Health budgets

Insufficient public investment in health systems is a major barrier to the delivery of high quality care. Without health-financing solutions, the poorest people – including women and families – are unable to access life-saving treatment and care.

Our take on the issue

Many health systems in sub-Saharan Africa are still funded by households. Poorer women are often forced to choose between receiving care and paying for it, or providing an education or food for their children – this is not a choice that should have to be made.

Financial risk protections, such as insurance, are essential in reducing the amount of ‘out of pocket’ expenditure on health.

Without this protection, insufficient household resources mean that women will try to give birth in their homes, or wait to seek care until it becomes an emergency, when it is often too late. Or, families are forced to borrow significant amounts or sell their assets to pay for healthcare, which can drive them further into poverty.

A lack of transparency in the budgeting process means that those in power are not held to account for allocating budget to health, and for translating this budget into the resources that health workers need so they can provide quality care.

The 2030 Agenda for Sustainable Development has set goal 3.8, which outlines that by 2030 the world must achieve universal health coverage (UHC), including financial risk protection, access to quality essential healthcare services and access to safe, effective, quality, affordable essential medicines and vaccines for all.

Over 1/3
of total health expenditure
is paid out-of-pocket directly by household
Less than 2.5%
of GDP is spent
on public health systems

Global commitments

The 2030 Agenda for Sustainable Development has set goal 3.8, which outlines that by 2030 the world must achieve universal health coverage (UHC), including financial risk protection, access to quality essential healthcare services and access to safe, effective, quality, affordable essential medicines and vaccines for all.

This means achieving access to essential family planning, and maternal and newborn health services for all women in Africa, including young women.

It is internationally recognised that low-income countries aiming to provide Universal Health Coverage (UHC) of essential health services should spend at least 5% of GDP on health, or US $86 per person if their GDP is low.

At least $86
PER PERSON
should be spent on health by all countries

What mamaye is doing

Advocacy for more and better public spending is vital. MamaYe works at a regional, country and sub-national level to support health budget advocacy efforts, training activists and civil society organisations in health-budget analysis so that they can better hold governments to account with regard to health financing commitments. Our combined expertise in health financing, budget analysis and evidence-based advocacy enables us to make a strong case for public investment in reproductive, maternal, newborn and child and adolescent health (RMNCAH).

Across Africa, we're supporting civil society engagement with the Global Financing Facility (GFF), a multi-stakeholder financing mechanism in support for Every Woman, Every Child. We use real voices and local realities in global level discussions among the GFF Investors Group and Secretariat. At country levels, we're supporting civil society to track commitments and implementation of GFF investment cases, and strengthening civil society participation in GFF Country Platforms.

In Nigeria, we've successfully supported evidence-based advocacy to ensure a family planning budget line is included within the national budget.

In Malawi, we're working in partnership with district councils and local partners to monitor health budget transparency at a district level.

In Kenya, we're building the skills of county officials and partners to understand and track their health budgets.

Good advocacy is strengthened by credible evidence and the real aim is to ensure that the citizens of a county or sub-national unit receive better quality health care.
Ibitein Modupe Fiberesima, Nigeria
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