The Health Nutrition and Population (HNP) Flagship course is one of the World Bank’s offerings for policy dialogue and capacity building and aims to facilitate a strategic and systematic approach to planning health system reforms that will move countries to Universal Health Coverage (UHC).
Flagship ‘deep dives’ webinars allow World Bank staff and other faculty members to tailor content to clients and alumni of the Flagship course, while encouraging peer-to-peer interaction.
HNP Flagship Course: Domestic Resource Mobilization (DRM) Deep Dive
Session take aways, resources and remaining Q&A
June 22, 2021 Overview
Overview
The need to explore health financing challenges and solutions is now more acute than ever. Expanding on the paper, From Double Shock to Double Recovery - Implications and Options for Health Financing in the time of COVID-19, participants examined the macro-fiscal and health spending impacts from COVID-19, as well as how the concept of DRUM can help to frame solutions and align with providing a broader rationale for investing in health. Tools produced by the JLN Health Financing Technical Initiative were explored with a focus on the DRM Collaborative Knowledge Product Making the Case for Health: A Messaging Guide for Domestic Revenue Mobilization, which can support the country level DRM agenda.
A deep dive was provided on the concept of domestic revenue mobilization through health taxes, positioning this as one tool for raising revenue in a pandemic context with the added favorable impact on health outcomes combined with greater feasibility and acceptability. Participants were given a chance for 1:1 learning with facilitators during breakout sessions on the topics covered.
The objectives of this session were:
To provide interested Flagship participants with an opportunity for a deep dive discussion on contemporary themes relevant for domestic resource mobilization for health.
To discuss with Flagship participants the emerging macrofiscal impact of COVID-19, that will provide the context and underpinnings for the DRM discussions in the near future.
To explore the role that health taxes can play as one potential tool for DRM in the current pandemic context.
To share the knowledge products created by the Joint Learning Network’s DRM collaborative, with a special focus on the recently launched Messaging Guide as a practical resource for shaping dialogue in their country.
The Health Nutrition and Population (HNP) Flagship course is one of the World Bank’s offerings for policy dialogue and capacity building and aims to facilitate a strategic and systematic approach to planning health system reforms that will move countries to Universal Health Coverage (UHC). Flagship ‘deep dives’ webinars allow World Bank staff and other faculty members to tailor content to clients and alumni of the Flagship course, while encouraging peer-to-peer interaction. The first deep dive was focused on Domestic Resource Mobilization and hosted by the Joint Learning Network’s Health Financing Technical Initiative. This document summarizes key take aways provides a list of resources, and answers questions left over from the session Q&A.
High level take aways:
Countries are facing a double shock. This double shock is both health (morbidity and mortality, effect on essential services) and economic. It is in fact the largest contraction in many years. Recovery remain uncertain, and poverty is rising- affecting the financing and health landscape.
While most countries responded to COVID-19 with rapid increases in government spending during 2020 to control the pandemic and protect people, jobs, and businesses, these government expenditure levels were insulated by borrowing.
Despite an expected return to economic growth, the International Monetary Fund (IMF) projects government per capita spending to fall across all country income groups in 2021 and 2022, which will threaten return to normal. Moving forward, debt servicing will also increase
In fact a double recovery will be needed, both health and economic: However, an end to the pandemic can only come through enhanced disease surveillance, strengthened delivery platforms, and the roll out of COVID-19 vaccines. As such there is no economic recovery without a health recovery. Beyond responding to the pandemic, an additional challenge is maintaining essential services and coping with pent up demand, to avoid further health burden and development backslide.
Countries must consider efficiency gains as well as different revenue mobilization efforts to ensure that resources are effectively used. There is a need to build a whole-country approach considering that COVID 19 is a multisectoral response, and to build dialogue between sectors.
A number of tools produced by the JLNs DRM and Efficiency Collaboratives can help to further dialogue at the country level around DRUM, a framework that helps to show the inter-connectedness between domestic resource mobilization and use/efficiency.
The DRM collaborative messaging guide contains 16 messages built around health financing principles and using macroeconomic concepts to support dialogue between health and finance
Health taxes are a reform touched on in the guide that can support expanding overall fiscal space, with potential spillover effects for health
Health taxes – sometimes called sin tax, or pro-health taxes – are levied on products that negatively impact health and can also have significant revenue benefits. There are also newer targets of products, including -sugary and salty products, caffeine, and e-cigarettes.
Health tax helps to correct market failure – there are externalities (high cost on society), and internalities (cost to the individual) not reflected in the cost of the products in terms of future harm or addictiveness.
The design and selection of how to structure health taxes matters to get the most out of them from both a health protecting and revenue raising perspective
Additionally, there are common misconceptions of health taxes that they cause– loss of jobs, negative impacts on business, encourage illicit trade, are discriminatory, unconstitutional, regressive and that they connote earmarking for the health sector. Many of these do not hold true, including that they must be earmarked and that having a health tax in place guarantees that revenue will go to health.
Resources
From Double Shocks to Double Recovery
Health taxes and health earmarks: What do we know?
Health taxes and sugar sweetened beverages
WHO earmarking for health paper
Overview of DRUM
Session recording here
JLN Tools
Domestic Resource Mobilization Collaborative
Policy Dialogue Workshops are country-led meetings with various Ministry of Health, Finance, and other key stakeholders used to discuss common communication challenges and share mutual targets for making the case for investment in health.
Policy Dialogue Toolkit (MyJLN users only) is a compilation of tried and tested adaptable materials that can be used during and outside of these workshops
Making the Case for Health: A DRM Messaging Guide *NEW* is a set of messages that can support communication across health and finance sectors to make the case for investment in health.
Narrative summaries of country budgetary data that demonstrate how countries can summarize, analyze, and describe their historical budgetary data to inform country dialogue.
Dynamic Inventory of DRM Resources and Efforts -easy-to-access digest of existing resources, including databases, case studies, and other tools that can be used to make the case for DRM for health.
On prioritizing health: a background analysis- review of country efforts to prioritize spending in the public sector, with the future aim of identifying drivers of reprioritization.
Efficiency Collaborative
Health Priority Setting: A Practitioner’s Handbook compiles a set of existing tools and databases with practical experience collected from across 11 JLN countries
Health Priority Setting and Resource Allocation (HePRA) Tool and Database captures the current landscape of priority-setting and resource allocation practices across a set of 10 Joint Learning Network countries, and provides a tool for countries to assess their own environments. Related products include an excel database capturing these country experiences in detail, a fillable questionnaire, and visualization tool.
The Resource Guide for Measuring Health System Efficiency in LMICs provides a framework for identifying and measuring health system efficiency, including 30+ indicator fact sheets, experience from country pilots in Kenya and Malaysia, as well as inputs from 9 JLN countries
Outstanding Questions
Q1: Securing alignment in government health expenditure between the national and subnational levels in a decentralized system is a key problem in some countries. Is there any tool within the JLN for addressing such a problem?
Response Facilitator 1: Not explicitly. However, the Making the Case for Health: A Messaging Guide for Domestic Resource Mobilization was created following DRM collaborative member country requests for evidence-based arguments that can support communication across the health and finance sectors to make the case for investment in health. The Policy Dialogue Toolkit can be adapted by countries interested in mobilizing domestic resources for health to plan a policy dialogue workshop that engages finance stakeholders around health sector financing goals. For more information, please visit: https://www.jointlearningnetwork.org/what-we-do/domestic-resource-mobilization/
Facilitator 2: The guide is a messaging tool. It's important to contextualise the tool in a country specific scenario. Important to focus on clarity and consistency of messages rather than a detailed investigation. There are references on detailed studies as well. Useful for those who would like to prepare communication material for the need to prioritise health from the public side.
Q2: Issue of messaging to encourage policymakers to invest more in health. The issue in Nigeria is that stakeholders are outside the health sector blame the health sector for poorly managing the health funds. The need to mobilise funds for the health for UHC is important.
Facilitator: there are messages within the guide that focus on efficiency, PFM as well as the benefit of investing in health for other sectors- perhaps looking at some of the arguments that have been put forward in this regard can support making the case.
Q3: Politicians in LMIC like to invest in tangible infrastructure rather than health investments that are not tangible and visible. How do we use the MG tool to prioritise health.
Facilitator: The messaging guide has a strong focus on human capital and the need to invest in human capital as a driver of productivity. As well, investing in health and human capital is a direct investment in constituents- I believe that some of the arguments within the guide can be used to counter these points
Q4: Trying to build confidence between health and other sectors. Requirement is to convince MOF that this is required.
Facilitator 1: I am hopeful that the economic rationale presented can support making the case for investing in health to finance decisionmakers.
Facilitator 2: relevant questions and these are not easy issues to solve.
Q5: Mismanagement of resources/funds in some countries make a difficult case for DRM in health. Dialogue would need to be first around efficiency about spending health
Facilitator 1: Agree is important to see how the health system in country is functioning and target big ticket items that provide maximum returns in health investments – can refer to MG briefs on PFM,
transparency, allocating resources in the right areas of support, PFM mechanisms that support efficient public spending – MoH needs to demonstrate better links between funding and results.
Facilitator 2: Political economy of investing health- investing in infrastructure vis health. COVID-19 provides an opportunity to rethink the political economy of health due to the increased attention of government on the response cost, and the opportunity cost of not having strong systems in place before the crisis hit. There are a lot of important research pieces around the political economy of the COVID-response. Refer to perceptions around the management of the COVID response in the US and in Brazil, with political consequences in the US, and maybe in Brazil ahead of the 2022 elections. The role of CSOs, of the media is particularly important to raise the value of investing in the right priorities/interventions for the policy makers. We hope that the messaging guide will help these target audiences to convey these messages around making the case for investment in health, beyond the construction of hospitals, towards the general public.
Indeed, and this is why the focus of the messaging guide is to use arguments as close as possible to analytical referentials beyond health (productivity, human capital, poverty, equity, etc.)
Q6: Conditional cash transfer schemes are usually difficult to push through with policy makers - what other ways can be used to effectively reduce OOPs which is a major problem for LMICs. Can donors encourage countries to build in conditional cash transfers at the level of country negotiations
Facilitator: Targeted monetary transfers (conditional or not) are a type of demand side intervention which has proven effective at scale and politically attractive in several countries (e.g Mexico’s Progressa, Brazil’s Bolsa Familia, Senegal, etc.). Supply side interventions can also be used to provide compensatory funding for facilities to treat incoming patients.
Q7: What are key health spending efficiency indicators and how these can be made part of regular DHIS , HMIS reporting. Any examples on routine health financing reporting and monitoring of the same. Some more reflections on this will be really helpful.
Facilitator: I suggest referring to the Efficiency resource guide here.
Q8: One can predict the COVID-19 will heavily and negatively impact the SDGs. Is there any workable solution to alleviate this situation?
Facilitator: Before COVID, service coverage was improving in most settings, but financial protection indicators were trending downward. Additional public resources to increase investments in the social sectors will be difficult to mobilize, and the prospect for increasing external funding towards LICs/MICs will also likely shrink due to the fiscal constraints faced by HICs. Therefore, unlocking efficiency gains, reprioritizing social spending, and sharper and proactive targeting towards the poorest and more vulnerable will be key to maintain the course towards reaching the SDGs.
Blog » Health Systems - HNP Flagship - Deep Dives Resources
Health Systems - HNP Flagship - Deep Dives Resources
The Health Nutrition and Population (HNP) Flagship course is one of the World Bank’s offerings for policy dialogue and capacity building and aims to facilitate a strategic and systematic approach to planning health system reforms that will move countries to Universal Health Coverage (UHC).
Flagship ‘deep dives’ webinars allow World Bank staff and other faculty members to tailor content to clients and alumni of the Flagship course, while encouraging peer-to-peer interaction.
HNP Flagship Course: Domestic Resource Mobilization (DRM) Deep Dive
Session take aways, resources and remaining Q&A
June 22, 2021 Overview
See also Attached PDF file with linked resources and a recording of the Deep Dive
Overview
The need to explore health financing challenges and solutions is now more acute than ever. Expanding on the paper, From Double Shock to Double Recovery - Implications and Options for Health Financing in the time of COVID-19, participants examined the macro-fiscal and health spending impacts from COVID-19, as well as how the concept of DRUM can help to frame solutions and align with providing a broader rationale for investing in health. Tools produced by the JLN Health Financing Technical Initiative were explored with a focus on the DRM Collaborative Knowledge Product Making the Case for Health: A Messaging Guide for Domestic Revenue Mobilization, which can support the country level DRM agenda.
A deep dive was provided on the concept of domestic revenue mobilization through health taxes, positioning this as one tool for raising revenue in a pandemic context with the added favorable impact on health outcomes combined with greater feasibility and acceptability. Participants were given a chance for 1:1 learning with facilitators during breakout sessions on the topics covered.
The objectives of this session were:
The Health Nutrition and Population (HNP) Flagship course is one of the World Bank’s offerings for policy dialogue and capacity building and aims to facilitate a strategic and systematic approach to planning health system reforms that will move countries to Universal Health Coverage (UHC). Flagship ‘deep dives’ webinars allow World Bank staff and other faculty members to tailor content to clients and alumni of the Flagship course, while encouraging peer-to-peer interaction. The first deep dive was focused on Domestic Resource Mobilization and hosted by the Joint Learning Network’s Health Financing Technical Initiative. This document summarizes key take aways provides a list of resources, and answers questions left over from the session Q&A.
High level take aways:
Resources
JLN Tools
Domestic Resource Mobilization Collaborative
Efficiency Collaborative
Outstanding Questions
Q1: Securing alignment in government health expenditure between the national and subnational levels in a decentralized system is a key problem in some countries. Is there any tool within the JLN for addressing such a problem?
Response Facilitator 1: Not explicitly. However, the Making the Case for Health: A Messaging Guide for Domestic Resource Mobilization was created following DRM collaborative member country requests for evidence-based arguments that can support communication across the health and finance sectors to make the case for investment in health. The Policy Dialogue Toolkit can be adapted by countries interested in mobilizing domestic resources for health to plan a policy dialogue workshop that engages finance stakeholders around health sector financing goals. For more information, please visit: https://www.jointlearningnetwork.org/what-we-do/domestic-resource-mobilization/
Facilitator 2: The guide is a messaging tool. It's important to contextualise the tool in a country specific scenario. Important to focus on clarity and consistency of messages rather than a detailed investigation. There are references on detailed studies as well. Useful for those who would like to prepare communication material for the need to prioritise health from the public side.
Q2: Issue of messaging to encourage policymakers to invest more in health. The issue in Nigeria is that stakeholders are outside the health sector blame the health sector for poorly managing the health funds. The need to mobilise funds for the health for UHC is important.
Facilitator: there are messages within the guide that focus on efficiency, PFM as well as the benefit of investing in health for other sectors- perhaps looking at some of the arguments that have been put forward in this regard can support making the case.
Q3: Politicians in LMIC like to invest in tangible infrastructure rather than health investments that are not tangible and visible. How do we use the MG tool to prioritise health.
Facilitator: The messaging guide has a strong focus on human capital and the need to invest in human capital as a driver of productivity. As well, investing in health and human capital is a direct investment in constituents- I believe that some of the arguments within the guide can be used to counter these points
Q4: Trying to build confidence between health and other sectors. Requirement is to convince MOF that this is required.
Facilitator 1: I am hopeful that the economic rationale presented can support making the case for investing in health to finance decisionmakers.
Facilitator 2: relevant questions and these are not easy issues to solve.
Q5: Mismanagement of resources/funds in some countries make a difficult case for DRM in health. Dialogue would need to be first around efficiency about spending health
Facilitator 1: Agree is important to see how the health system in country is functioning and target big ticket items that provide maximum returns in health investments – can refer to MG briefs on PFM,
transparency, allocating resources in the right areas of support, PFM mechanisms that support efficient public spending – MoH needs to demonstrate better links between funding and results.
Facilitator 2: Political economy of investing health- investing in infrastructure vis health. COVID-19 provides an opportunity to rethink the political economy of health due to the increased attention of government on the response cost, and the opportunity cost of not having strong systems in place before the crisis hit. There are a lot of important research pieces around the political economy of the COVID-response. Refer to perceptions around the management of the COVID response in the US and in Brazil, with political consequences in the US, and maybe in Brazil ahead of the 2022 elections. The role of CSOs, of the media is particularly important to raise the value of investing in the right priorities/interventions for the policy makers. We hope that the messaging guide will help these target audiences to convey these messages around making the case for investment in health, beyond the construction of hospitals, towards the general public.
Indeed, and this is why the focus of the messaging guide is to use arguments as close as possible to analytical referentials beyond health (productivity, human capital, poverty, equity, etc.)
Q6: Conditional cash transfer schemes are usually difficult to push through with policy makers - what other ways can be used to effectively reduce OOPs which is a major problem for LMICs. Can donors encourage countries to build in conditional cash transfers at the level of country negotiations
Facilitator: Targeted monetary transfers (conditional or not) are a type of demand side intervention which has proven effective at scale and politically attractive in several countries (e.g Mexico’s Progressa, Brazil’s Bolsa Familia, Senegal, etc.). Supply side interventions can also be used to provide compensatory funding for facilities to treat incoming patients.
Q7: What are key health spending efficiency indicators and how these can be made part of regular DHIS , HMIS reporting. Any examples on routine health financing reporting and monitoring of the same. Some more reflections on this will be really helpful.
Facilitator: I suggest referring to the Efficiency resource guide here.
Q8: One can predict the COVID-19 will heavily and negatively impact the SDGs. Is there any workable solution to alleviate this situation?
Facilitator: Before COVID, service coverage was improving in most settings, but financial protection indicators were trending downward. Additional public resources to increase investments in the social sectors will be difficult to mobilize, and the prospect for increasing external funding towards LICs/MICs will also likely shrink due to the fiscal constraints faced by HICs. Therefore, unlocking efficiency gains, reprioritizing social spending, and sharper and proactive targeting towards the poorest and more vulnerable will be key to maintain the course towards reaching the SDGs.
Thanks for sharing.
Can external links be provided to share on other platforms such as LinkedIn?