Diagnosing expenditure performance through health financing analysis

A lowly performing health-financing function compromises the performance of the entire health system because the way in which health services are financed is a strong driver of health outcomes.

Many countries and the development partners that support them do not always have a clear view of how the financing system is performing, leading to poor health outcomes. Even where performance is shown to be poor, remedial steps and entry points are often less clear.

Our client needed to identify health-financing challenges driving poor system performance and the entry points in addressing the challenges. Through a holistic analytical assessment of financing performance across the value chain of services provision, from health inputs to outcomes, we assessed the performance of six countries’ health-financing systems to understand performance and identify entry points for improvement. Our analysis focused on:

• Revenue raising and resources mobilisation performance;
• Allocation of resources and the extent to which it was fair;
• Public finance management performance and the extent to which it supported the policy decisions by ensuring full budget execution;
• Purchasing decisions and how these were linked to performance, and;
• The efficiency and effectiveness of the health system as a whole.

Using a suite of health financing and analytical approaches, benchmarking, regression and trend analysis, we supported the creation of country-health financing dashboards.

The dashboards presented a country scorecard of overall health system and financing performance, a resource flow summary illustrating how finances flowed through the system, and an opportunity sizing assessment that highlighted the specific gains to be made over a medium term if the identified entry points were improved to target levels. The project was global with focus on Kenya, Nigeria, Ethiopia, Burkina Faso India and Pakistan.

Our work has been used by the client to refine its strategic focus in health financing in LMICS, potentially accelerating progress towards universal health coverage.