Publication: Budget Execution in Health: From Bottlenecks to Solutions
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2025-03-11
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2025-03-11
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This report builds on a joint WHO-World Bank initiative on budget execution challenges (described in more detail in Appendix 1). Following the introduction, section 2 provides an overview of core concepts from both a public financial management perspective and a health financing perspective and discusses how budget execution challenges can differ in countries with a separate purchasing agency, varying degrees of decentralization and significant donor funding. The trends and patterns in health budget execution data are analyzed and discussed in section 3. The analytical approach is detailed in Appendix 2. Section 4 identifies challenges that hinder good budget execution in health. These are drawn from an extensive literature review and a set of case studies. A summary of the case studies is provided in Appendix 3. Policy responses to these challenges are offered in section 5. This section lays out a pragmatic approach that Ministries of Finance, Ministries of Health and local governments can take to address six of the most frequently encountered budget execution challenges and points to examples from cases studies. Section 6 offers an engagement approach to address budget execution challenges. A four step diagnostic-to-solution model is proposed that guides an analyst through the process of identifying the right questions, data, and policy options in a structured manner. Section 7 concludes with a call to action for countries to embrace a more purposeful and collaborative budget implementation approach that involves finance, health and local government stakeholders. The compiled dataset used for the analysis is being released jointly with this report to support complementary analytical efforts.
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“World Health Organization; World Bank. 2025. Budget Execution in Health: From Bottlenecks to Solutions. © World Bank. http://hdl.handle.net/10986/42930 License: CC BY-NC-SA 3.0 IGO.”
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