The COVID-19 pandemic has pushed health on top of the policy agenda of many governments. As economies also got bettered by the pandemic and the Russia-Ukraine war, governments have limited fiscal space to allocate funds for strengthening health systems and making them more resilient. In this context, how governments prioritize the allocation of limited budgets becomes vital.

The economic value of investing in a strong public health system and primary health care is well established. Though investments in social determinants of health (education, employment, nutrition, hygiene, clean air, clean energy, safe water, etc.,) do not figure in health budgets, they contribute as much or more to improving the health status of people. Investments in primary health care should take precedence over those in hospital-based care. Investment in a competent health workforce skilled in public health and primary healthcare is as important as that in supporting infrastructure.

Nearly 20 to 25 percent of allocated budgets remain unspent due to poor public health financial management systems. Another 20 to 25 percent of the amounts spent go into low-value care like unnecessary visits, drugs, and procedures. Corruption eats further into already constrained budgets. Hence, investing in strengthening health management tools and skills has the potential to improve efficiency in operations across health systems.

A significant portion of health budgets, both capital and operational, go into health technologies. Investments in indigenous health technology development generate not only more monetary value but also greater resilience in the face of supply-chain disruptions being witnessed due to the pandemic and wars. Investments in digital technologies not only improve efficiencies across systems but also overcome some of the challenges in healthcare provision. Advances in biotechnologies have demonstrated the power of these investments, in surveillance, prevention, rapid diagnosis, and treatment during the COVID-19 pandemic.

Timely access to acute care saves lives during a health crisis. Many emergency conditions get the best outcomes if attended to within the golden first hour. Hence, investments are essential in ambulance networks, emergency rooms, and intensive care units to save lives. Telemedicine and e-ICU systems are able to address the shortage of qualified critical care specialists. Investment in building a frontline cadre with competencies to manage acutely ill patients has become essential to meet current health needs and future health crises.

The best value for the money comes from investing in health workforce. While most health systems focus on investing in medical professionals, investments in community health workers, nurses, and allied health professionals and in their skills development yields equal or greater value. No amount of technology can replace the care provided by the health workforce. In addition, a competent health workforce cannot be generated at short notice unlike a temporary hospital or an oxygen plant, or an isolation center. The availability of the health workforce defines the number of services one can provide and not just the number of beds or diagnostic or procedure equipment as was evident during the surges of Covid variants. Hence, investment in a surplus health workforce becomes essential to be resilient against future shocks.

In addition to the provision of needed healthcare services and protection against financial hardships, securing people against a growing number of future health and other shocks has assumed equal importance. Investments in robust surveillance systems across human, animal, and environmental settings (so-called ‘One Health’ concept), and rapid alert and response systems have become essential to mitigate future threats, to prepare the system to mount rapid and effective responses to minimize the impact on not only people’s health but also on the economy and other social systems.    

How to raise additional financial resources, how best to pool them, how to allocate them as per priority setting, and how to deploy them efficiently and effectively are crucial in meeting health financing needs. Raising additional taxes on unhealthy foods and habits, so-called ‘sin taxes’, serves the dual purpose of mobilizing more resources while reducing harmful health effects. Pooling taxes, insurance premiums, philanthropic donations, international aid, contributions from corporates towards their social responsibility, etc., is the best strategy to undertake financing in the context of limited budgets. However, evidence-informed priority setting is as critical to making the limited resources work for the health of people.

In conclusion, it becomes clear that governments should acquire institutional capacities to prioritize the allocation of insufficient health budgets to derive maximum health and economic value. It can leverage policies that influence and strategies that incentivize the private sector to make investments in priority areas. They should make their voice heard in global fora to support their efforts ineffective use of limited resources in areas of trade, intellectual property, labor, and information sharing.

Dr. Krishna Reddy Nallamalla
President, InOrder, the Health Systems Institute
Regional Director, South Asia, ACCESS Health International

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