Sustainable Finance is Key to Health Equity

If the world is to end hunger, malnutrition, preventable deaths, and extreme poverty, we need intelligent, new forms of development finance to unlock, leverage, and catalyze resources.

We face an alarming shortfall of funding needed to transform global health, meet our development challenges, and attain the Sustainable Development Goals (SDGs).

Despite remarkable progress across global health, the brutal fact is the world’s poorest people still pay the most for things like clean water and basic health services. And poor health and health shocks are leading causes of chronic poverty and impoverishment.

The United States is the world’s leading donor in global health. We are strongly committed to working with partner nations to reach our goals of an AIDS-free generation, ending preventable child and maternal deaths, and protecting communities from infectious disease.

There is substantial evidence on the “health-to-wealth” pathway, and how investing in survival and health than lead to greater individual and national productivity and growth. Increasing access to health services -- especially for the poor – is a sound and sustainable investment that can command great economic returns.

But donor resources alone are not sufficient to reach our targets.  We need innovative approaches to financing, with increased domestic commitment from countries and regional development banks, as well as increased engagement by the private sector. Our core intent is to support countries as they work to provide for the health of their own citizens, and help them along the pathway to sustainable financing.

At the Conference on Financing for Development in Addis this/last week in Addis Ababa, domestic resource mobilization was at the heart of the deliberations. Broad issues like tax administration and the elimination of energy subsidies are opportunities to increase revenues for public financing of social services like maternal and child health.  Ethiopia is rolling out another important source of sustainable health financing: individual premiums as part of their new social health insurance and community-based health insurance to decrease catastrophic health expenditures and supplement Ministry of Health (MoH) budgets for essential health services. The combinations of all these efforts will enable national aspirations for universal health coverage.

The U.S., via the U.S. Agency for International Development (USAID), has launched a financing framework to promote the use of financing tools to accelerate progress and help countries transition to self-financing for maternal and child survival – and applicable to health more broadly.  Financing policies must focus on increasing equity and access to quality essential health services. The array of tools will help countries to prioritize equity in health service delivery, support models that reduce the share of health expenditure shouldered by the poor, and maximize the use of funds.

Reflective  of our commitment to sustainable financing, we have come together with the World Bank and many other partners to establish a Global Financing Facility (GFF) in support of Every Woman Every Child that will leverage additional resources, private capital and results-based financing to accelerate and sustain progress in maternal and child survival. The GFF is also an alliance, which brings us together with host governments, private sector and civil society to invest in helping countries implement evidence-based, life-saving interventions at scale and reach those that are most in need.

By investing $50 million into the Global Financing Facility, subject to Congressional approval, the U.S. Agency for International Development will support the Democratic Republic of the Congo, Ethiopia, Kenya, and Tanzania to scale up national strategies and efforts to end preventable child and maternal deaths. 

As a financing mechanism, the GFF is an example of how to use official development assistance to catalyze additional domestic and international, public and private financing.  As such, the GFF will help drive the transformative change needed to further accelerate investments in maternal and child survival and serve as a pathfinder mechanism for financing the Sustainable Development Goals. 

Tanzania is an excellent example of the increased focus on women and children that the GFF can help bring about in country. By blending some of our existing grants through the GFF, we have already incentivized the Government of Tanzania to significantly increase financing for women’s and children’s survival and health.  Results from the Tanzania and the other three countries will then serve to inform the best way forward relative to any continued US government funding of the GFF.

We have a clear and conclusive case to invest in health. Now we must summon the will and creativity to mobilize domestic resources and activate co-financing approaches that will transform societies.

About the Author: Dr. Ariel Pablo-Mendez serves as Assistant Administrator for Global Health, Child, and Maternal Survior Coordinator at USAID.



Hope O.
July 16, 2015
One can never know when they will fall sick. To protect the most vulnerable from the challenges they face due to unplanned sicknesses and then having to look for out of pocket money,to pay for their treatment, its will further drive this group into more poverty. Our governments need to come out clear with better health financing mechanisms.
Patrick W.
Maryland, USA
July 23, 2015
Sustainable Mental Health Finance is the Key to Health Equity in America and other countries. Especially, with all we have had to deal with in the past few years !!! :)
Anupama S.
United States
July 27, 2015

It is shocking how the poor pay the most for things like clean water and health access. I just read this and was amazed that half of the poorest people have no access to health care at all: Initiatives such as you describe here in the field of sustainable finance are valuable, plus the idea that women and children are key to breaking the negative cycle of poor health and poverty. A fresh focus on women and children helps drive development forward and strong women equal strong communities - wherever they are in the world.

Mother and her baby leave maternal health clinic in Ethiopia [Photo by Nena Terrell/USAID Ethiopia]
July 15, 2015


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