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This report summarizes the findings of an allocative efficiency analysis of Togo's HIV response. The Government of Togo indicated a desire to mobilize additional resources, including domestic and private resources, for comprehensive HIV services to respond to the goals of the national HIV Strategic Plan. To ensure that the resources that have been, or will be, mobilized are used in the most efficient way, and to determine the allocation of resources that brings the greatest health benefit, the Government of Togo asked the World Bank to conduct an allocative efficiency analysis using the Optima HIV mathematical model. The findings highlighted a significant treatment gap, and argue strongly for additional funding to scale up ART and increase coverage, in particular for key populations. In order to reduce incidence and deaths by 50 percent, resources should be shifted from prevention programs targeting the general low risk population to ART, PMTCT, and non-ART prevention programs targeting key populations.

Health Economics and Finance --- Health, Nutrition and Population

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Myanmar's National Health Plan (NHP) for 2017-2021 has laid out the vision of achieving Universal Health Coverage (UHC) by 2030. The NHP aims to improve the delivery of health services and financial protection for Myanmar people through substantial investments in frontline service delivery units and through a range of reforms in the health system, including on health financing. This report assesses Myanmar's health financing system. The analysis is structured around three main sets of questions: (i) Who pays for health in Myanmar? Given that the government needs to invest more in the health sector, where could (or should) the money come from; (ii) Are prepaid and pooled funds for health sufficient and equitable? What additional pooling arrangements could Myanmar consider; and (iii) What key steps and reforms are needed for Myanmar to develop the capabilities of a strategic purchaser in the medium term? This Health Financing System Assessment aims to inform health financing policy choices that the Government of Myanmar will need to make as part of the development and implementation of its Health Financing Strategy.

Health economics and finance --- Health finance --- Health systems development and reform --- Health, nutrition and population

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Most countries are committed to the provision of quality health services to all, without risk of financial hardship. Adequate budget provisions are an important, yet insufficient requirement in this pursuit. The budget also needs to be implemented in full and with regard to efficiency and accountability. While this is widely acknowledged, there is no systematic evidence on how well the health budget is implemented and literature remains thin on how budget execution practices relate to health financing functions and service delivery. This report is the first in a series of publications on the topic following an active World Health Organization and World Bank collaboration. It aims to define concepts, characteristics and trends in health sector budget execution. The report first calls for clarity in use of terminology. It helps to differentiate between 'budget execution rates' and 'budget execution practices'. The former refers to the share of the budget being executed. The latter to processes on how well the budget is executed. Both aspects are equally important. Not implementing the budget in full is a lost opportunity, efficiency and accountability concern and undermines the health sector's ability to deliver services. It also undermines prospects for increased fiscal space going forward. To identify trends and patterns in over and underspending, the report draws on previously unexplored PEFA annex and World Bank BOOST data. This reveals the following: Health budget execution rates are inversely related to levels of income and maturity of PFM systems. Health budget under-execution is particularly pervasive in LMICs where the budget is executed at around 85-90 percent. Some countries have chronic budget execution problems where the budget is executed at a rate below 85 percent across consecutive years. In LMICs, the health budget is systematically implemented at a lower rate than the general government budget. This means, that governments are effectively deprioritizing health during budget implementation. For Sub-Saharan Africa countries in the sample, the average health budget was 6.7 percent of the general government budget. Health spending as a share of general government spending was half a percentage point less at 6.2 percent. In some countries this is much more pronounced, where health is deprioritized by 2-3 percentage points of general government spending during implementation. The health budget was also implemented at a lower rate than the education budget in most countries at an average rate of 4 percentage points. Underspending in some categories often occurs concurrently with overspending on other expenditure items. While the wage and salary budget tend to be implemented in full, this is less so for goods and services or the capital budget. This can leave health workers without the necessary supplies or support infrastructure to provide quality services and invariably lead to inefficiencies.

Health Economics and Finance --- Health Finance --- Health, Nutrition and Population --- Public Sector Development

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Armenia has made significant progress in improving population health outcomes over the past two decades. However, essential health care for non-communicable diseases (NCDs) is underutilized in part due to the cost of access. Armenia has also committed as a signatory to the Sustainable Development Goals, to making progress towards Universal Health Coverage (UHC). This commitment involves guaranteeing access to essential health care for all its citizens. The Ministry of Health (MoH) has developed a concept note for the introduction for Universal Health Insurance that proposes to mobilize additional revenue through payroll taxes or higher budgetary allocations to the sector. However, the Ministry of Finance (MoF) has noted that revenue mobilization options should ideally demonstrate positive returns in terms of economic growth and employment. Therefore, at the request of the MoH, the World Bank has modeled the macroeconomic impacts of options to increase domestic resource mobilization to finance universal access to essential health services in the basic benefits package. The analysis assumes that through UHC reforms that mobilize additional public spending, the government would cover the cost of ninety-five percent of household needs for health care from 2021 to 2050, and that the increase in the demand for care will be supported by improvements in supply-side efficiency. The results suggest that increasing direct taxes is better than increasing indirect taxes as the former are less distortionary and cause smaller allocative inefficiencies.

Economic Growth --- Health Economics and Finance --- Health Indicators --- Health, Nutrition and Population --- Macroeconomics and Economic Growth

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This report seeks to formulate a long-term vision for Haiti's health sector to accelerate progress toward universal health coverage (UHC), a key objective of the government's National Health Policy (Politique Nationale de Sante, PNS)-MSPP (2012). Progress toward this goal has been hindered by political instability and frequent natural catastrophes. Most recently, in October 2016, Hurricane Matthew wreaked havoc on Haiti's health system. It has been estimated that at least 1,000 people died and 1.4 million Haitians were directly affected by the hurricane. Such disasters have influenced Haiti's government and development partners by demanding a short-term focus on acute need priorities. This study aims to take a step back, assess Haiti's health financing system, and identify critical constraints and opportunities to accelerate progress toward UHC and the health-related United Nations' Sustainable Development Goals (SDGs) in the long term. The report compiles existing studies and information, and it provides new analysis of larger data sets, as well as hospital financing data. To our knowledge, it is the first attempt to assess systematically the health financing system in Haiti.

Health Economics and Finance --- Health Systems Development and Reform --- Health, Nutrition and Population