Who Pays For Progress?

Who pays for progressJuly 2015 - A new report from Results UK uses Kenya as a case study to explore the implications of scaling-up Universal Health Care (UHC) in a country graduating from lower income to lower middle income status, and the challenge this will pose the country as Overseas Development Assistance (ODA) levels for health reduces in future years.

While acknowledging the need for ODA to continue to play a vital role, they also point to the increasingly important role domestic resource mobilisation (DRM) will have to play in the context of stagnating aid - especially when aid has previously provided close to 50% of the health budget (rising to 70% in some highly donor dependent sub-sections, such as HIV & AIDS).

This will necessitate a huge scale-up of DRM. Using Government Spending Watch estimates of the need to double tax revenues, as well as ensuring more equitable spend, they look at how this could be achieved progressively and equitably and outline a number of recommendations, including reducing illicit financial flow leakage out of the country, fighting against tax avoidance and tax evasion, improving the efficiency of the domestic tax base, and prioritising health spending.

Health Spending Scorecard


July 2015 - Are African countries meeting the health spending targets? Based on the latest GSW spending data, this scorecard developed by GSW and the Africa Health Budget Network provides an at-a-glance view of 30 African countries’ performance in reaching health spending targets.

The scorecard assesses performance on 4 indicators:

1.  Is government health spending consistent with country wealth?

2.  Is health spending prioritised in the government budget?

3.  Does the government spend enough on each person’s health?

4.  Is government health spending transparent?

For each indicator, performance is scored against global targets but also according to whether progress was made between 2013 and 2014.

While a few countries register some positive progress, there is a still a long way to go for most to meet the targets which would ensure that healthcare is free and universally provided.  To find out more on how developing countries have progressed on MDG spending in health and other key sectors and why spending must be scaled up, read the latest in-depth GSW research “Financing the Sustainable Development Goals: Lessons from Government Spending on the MDGs”.

Health spending

MDG Target 4MDG Target 5 MDG Target 6

This analysis is based on the latest trends analysis of GSW data in the GSW 2015 report

Health is the most prominent sector in the MDGs, with three goals dedicated to health, on which progress has varied. MDG Target 4.A aimed to reduce by two-thirds the under-five mortality rate, but only a 50% reduction has been achieved. The MDG Target 5.A (to reduce maternal mortality by three-quarters), and target 5.B (universal access to reproductive health care) will be missed by wide margins. Efforts to combat key diseases (Target 6) are mainly paying off, with a 25% fall in deaths from malaria, and lower new HIV infections, but many people still do not have access to anti-retroviral treatment.

What does the latest GSW data on health show?

  • No African country is meeting its targets.
  • 40% of all countries are meeting WHO per capita spending targets (US$60).
  • Average spending is only half the targeted level, and recent trends have been mixed.
  • Universal free health care will require an increase of US$50-80 billion, and a major effort to monitor spending split by disease and beneficiary group.
    • To read more about the Health sector findings in the GSW 2015 report herepdf.
    • To see what explains these trends, by understanding the financing behind them, including donor aid performance, click herepdf.
    • To see how accessible data are for this sector, click herepdf.


Enhancing the IMF’s Focus on Growth and Poverty Reduction in Low-Income Countries

Enhancing the IMFS Focus PublicationDevelopment Finance International for Norwegian NGO coalition Save the Children Norway, Norwegian Church Aid and the Norwegian Forum for Environment and Development

This report examines whether the IMF's Poverty Reduction and Growth Trust (PRGT) lending facilities have been delivering poverty reduction and growth to low-income countries. It finds that there was an increase in overall spending in almost all LICs in 2009-10, but in 2010-12 most IMF programme countries are cutting overall spending, while most non-programme countries are not: as a result, PRGT countries' spending will be almost the same as % of GDP in 2012 as in 2008, while that of other LICs will be 2.3% of GDP higher. Health spending will have decreased as % of GDP during 2009-11 for 68% of IMF programme countries, but only 53% of non-IMF countries. The report recommends 9 important steps to enhance PRGT focus on poverty reduction and growth.