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dc.rights.licenseCreative Commons Attribution-NonCommercial- ShareAlike 3.0 IGO licence
dc.contributor.authorWitter, Sophieen
dc.contributor.authorBertone, Maria Paolaen
dc.contributor.authorDale, Elinaen
dc.contributor.authorJowett, Matthewen
dc.identifier.citationWitter, S., Bertone, M. P., Dale, E. & Jowett, M. (2020) Health financing in fragile and conflict-affected situations: A review of the evidence [Working Paper]. Geneva: World Health Organization.en
dc.descriptionWitter, Sophie - ORCID 0000-0002-7656-6188
dc.descriptionBertone, Maria Paola - ORCID 0000-0001-8890-583X
dc.descriptionReplaced with final published version 2020-04-16
dc.description.abstractWHO has well-developed guidance for health financing policy, which supports progress towards universal health coverage (UHC) and overall health system goals. Central to this is the importance of public finances, and the role of government in using those finances in the best way, to strengthen their health system to maximize progress towards UHC. Fragile and conflict affected settings (FCAS) present a growing challenge for countries trying to make progress towards UHC and improve health. This paper examines the core features of FCAS, including deficits in capacity, legitimacy, and security, and considers their implications for efforts to build resilient health systems. Health financing interventions pursued in FCAS in response to both the challenges and opportunities arising from the different deficits are summarized using the WHO health financing functional approach as the organizing framework. Data analysis shows that FCAS countries have significantly higher out of pocket expenditures, greater external dependency and health-related impoverishment, as well as lower mean government expenditure on health. There are substantial challenges for health financing in FCAS settings but considerable ingenuity has also been shown in addressing them, often driven by external stakeholders. Certain approaches, such as performance-based contracting and funding emerged in FCAS settings out of the need to innovate but leave a longer legacy which is given close consideration. This paper forms provides the background to and informs a second paper which revises and adapts WHO’s health financing guidance in the context of FCAS.en
dc.description.sponsorshipFinancial support was provided by the United Kingdom’s Department for International Development (Making Country Health Systems Stronger programme).en
dc.publisherWorld Health Organizationen
dc.relation.ispartofseriesHealth financing working paper;13
dc.rights© World Health Organization 2019
dc.rights.uri 3.0/igo
dc.titleHealth financing in fragile and conflict-affected situations: A review of the evidenceen
dc.typeWorking Paperen
rioxxterms.typeWorking paperen
qmu.authorWitter, Sophieen
qmu.authorBertone, Maria Paolaen
qmu.centreInstitute for Global Health and Developmenten

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