How to establish the health financing context

Health Financing
Establishing the health financing context can help you to get a better picture of the state of funding for health in your country. It will help you to check who is paying for health, and to what extent the Government are moving towards universal health coverage.

WHAT is it?

The Health Financing Context tool (download available below) will help you to check your country's status against key health financing indicators and what these indicators mean. It can be used to gain a better understanding of what the health financing status is, what questions to ask, and the implications for what you might focus advocacy and accountability interventions on.

The accompanying training slides (download available below) can help you to understand what UHC is, define key health financing concepts, and identify key indicators that will help you to establish the health financing context in your country. At E4A-MamaYe, we establish the health financing context to get a quick snapshot of the health financing status in a country, in order to identify what opportunities and challenges there might be for improving funding for health.


HOW do I do this?

You will need:

  • The Health Financing Context tool 
  • Connections with decision makers, health workers, other organisations and/or the community to ask more questions
  • An understanding of how people are meant to pay for health services according to policies- by insurance, tax or user fees


Tips when using the tool on health financing context 

  1. Select your country from the dropdown list
  2. Examine the 3 graphs
  3. Review the information on what each indicator means and why it matters
  4. Consider asking the suggested questions to find out more around the indicators you are interested in
  5. Use these indicators to help to inform the objectives for your advocacy efforts


WHEN do I do it?

For best results, use the tool as you are starting to engage in health financing in your country, or want to get a better understanding of the context to inform interventions. This can be done as part of a political economy analysis (further information on this is available here). The data comes from the WHO Global Expenditure Database, and is drawn from the National Health Accounts. The data is not updated regularly (the latest annual figures are for 2018), so it is important to complement this data with the experiences of the communities you represent- finding out how funding and health services have changed for them.


WHAT can I do with the information?

Look at the graphs and the indicator table, and discuss these questions as a group:

  1. What is the trend of Government Health Expenditure over time? Is it accounting for an increasing share of current health expenditure? Is it accounting for an increasing share of government expenditure? Why might this be the case?
  2. With your group, have you, or do you know of others who have been asked to pay out of pocket to access health services? Are you surprised by the proportion of current health expenditure from out of pocket payments? How can they be further reduced?
  3. Does your country conduct National Health Accounts? If yes, when is the next one? Can you keep an eye out for findings? If no, can you advocate for this important data to be collected?


Specific questions relating to each indicator are included in the Health Financing Context Tool. As you ask yourself these questions, consider what it can tell you about the bottlenecks or challenges that might require advocacy efforts to improve. Use E4A-MamaYe's Advocacy Handbook to consider who can best effect this change.