Kikwete Davos2013 02 300dpiAs the world focuses on the post-2015 development agenda, we must continue to look for ways to improve financing for health. As a global health community, we have made significant progress during the past 15 years and it would be a shame to allow a reversal of this progress because of a lack of adequate funds. This will require an unprecedented level of cooperation and collaboration between donor, recipient nations, the private sector and global health implementers.

The focus on financing for health is as important for continuing the successes we have made over the past 15 years, as it is to helping us address new challenges. The rise of non-communicable disease threatens our fragile health systems with complicated, often expensive diseases. NCDs often exacerbate the doctor and nurse shortages that many developing nations face as an adequate approach to addressing NCDs, usually includes advanced training in oncology or surgery for example.

Likewise, the global slowdown of funding available for global health combined with the pressure that national budgets currently face, threatens to reverse important health improvements. If we cannot continue to scale up the various successful programs for maternal and child health, for example, we may see a rise in mortality rates after a decade of strong declines. Financing for health is critical to addressing this problem.

While the challenges are immense, there are some promising solutions. I would like to highlight one example – specific to Tanzania – that reflects a new approach to generating funding for global health. One of our major health focuses is improving the health of women and children. While the government has focused a lot of resources to address this problem, there are still significant gaps particularly in scaling services around throughout the country. Fortunately, our friends at Barclays Tanzania took up this call and through their corporate social responsibility efforts, were able to generate 187 million TZS (Tanzanian shilling) to support the expansion of maternal and child health programs. The funding will go to support two recognized leaders in providing these services: AMREF and CCBRT Hospital. The new funding will go to scaling proven maternal health services in areas where resources are scarce. This is just one example of the types of new partnerships that are needed to help a country like Tanzania address its health financing challenges.

As I mentioned above, donor nations are not the only ones responsible for improving financing for health. As leaders of developing nations, we owe it to our people and to the global community to continue to look for ways to improve the impact of the funding that we do receive and to ensure that it is improving health outcomes. In Tanzania, we have put a particular emphasis on results-based financing (RBF) for health. RBF changes the paradigm by switching for a focus on paying for inputs to paying for positive health outcomes by rebalancing incentives towards the outcomes we want to see.

RBF has been very effective in Tanzania. We have used RBF to help improve the quality and quantity of services in our birthing clinics by ensuring 24-hr access to qualified, dedicated staff. Furthermore, our efforts to use RBF for maternal and child health have demonstrated significant gains. Pay for performance programs have been implemented that have not only improved the performance of our health professionals, but have also helped address bottlenecks and improve transparency and accountability. Overall RBF has allowed us to better prioritize our health spending and target it to achieve positive outcomes. In short it has allowed us to get more health per dollar and incentivize the entire system towards results.

I look at the health financing challenge as two different challenges rolled into one. First we must focus on generating new resources for health. Organizations such as the Global Fund, World Bank and private sector partners such as Barclays are critical in this fight. They will be increasingly important in complementing the generous but declining funding from donor nations that struggle with internal fiscal challenges. Raising additional revenue for health in the developing world must be a multi-faceted approach that operates with the assumption that we welcome all of the entities that want to help.

The second challenge is to align the incentive properly so that we can do more with our existing resources. A shift towards results-based financing and a focus on creating the right incentives to improve health outcomes is critical. A situation with declining resources demands that we find more efficient ways to use the money we receive. This requires a commitment to improving the flow of information about what is working and what is not, while also incentivizing the best and brightest to dedicate their careers to improving the health of their fellow citizens.

To reiterate, international diplomacy plays a significant role here in helping to communicate the positive impact that global health funding has on populations in the developing world. This will help the global dialogue around global health financing to shift from the discussion of ideas to the implementation of strategies. Platforms to facilitate this dialogue and to stimulate action are desperately needed as we move forward with ways to improve financing for health in the developing world.

While the solutions to addressing our health financing challenges are wide-spread, we are confident that we can achieve our goals. It will take openness to new approaches and a commitment to integrating results-based financing into our current efforts. It will also require a commitment to reach out to new partners such as global banks and financial institutions to ensure that we are tapping into as many resource pools as we can. Finally, it will take a commitment to our people – our mothers and our children –to use whatever means necessary to address these challenges and emerge from them stronger and healthier as a result. GHD