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.
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
- The Missing Link: Applied Budget Work as a Tool to Hold Governments Accountable for their Maternal Mortality Reduction Commitments.
This joint publication from the International Initiative on Maternal Mortality and Human Rights and the IBP explores the relevance of civil society budget analysis and advocacy and its potential as a tool to hold governments accountable for their commitments around maternal health.
- Lessons from India’s Health Budget: Out-of-Pocket Expenses for All
by Ravi Duggal.
This IBP newsletter article compares India’s public health spending with patients’ out of pocket health costs, raising questions of equity, access, and resource adequacy.
- Ghana: Budget Monitoring by SEND-Ghana and its Partners Helps Improve Nutrition for Children and Support Local Farmers.
This case study examines the work done by IBP partner the Social Enterprise Development (SEND-Ghana) Foundation monitoring the performance of the Ghana School Feeding Programme.
- In the Face of Crisis: The Treatment Action Campaign Fights Government Inertia with Budget Advocacy and Litigation.
This study looks at how a civil society organization’s ongoing campaigns for treatment access that combined negotiations with the government, mass mobilization of its members, and litigation contributed to an increase in the funding spent by the South African government to fight HIV/AIDS.
- Social Justice Coalition Pushes for Access to Sanitation in Informal Settlements in South Africa.
This case study follows the work of the Social Justice Coalition as it launched the Clean and Safe Sanitation Campaign in the informal settlement of Khayelitsha in Cape Town, South Africa. The campaign sought to improve the conditions of, and access to, sanitation facilities in the settlement.
- New Allocations for ARV Treatment: An Analysis of 2004/5 National Budget from an HIV/AIDs Perspective
- The Direct Financial and Human Resource Costs of Providing Tuberculosis Treatment Services in Nigeria, 2008-2012
- Budget 2009-10: A Lukewarm Response to a Forbidding Health Scenario
- The Health Budget in Karnataka
Learn More about Health and Budget Analysis
- The human rights and budget work website of the International Human Rights Internship Program provides resources on integrating budget analysis into health care advocacy.
- The International Initiative on Maternal Mortality and Human Rights’ website provides news and resources on the use of a human rights approach to fighting maternal mortality.
Summary of the Health Sector Analysis (4 May 2015)
- This note compares allocations for the health sector between the years.