Reducing fragmentation of primary healthcare financing for more equitable, people-centred primary healthcare
Despite primary healthcare (PHC) being recognised in global declarations—Alma Ata in 1978 and Astana in 2018—and prioritised in national health strategies, chronic under-resourcing of PHC persists in most low-income and middle-income countries. More public spending is needed for PHC, but macrofiscal...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2025-01-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/10/1/e015088.full |
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| author | Kara Hanson Gemini Mtei Agnes Gatome-Munyua Susan Sparkes Martin Sabignoso Prastuti Soewondo Pierre Yameogo Cheryl Cashin |
| author_facet | Kara Hanson Gemini Mtei Agnes Gatome-Munyua Susan Sparkes Martin Sabignoso Prastuti Soewondo Pierre Yameogo Cheryl Cashin |
| author_sort | Kara Hanson |
| collection | DOAJ |
| description | Despite primary healthcare (PHC) being recognised in global declarations—Alma Ata in 1978 and Astana in 2018—and prioritised in national health strategies, chronic under-resourcing of PHC persists in most low-income and middle-income countries. More public spending is needed for PHC, but macrofiscal and political constraints often limit the ability of governments to allocate more public resources to PHC. Under-resourcing has been compounded by fragmented and rigid funding flows, which are inefficient and may erode equity, quality of care and public trust in PHC.This article explores the drivers of fragmentation in PHC financing—low public spending, which results in over-reliance on external sources to fund critical health interventions, and the proliferation of new financing schemes that do not take a system-wide view or adhere to the principles of universality. It then highlights some of the possible consequences of this fragmentation for the efficiency, equity and effectiveness of service delivery.Four countries—Argentina, Burkina Faso, Indonesia and Tanzania—are used to illustrate practical steps that may be taken to minimise the consequences of fragmentation in PHC financing: (1) consolidating multiple coverage schemes, (2) avoiding further fragmentation, (3) harmonising health purchasing functions and (4) streamlining funding flows to the provider level.The country examples reveal lessons for policy-makers grappling with the consequences of fragmented PHC financing. The paper concludes with a research agenda to generate additional evidence on what works to address fragmentation. |
| format | Article |
| id | doaj-art-dc57d783e8514806a5fa5efa1396794a |
| institution | Kabale University |
| issn | 2059-7908 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Global Health |
| spelling | doaj-art-dc57d783e8514806a5fa5efa1396794a2025-01-16T12:55:11ZengBMJ Publishing GroupBMJ Global Health2059-79082025-01-0110110.1136/bmjgh-2024-015088Reducing fragmentation of primary healthcare financing for more equitable, people-centred primary healthcareKara Hanson0Gemini Mtei1Agnes Gatome-Munyua2Susan Sparkes3Martin Sabignoso4Prastuti Soewondo5Pierre Yameogo6Cheryl Cashin7Department of Global Health Development, London School of Hygiene and Tropical Medicine, London, UKAbt Associates, Dar es Salaam, Tanzania, United Republic ofResults for Development Institute, Nairobi, KenyaWorld Health Organization, Geneva, SwitzerlandIndependent Consultant, Buenos Aires, ArgentinaMinistry of Health, Jakarta, IndonesiaMinistry of Health and Public Hygiene, Ouagadougou, Burkina FasoResults for Development Institute, Washington, District of Columbia, USADespite primary healthcare (PHC) being recognised in global declarations—Alma Ata in 1978 and Astana in 2018—and prioritised in national health strategies, chronic under-resourcing of PHC persists in most low-income and middle-income countries. More public spending is needed for PHC, but macrofiscal and political constraints often limit the ability of governments to allocate more public resources to PHC. Under-resourcing has been compounded by fragmented and rigid funding flows, which are inefficient and may erode equity, quality of care and public trust in PHC.This article explores the drivers of fragmentation in PHC financing—low public spending, which results in over-reliance on external sources to fund critical health interventions, and the proliferation of new financing schemes that do not take a system-wide view or adhere to the principles of universality. It then highlights some of the possible consequences of this fragmentation for the efficiency, equity and effectiveness of service delivery.Four countries—Argentina, Burkina Faso, Indonesia and Tanzania—are used to illustrate practical steps that may be taken to minimise the consequences of fragmentation in PHC financing: (1) consolidating multiple coverage schemes, (2) avoiding further fragmentation, (3) harmonising health purchasing functions and (4) streamlining funding flows to the provider level.The country examples reveal lessons for policy-makers grappling with the consequences of fragmented PHC financing. The paper concludes with a research agenda to generate additional evidence on what works to address fragmentation.https://gh.bmj.com/content/10/1/e015088.full |
| spellingShingle | Kara Hanson Gemini Mtei Agnes Gatome-Munyua Susan Sparkes Martin Sabignoso Prastuti Soewondo Pierre Yameogo Cheryl Cashin Reducing fragmentation of primary healthcare financing for more equitable, people-centred primary healthcare BMJ Global Health |
| title | Reducing fragmentation of primary healthcare financing for more equitable, people-centred primary healthcare |
| title_full | Reducing fragmentation of primary healthcare financing for more equitable, people-centred primary healthcare |
| title_fullStr | Reducing fragmentation of primary healthcare financing for more equitable, people-centred primary healthcare |
| title_full_unstemmed | Reducing fragmentation of primary healthcare financing for more equitable, people-centred primary healthcare |
| title_short | Reducing fragmentation of primary healthcare financing for more equitable, people-centred primary healthcare |
| title_sort | reducing fragmentation of primary healthcare financing for more equitable people centred primary healthcare |
| url | https://gh.bmj.com/content/10/1/e015088.full |
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