Assessing Fiscal Space For Health In The Sdg Era

Initially defined for overall public purposes, the concept of fiscal space was subsequently developed and adapted for the health sector. In this context, it has been applied in research and policy in over 50 low- and middle-income countries over the past ten years. Building on this vast experience and against the backdrop of shifts in the global health financing landscape in the Sustainable Development Goals (SDG) era, the commentary highlights key lessons and challenges in the approach to assessing potential fiscal space for health. In looking forward, the authors recommend that future fiscal space for health analyses primarily focus on domestic sources, with specific attention to potential expansion from the improved use and performance of public resources. Embedding assessments in national health planning and budgeting processes, with due consideration of the political economy dynamics, will provide a way to inform and impact allocative decisions more effectively.

This paper uses a novel macroeconomic framework to identify policy and financing options to help Rwanda achieve its sustainable development goals (SDGs). Under current policies, Rwanda would meet its SDGs right after 2050. Active policies that combine fiscal reforms and higher private sector participation could fulfill more than one third of Rwanda’s post-pandemic SDG financing gap, enabling the country to meet its SDG targets by 2040. For Rwanda to meet its SDGs by 2030, active policies would need to be complemented with about 133⁄4 percentage points of GDP in additional resources annually until then.

IMF country teams have become increasingly engaged on health spending issues in surveillance and program work, and more so since the COVID-19 pandemic. The primary objectives of health spending are to improve health outcomes and provide protection to households against high financial costs of health care. The Fund’s engagement on health spending issues is guided by an assessment of its macro-criticality, with the scope and purpose of engagement varying across countries and depending on whether it occurs in surveillance or program contexts. This technical note discusses how to assess the macro-criticality of health spending and reviews appropriate policy responses. The design and implementation of macro-critical health reforms often require specific sectoral knowledge and experience. Thus, this note emphasizes the importance of collaborating with development partners on health policy issues.

The COVID-19 pandemic hit countries’ development agendas hard. The ensuing recession has pushed millions into extreme poverty and has shrunk government resources available for spending on achieving the United Nations Sustainable Development Goals (SDGs). This Staff Discussion Note assesses the current state of play on funding SDGs in five key development areas: education, health, roads, electricity, and water and sanitation, using a newly developed dynamic macroeconomic framework.

This paper assesses the additional spending required to make substantial progress towards achieving the SDGs in Pakistan. We focus on critical areas of human (education and health) and physical (electricity, roads, and water and sanitation) capital. For each sector, we document the progress to date, assess where Pakistan stands relative to its peers, highlight key challenges, and estimate the additional spending required to make substantial progress. The estimates for the additional spending are derived using the IMF SDG costing methodology. We find that to achieve the SDGs in these sectors would require additional annual spending of about 16 percent of GDP in 2030 from the public and private sectors combined.

"The presence, or absence, of neglected tropical diseases (NTDs) can be seen as a proxy for poverty and for the success of interventions aimed at reducing poverty. Today, coverage of the public-health interventions recommended by the World Health Organization (WHO) against NTDs may be interpreted as a proxy for universal health coverage and shared prosperity - in short, a proxy for coverage against neglect. As the world's focus shifts from development to sustainable development, from poverty eradication to shared prosperity, and from disease-specific goals to universal health coverage, control of NTDs will assume an important role towards the target of achieving universal health coverage, including individual financial risk protection. Success in overcoming NTDs is a "litmus test" for universal health coverage against NTDs in endemic countries. The first WHO report on NTDs (2010) set the scene by presenting the evidence for how these interventions had produced results. The second report (2013) assessed the progress made in deploying them and detailed the obstacles to their implementation. This third report analyses for the first time the investments needed to achieve the scale up of implementation required to achieve the targets of the WHO Roadmap on NTDs and universal coverage against NTDs. INVESTING TO OVERCOME THE GLOBAL IMPACT OF NEGLECTED TROPICAL DISEASES presents an investment strategy for NTDs and analyses the specific investment case for prevention, control, elimination and eradication of 12 of the 17 NTDs. Such an analysis is justified following the adoption by the Sixty-sixth World Health Assembly in 2013 of resolution WHA6612 on neglected tropical diseases, which called for sufficient and predictable funding to achieve the Roadmap's targets and sustain control efforts. The report cautions, however, that it is wise investment and not investment alone that will yield success. The report registers progress and challenges and signals those that lie ahead. Climate change is expected to increase the spread of several vector-borne NTDs, notably dengue, transmission of which is directly influenced by temperature, rainfall, relative humidity and climate variability primarily through their effects on the vector. Investments in vector-borne diseases will avoid the potentially catastrophic expenditures associated with their control. The presence of NTDs will thereby signal an early warning system for climate-sensitive diseases. The ultimate goal is to deliver enhanced and equitable interventions to the most marginalized populations in the context of a changing public-health and investment landscape to ensure that all peoples affected by NTDs have an opportunity to lead healthier and wealthier lives."--Publisher's description.

In the global race to reach the end of AIDS, why is the world slipping off track? The answer has to do with stigma, money, and data. Global funding for AIDS response is declining. Tough choices must be made: some people will win and some will lose. Global aid agencies and governments use health data to make these choices. While aid agencies prioritize a shrinking list of countries, many governments deny that sex workers, men who have sex with men, drug users, and transgender people exist. Since no data is gathered about their needs, life-saving services are not funded, and the lack of data reinforces the denial. The Uncounted cracks open this and other data paradoxes through interviews with global health leaders and activists, ethnographic research, analysis of gaps in mathematical models, and the author's experience as an activist and senior official. It shows what is counted, what is not, and why empowering communities to gather their own data could be key to ending AIDS.