Effective budget execution in health is critical for achieving universal health coverage and reaching 1.5 billion people with quality health services by 2030. Developed by the World Health Organization (WHO) and the World Bank, this report examines how budget execution impacts health service delivery, identifies common challenges, and offers practical recommendations for improvement. Country case studies from the Democratic Republic of Congo, Ethiopia, Kyrgyzstan, Lao PDR, Pakistan, the Solomon Islands, and Ukraine provide insights into successful practices and actionable policy lessons across diverse contexts.
Data from the report reveal significant underspending in health budgets across low- and lower-middle-income countries. On average, these countries underspend by 13%, equivalent to approximately US$4 per capita—more than many countries allocate to primary care. This underspending represents a substantial missed opportunity to improve health outcomes and weakens ministries of health when advocating for higher budgets, as they struggle to fully utilize existing funds.
Underspending also reflects the relative prioritization of health within governments. Budgets alone do not determine priorities; effective implementation is crucial. In many low- and lower-middle-income countries, health budgets are executed at lower rates than other sectors, such as education, signaling a deprioritization of health during budget execution. Addressing this requires close collaboration and trust between ministries of finance, health, and local governments at all stages of the budget cycle.
The report emphasizes the importance of deliberate planning rather than reactive responses. Anticipating execution challenges, such as cash rationing, allows governments to respond more effectively. Purposeful application of expenditure controls and the delegation of authority to lower levels can enhance both accountability and empowerment, improving overall budget execution.
Country experiences further highlight the need to understand political economy dynamics when designing strategies to navigate budget execution challenges. Recognizing these dynamics enables governments to implement more effective, context-sensitive solutions, ultimately strengthening health systems and improving service delivery outcomes.
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