A strong health system response to the pandemic requires additional public funds that can be deployed quickly and transparently. Without additional public funding, the health system will not only struggle to control the pandemic but also may fail to maintain essential health services for other conditions.
Simply reallocating the existing health budget is not a viable way of addressing the pandemic for two reasons. First, it will not be enough to meet greater demand for health services, including new infrastructure, staff and supplies; outreach to ensure access to testing and treatment for all those who need it; and overtime and supplementary payments for health workers. Second, many countries have postponed and cancelled the delivery of essential health services for other conditions to release capacity to respond to the outbreak in the short run. This is likely to result in unmet need and adverse effects on health and will require immediate attention once the most urgent phase of the pandemic has passed.
We describe some of the ways in which countries are mobilizing public funds taking examples from the COVID-19 Health System Response Monitor unless otherwise noted. The post draws on a short paper from the WHO Barcelona Office for Health Systems Strengthening on key health financing actions countries can take to reduce the adverse effects of the pandemic.
Reprioritizing the government budget
Additional public funds can be drawn from regular budget sources or national emergency reserves (contingency funds). Many countries in Europe have reprioritized the government budget to mobilize funds for the health sector in response to the outbreak. Some are suspending national debt and deficit controls to facilitate access to resources. For example, Greece has excluded spending on health and immigration from national budget deficit targets and Spain is considering lifting national budget deficit restrictions. Armenia, Georgia, Kyrgyzstan, North Macedonia, Serbia and Ukraine have negotiated donor grants to complement additional government funds.
Removing administrative constraints so that new funds can be deployed quickly
Administrative processes should allow reallocations and budget transfers to be made immediately, through the usual channels where appropriate. Several countries are channelling additional funds through purchasing agencies, including Austria, Croatia, Estonia, Latvia, Poland, Romania and Serbia. Some countries may need to activate exceptional spending procedures in the first phase of the crisis and then formalize these procedures using supplementary budget laws. Declaring a state of emergency can facilitate the release of new funds and speed up public procurement by enabling simplified procedures for trusted suppliers.
Tracking and reporting spending for transparency and accountability
The fast release of funds and simplified procedures for spending and procurement should be accompanied by mechanisms to prevent fraud and build public trust. These mechanisms may include the introduction of a COVID-19 accounting code to track spending and the publication of spending information in government portals. Italy, for example, records all expenses in a special COVID-19 account and requires any spending to be published.
Sarah Thomson, Triin Habicht, Tamás Evetovits