There is growing consensus that primary healthcare (PHC) facility financial autonomy, particularly allowing facilities to receive funds directly, is important for achieving universal health coverage. It has been shown to enhance efficiency in the flow of funds, strengthen transparency and accountability, improve responsiveness to local needs, and result in better and more equitable health outcomes (Kuwawenaruwa et al. 2018; WHO 2022; Barroy et al. 2019).
The Public Financial Management (PFM) system and Ministry of Finance (MoF) are often viewed as bottlenecks to increasing facility financial autonomy. The PFM system and MoF can, however, also be important enablers of facility autonomy, supporting greater operational efficiency and accountability. The MoF can support facility autonomy by: (1) sensitising health stakeholders on existing PFM arrangements to ensure common understanding of what is and is not feasible in financing facilities; (2) critically reflecting, with health stakeholders, on the optimal flow of funds for facilities; (3) allowing facilities to receive funds by becoming budget entities or cost centres; (4) permitting facilities to open bank accounts, either within the treasury single account or outside of it; (5) allowing facilities to retain funds earned and to roll them over to the next financial year; and (6) supporting information sharing and accountability through development of digital innovations, such as financial management information systems (FMIS) and mobile money.
Facility financing reforms often incorporate the MoF too little or too late. Its role is often unappreciated by health stakeholders and the MoF may also not see a role for itself in this and other health financing reforms.
CABRI’s Policy Dialogue on PFM as Enabler of Greater Health Facility Autonomy scheduled from 27-29 August in Mauritius, aims to address this shortcoming by bringing together MoFs, ministries of health and, where appropriate, ministries of local government, to reach a shared understanding of how each can support facility autonomy. More specifically it aims to:
- Provide a shared understanding and common language of what facility financing is, what problems it aims to resolve, prerequisites, different models of implementation and the benefits and challenges.
- Outline where the PFM system might be a bottleneck to increasing financial autonomy, how the MoF can support this reform and understand the MoF’s perspective on the risks of increasing financial autonomy.
- Create a basis for improved dialogue and collaboration between stakeholders going forward.
References
Barroy, Kabaniha, G., Boudreaux, C., Cammack, T., and Bain, N. 2019. “Leveraging Public Financial Management for Better Health in Africa: Key Bottlenecks and Opportunities for Reform.” World Health Organization. https://doi.org/10.1017/CBO978....
Kuwawenaruwa, August, Michelle Remme, Gemini Mtei, Suzan Makawia, Stephen Maluka, Ntuli Kapologwe, and Josephine Borghi. 2018. “Bank Accounts for Public Primary Health Care Facilities: Reflections on Implementation from Three Districts in Tanzania.” https://researchonline.lshtm.a....
WHO. 2022. “Direct Facility Financing: Concept and Role for UHC.” WHO.