Domestic Financing

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To accelerate response to diseases, global health financing has a great challenge: finding new ways of raising adequate resources. Many low- and middle-income countries are taking up more responsibility for investing in health. For the first time in the history of global health, Africa is mobilizing more domestic resources for health than foreign development investments in the sector. In the spirit of shared responsibility and global solidarity with the international community, these countries are taking the lead and investing heavily in sectors that have been traditionally dominated by foreign development investments.

For instance, with the support of partners such as UNAIDS, African countries have increased their domestic resources to respond to HIV by 150 percent in the last four years. In a bid to end HIV, TB and malaria as epidemics, increasing domestic finances for health is tremendously important. Increased domestic investments in health signal country ownership and are a pathway to real sustainability of programs. While seeking to catalyse domestic investments in health, the Global Fund partnership is supporting in-country innovations that increase domestic investments in health.

Partnerships between UNITAID and Clinton Health Access Initiative (CHAI) are catalyzing innovative mechanisms for increased domestic investments in health. CHAI’s entrepreneurial approach to providing access to health care and UNITAID’s innovative financing mechanisms have emphasized creating partnerships and fostering strong country investments and ownership of programs.

The Global Fund has found an effective way to stimulate domestic investments in health. It starts with the conviction that making a transformational difference in the lives of the millions of people affected by diseases in low- and middle income countries will require significantly bigger domestic investments in health – private and public.

Country Income Level Government Contribution (million US$)
2012-2014 2015-2017 Additional Percentage Increase
Low 1.511 2.226 714 47%
Low-Middle 3.300 5.943 2.642 80%
Upper-Lower Middle 1.195 1.684 489 41%
Upper-Middle 2.761 3.463 702 25%
Total 8.768 13.316 4.548 52%

The Global Fund implements counterpart financing policies to support countries to increase domestic funding for the three diseases and the health sector. The current funding model supports ministries of health and finance to access an additional 15 percent of a country resource envelop as domestic resources increase. Thus far, countries have committed an additional US$4.3 billion to their health programs for 2015-2017. Compared with spending in 2012-2014, this represents a 52 percent increase in domestic financing for health. Here is a breakdown, separated by income level of the countries involved:

Countries implementing the funding model say its requirements for counterpart financing are valuable in unlocking more resources for health in their countries. In a survey conducted among 404 participants in country dialogue and concept note development in the first five funding windows of the funding model, 82 percent of respondents said the Global Fund's increased focus on counterpart financing encouraged greater government commitments in their countries.

Under the funding model, governments in several countries will for first time make substantive direct co-investments in Global Fund supported programs – an important step towards longer term sustainability of programs.

Published 15 November 2016