There was an estimated funding gap in 2015 of US$33.3 billion in 63 high burden low- and lower middle-income countries for RMNCAH, or $10 per capita. All countries face either funding gaps or gaps in disbursement to realize the vision of the Global Strategy. As described in the Global Strategy and the Global Financing Facility (GFF) Business Plan, closing these deficits requires an increase in domestic and international funding, increased efficiency of existing investments and strengthened national health financing strategies. A sustainable response to this challenge will require combining external support, domestic financing, the private sector and innovative sources for resource mobilization and delivery, while minimizing out-of-pocket expenditure and eliminating user fees.
National health financing strategies need to consider both current needs and deficits, as well as model requirements through the SDG period to 2030, keeping in mind the target of achieving universal health coverage and ensuring financial risk protection. In humanitarian and fragile settings, increasingly the context for the majority of maternal, newborn and child mortality and stillbirths, intensified efforts are required to increase financing, which will mostly be required from external sources throughout the SDG era. Within countries, funding needs to be prioritized for the worst off to help reduce inequities.
2.1 Identification of funding requirements and mobilization of all potential sources and support for funding
Financing for RMNCAH should be integrated into core national planning processes for health financing, without duplication or undertaking parallel exercises, for example in the development of prioritized, costed plans described in the section on country leadership. Once developed, progress requires monitoring of implementation at both national and sub-national levels, including scale-up of interventions and mobilization of resources. Resource mapping can be used to identify all potential forms of funding, both domestic and external (including viable options of revenue reform measures, such as fuel subsidy reform or taxes on consumption of harmful substances), to meet country health financing needs. The aim should be to develop a national health financing strategy. Key steps in this process include:
- estimating resource needs, using tools such as “OneHealth”
- resource mapping to estimate financing flows from all sources
- estimating overall resource gaps
- identifying potential sources to close gaps (including innovative financing measures, development partners and private sector)
- mobilizing sources of funding
- monitoring and transparent publication of disbursement and funding flows
- establishing a multi-stakeholder review process to review disbursement and funding flow data, and address shortcomings.