invest-2016-600x315 The role of public investment in health

When: 28 September 2016, at 5:30 -7:30 pm (EST Time)

To analyze country experiences in the Region of the Americas to increase public investment in health with equity and efficiency; and to promote the need to increase and improve public investment in health to advance toward universal health.


In English

In Spanish

After presentation of PAHO vision in the context of strategic line three (3) of the Regional Strategy for universal access to health and universal health coverage (Res. CD53/5, Rev. 2), on the matter of fiscal space for health based on PAHO's technical perspective and several policy briefings, a moderator will make predefined questions to country and ECLAC representatives, who will answer in a limited time. Time for questions from the audience will be provided afterwards.


The concept of fiscal space for health refers to the capacity of governments to ensure additional budgetary resources for the health system, without affecting the financial position of the public sector or other socially necessary expenses. It tries to identify the prospects for increased spending on health in the short and medium term, with the aim of responding to a set of needs. Fiscal space for health can potentially be generated from a variety of sources that can be grouped into the following categories:

  • The creation of conducive macroeconomic conditions to economic growth, resulting in increased revenue for governments.
  • A re-prioritization of health in the government budget.
  • An increase in the resources directed to the health sector (e.g. through earmarked taxes)
  • External and internal aid (loans) and specific donations for the health sector.
  • An increase in the efficiency of tax collection (reducing avoidance and evasion)
  • An increase in the efficiency in existing health expenditures

The political commitment to move towards universal access to health and universal health coverage (universal health) must be accompanied by a consistent financial commitment. It is necessary that the national health authority and other actors in the health sector can, in an informed manner, encourage a broad social dialogue within and outside the government (including academia, scientific societies, unions and health professionals' corporations, nongovernmental organizations, and civil society) to build consensus and develop policy options. In this way it is crucial to facilitate mutual understanding among leaders and political authorities, ministries of health and finance and other key institutions throughout the society taking into account that the health sector competes with other important social priorities (education, infrastructure, housing, security, etc.).

A particular challenge faced by countries in the Region with an aging population and going through an epidemiological transition toward a higher prevalence of non-communicable diseases, relates to the financing of new, frequently long-term and high-cost interventions (including medicines and other technologies). Some countries have taken steps to address the issue from the demand side creating special funds to buffer the financial impact on households and to increase access to high-cost medicines and treatments. Complementary measures from the supply side should also be considered in order to promote the rational introduction of these technologies that represent an additional and increasing pressure on the health budgets.

In this context, the need for fiscal space for health as a mean to improve the response capacity of health systems (with efficiency) and the financial protection of the population (with equity), correlates with the need to adopt the necessary tools and skills to regulate the introduction of new technologies and treatments, while strengthening the stewardship capacity of the national health authorities. 

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