Syndicate content

Accountable Governance

Reinvigorating Health Services: An Agenda for Public Finance Management

Matthew Jowett's picture



At the recent “New Directions in Governance” meeting it was suggested that future meetings should bring governance advisors together with sector-specific colleagues. The different language we use in our respective disciplines is a serious barrier to taking forward an agenda of real importance and  hence this message seemed particularly pertinent. I came to the meeting with a number of thoughts on how public finance management (PFM) rules often hinder health system performance, some of which I outline below.

Over the past three decades a major focus in low- and middle-income countries has been to seek new revenue sources for health services to overcome strict controls over the use of budget funds which were seen as inefficient but difficult to address. Community-based health insurance schemes have been widely introduced, as were patient user charges and payroll tax-funded social health insurance schemes. These various developments reflected a belief that governments were unlikely to increase funding to health, or to introduce the flexibility in budget funds required to incentivize improvements in service delivery.

Citizens In Want of Stamina

Sina Odugbemi's picture

This is the age of hopeful citizens where in almost every part of the globe citizens are mobilizing, marching and, often successfully, pushing for change. But this is also the age of increasingly frustrated citizens. In some cases, the frustration is occasioned by the failure to achieve changes in regimes even after an astonishing sequence of heroic efforts and sacrifices by citizens. In other cases, the efforts originally appeared successful. Long-entrenched dictators fell and citizens were ecstatic, believing glorious days were imminent. Yet, in many of these cases, one disappointment is jumping on top of another. Change is proving far more difficult to achieve; it is even proving elusive.