Health financing for universal coverage

Health financing country diagnostic:
A foundation for national strategy development


The health financing country diagnostic provides step-by-step guidance on how to undertake a situation analysis of a country’s health financing system.

This guide to conducting a diagnostic considers a number of issues outlined below including the current of level, mix and sources of funding for the health sector and institutional arrangements for health financing. It also assesses the performance of the system against the objectives and goals of universal health coverage (UHC).

The main output of the Health financing country diagnostic is a comprehensive situation analysis, which helps countries identify priority issues for future health financing reforms.

The Diagnostic is written for Ministries of Health and other actors responsible for developing and implementing health financing policies, as well as those in an advisory role.

The Diagnostic is structured as follows:

Key contextual factors that influence health financing policy and attainment of policy goals

  • Important aspects of fiscal context, including government spending to Gross Domestic Product (GDP) ratio, tax to GDP ratio, government budget deficit, and government debt.
  • The structure of public administration.
  • Public sector financial management.

Overview of health expenditure patterns

  • What do different indicators mean?
  • What does general government expenditure on health (GGHE) as % of GDP tell about the country?
  • How to measure government prioritization of health spending?

Review of health financing arrangements

  • Revenue raising mechanisms and key issues in relation to different types of sources.
  • Key questions to ask on fund pooling arrangements.
  • Purchasing and policies for benefit design and rationing.

How are we doing? Analyzing UHC goals and intermediate objectives

  • Financial protection and equity in finance.
  • Equity in service use and in the distribution of resources.
  • Health service quality.
  • Health system efficiency.
  • Transparency and accountability.

Overall assessment: priorities for health financing reform

  • Main causes of inadequate financial protection in the existing health system.
  • Main contributory factors to inadequate and inequitable access to quality health services on the basis of need.
  • Policy priorities.