In developed countries, government spending on health services or on social health protection schemes (i.e., public health insurance mechanisms) represents a significant share of the health sector and is critical to ensuring that the poorest and most vulnerable in a society have access to adequate care. (Global data from World Health Organization’s National Health Accounts shows that access to health care with equity is most likely when government budgets make up more than half of total health expenditure.)

However, in less developed countries public investment and expenditure on health care is a very small proportion of overall health spending, leaving the poorest with difficult choices between paying out-of-pocket for health care or using their limited resources to meet other needs.

Civil society organizations (CSOs) can use budget analysis to evaluate whether their government is meeting the health care needs of its people and its commitments to meeting those needs in terms of access to services and the adequacy and quality of care provided. CSOs can also use budget analysis tools to independently assess health policy proposals and contribute to more effective public decision-making processes.

It’s important for health advocates to remember that government budgets are about allocating scarce resources among competing sectors, activities, and programs, which requires tough decisions and trade-offs. Budget analysis is a critical tool for strengthening CSOs’ advocacy for health care funding, as well as their ability to identify priorities within health sector spending, helping to ensure that health funds are put to the best use.

Learn more about combining budget analysis with advocacy.

CSOs in countries around the world have used budget data (e.g., How much money has been allocated in this year’s budget for public health clinics, immunizations, medicines, etc.? How has the overall share of the budget dedicated to health care changed over time?) and health ministry/department administrative data (e.g., What is the anticipated caseload of HIV/AIDS patients in rural areas? What is the doctor to patient ratio in the clinics with the best patient outcomes?) to assess the overall strength of the public health system and to advocate for specific improvements for targeted aspects of the system or particular patient groups.

For example, IBP civil society partner Fundar, based in Mexico City, has successfully used budget analysis and advocacy to improve access to prenatal services throughout Mexico in their ongoing struggle to end maternal mortality. Read more about how they were able to stop funding leakages and redistribute government health resources to address the persistently high rate of childbirth-related death and disability.

There are a variety of tools available to analyze health budgets. For instance, civil society health advocates will often use costing (a method of estimating the total costs direct, indirect, shared, etc.of a given activity or strategy in relation to its anticipated outputs or results, e.g., cost per measles case prevented) to inform decisions on expenditure levels and choices of activities. Learn more about costing analysis here, under Training Materials.

Advocates also have used budget monitoring tools at the local level to gauge whether the funds allocated for health service provision are being used efficiently and effectively, and whether they are achieving the desired results. By identifying funding leakages as money is transferred from the national to subnational level and problems in frontline service delivery, CSOs are able to play a key oversight role that can help to strengthen a country’s health system and address inequalities in access to care. Read more about how groups in Kenya and India combined budget analysis and monitoring to address challenges in their countries’ health systems.

Useful Guides and Publications

Model Reports


Learn More about Health and Budget Analysis


Summary of the Health Sector Analysis (4 May 2015)

  • This note compares allocations for the health sector between the years.