimal mechanisms for channelling the money where it is needed? These are some of the questions that participants grappled with.

Although we need to spend US$50 – 100 per capita, per annum to reach the health Millennium Development Goals 43 low income countries are still spending less than US$30. David Evans of WHO stressed that action is needed in three areas: to raise more money; raise it the right way and to ensure that it efficiently finances equitable services. Speakers were, in general, in favour of more money for healthcare but were divided on the second two points.

Many speakers at the Forum explored the mixture of international financing mechanisms for health and their effects. The fragmented nature of health financing was highlighted – particularly in relation to global health partnerships such as GAVI and the Global Fund to fight AIDS, TB and Malaria. Some speakers felt that they drew energy and investment from government systems and budgets generating transaction costs and diluting national ownership. However, there was no one size fits all solution to this problem.

Some were adamant that financing should flow to government through general and sectoral budget support and that this, along with progressive central taxation, would enable countries to implement universal access to health services as is seen in settings like the UK. Others, such as Gorick Ooms from the Institute of Tropical Medicine in Antwerp, pointed out the limitations of general budget support due to macro economic policy that sets ceilings for health expenditure.

Other speakers addressed the role of the private sector and enabling them to better meet the needs of the poor. The for profit, not for profit and informal sector are the first port of call for many when they fall ill. Whether it is through regulation, training, support or incentives more interventions are needed to ensure the private sector offer quality care and that ‘consumers’ are empowered to demand appropriate services. Discussions continue today.