Last week the 7th Annual Health Financing Forum (AHFF) brought public health and finance leaders together in Washington, DC for a critical discussion on health financing and spending during a challenging era of budgetary belt-tightening. Co-hosted by the World Bank, the United States Agency for International Development (USAID), and the Global Financing Facility, the three-day forum offered a valuable opportunity for the exchange of ideas and closer collaboration among sectors that are often siloed.


At this year’s AHFF, discussions focused on prioritizing health spending within government frameworks, strategically allocating resources toward vital health programs, and maximizing the impact of development assistance on government health investments. Several important takeaways from the AHFF included:


1. Health investment must come first

Investment in health is an investment in economic and social prosperity, yet historical underfunding has left health systems fragile, with health equity lagging. The result is a world in which too many go without life-saving care. Making more efficient use of existing budgets is certainly an important part of the puzzle, but more investment is also critical.


But with nations facing so many competing priorities, how can advocates convince leaders to prioritize health? AHFF speakers called for moving beyond technical discussions and finding new ways to create common ground. Building a compelling political, social, and economic case for increases in health financing is possible through strategies such as engaging in evidence-based policymaking, fostering strong intergovernmental relationships, and communicating results more effectively.


2. LMICs face strong headwinds

Experts at the forum highlighted a confluence of threats to health progress in low- and middle-income countries (LMICs), from climate change and conflict to escalating national debt. Stagnant development assistance for health, economic shocks, and a shift in priorities toward security and economic growth have left many LMIC governments with shrinking fiscal space for health spending.

Speakers pointed to a group of 28 LMICs with health spending below pre-pandemic levels, with little prospect of catching up even with increased aid. Such underspending threatens to reverse hard-won gains in health outcomes and leave millions without access to essential healthcare. This clearly underscores the urgent need for sustained and effective investment in health systems.


3. The burden of noncommunicable diseases is growing

 The rise of noncommunicable diseases (NCDs) further complicates the health financing picture. In the Solomon Islands, for example, a staggering 60-80% of deaths were reported to be from NCDs. The strain on health systems, already stretched thin by economic challenges and political unrest, has been immense.


Like many other Pacific Island nations, the Solomon Islands must contend with this NCD burden in conjunction with the ongoing challenges of infectious diseases and maternal health. Together, these create a complex landscape that demands significant investment and innovative solutions.


4. A regional approach with country ownership and knowledge sharing is needed

The forum acknowledged the critical need for locally driven solutions and the prioritization of countries’ voices. Country representatives from Bahrain, Djibouti, Indonesia, Kenya, Nigeria, and other countries shared their experiences throughout the AHFF’s three days. Discussions focused on ways to empower countries to set their own agendas, build local evidence, and share best practices. Investment strategies and development and technical partnerships, speakers argued, should reflect a country’s unique social, economic, and health needs and priorities.


Knowledge sharing emerged as a key theme, with calls for a global, regional, and country approach to address shared health financing challenges. Sharing frameworks, best practices, and proven strategies helps build collective wisdom and an important sense of agency for LMICs. Knowledge production, attendees heard, should be LMIC-led so that solutions can be tailored to their specific contexts.


Translating discussion into action

These calls for country-led solutions and a regional approach to knowledge sharing and technical expertise echo the priorities of the next phase of Access Accelerated. Working in partnership with the World Bank and others, Access Accelerated will support governments with impactful, sustainable NCD financing solutions. This means prioritizing the sharing of knowledge, capacity development and catalytic financing to build stronger and more adaptable health systems that integrate NCD services at the primary care level. Local ownership is a central pillar of this work. Actively engaging and empowering national governments and local stakeholders means that countries will be able to effectively address NCDs at all levels: community, national, and regional.


With the right approach, progress is possible

There’s no shortage of barriers on the road ahead, but despite these sometimes-daunting challenges, the AHFF carried with it a spirit of optimism and a hopeful outlook. Speakers reaffirmed that progress is achievable through a shift in approach, shared learnings, and a whole-of-government response. Many policy options, from increasing overall government revenue through taxation to targeted health for the “poor, near-poor and vulnerable populations” to financing reforms, were presented as potential pathways forward.

The call to action heard at the 7th AHFF is clear: more financing for health, not less, is urgently needed. There is a way forward for improving health financing in 2024 and beyond, and that begins with an open exchange of ideas, expertise, data and positive experiences.