The Health Financing Progress Matrix (HFPM) is WHO’s standardized qualitative assessment of country health financing systems. Specifically, the HFPM assesses the extent to which a country has developed, and is implementing, health financing policies which evidence shows are important to drive progress to UHC.
Several countries in the WHO AFRO region have already started implementing the HFPM with a number of others planning to conduct it in the near future. In response to this growing interest, WHO convened these country teams from 22-24 of June 2022 in Zimbabwe. This meeting was part-briefing, part-training event, to ensure that key officials understand the HFPM in terms of why it was developed, the technical framework and logic on which it is built, as well as a number of implementation and strategic issues to maximize the usefulness of the assessment.
Participants from 12 WHO AFRO countries included Ministry officials, WHO country office focal points, and health financing experts from academic and research institutions, and partner agencies, including the African Union (AU), Africa CDC, the African Development Bank (AfDB), the World Bank (WB) and Global Financing Facility (GFF), the Global Fund for Aids TB and Malaria, East Central and Southern Africa Community (ECSA), the Southern African Development Community (SADC), R4D, Thinkwell, KEMRI Research Welcome Trust, African Health and Policy Association (AFHEA), and Strategic Purchasing Research Center (SPARC).
Participants were provided with an overview on the HFPM, including the 19 desirable attributes which form the normative foundations, Stage 1 (landscaping of country’s health schemes and programmes) and Stage 2 (detailed assessment across 7 technical areas and 33 questions). When introducing the HFPM, Joe Kutzin, (Coordinator HF Team, WHO HQ), highlighted that the HFPM should not be seen as another tool: “The HFPM is rather an instrument meant to support and guide towards systematic thinking on health financing”, built on evidence of what works in health financing. Furthermore, the HFPM is parsimonious, with no primary analysis required as the assessment builds on existing documents and analysis.
During implementation, a critical issue which emerged was the need to ensure high level political buy-in to the process, to improve uptake of the findings and recommendations. Participants discussed the ongoing policy processes in their countries which the HFPM assessment could feed into e.g a new health financing strategy; review of an existing HF strategy; development of an M&E framework. Another important element highlighted was the importance of investing in national capacities to conduct the assessment. The role of academia came up prominently, both in supporting the assessment itself, but also with respect to research to further improve the instrument, and to help translate evidence into policy. “There is a need for the Ministries of Health and academia to co-conceptualize a domestic approach for implementation and co-build the evidence on the findings and recommendations for public policy”, said Prof. Gordon Abekah-Nkrumah from the University of Ghana.
In a panel discussion, experts from WB, AfDB, AU, SADC and ECSA presented their respective engagement in health financing in the region. The increased focus on support for health financing in Africa reflects its strategic importance, but at the same time requires harmonization and alignment. What emerged from this panel is that strategically, the HFPM can be leveraged for multiple purposes, and is hence relevant to a large number of stakeholders. For example, in his presentation on the ALM Declaration and the Tracker, Paul Booth, highlighted links between the AU Health Financing Tracker and the HFPM: “While the tracker helps to identify specific challenges in a country and get political commitment to overcome these challenges, the HFPM goes deeper into technical analysis helps to indicate what specifically you need to do to overcome challenges”, said Paul.
Finally, as more countries are planning to undertake the HFPM assessments, this will allow WHO to support countries in a very focused manner, and to facilitate greater collaboration across countries.