Publication: Fiscal Space for Health in Malawi and Revenue Potential of 'Innovative Financing'
Loading...
Published
2017
ISSN
Date
2017-09-25
Author(s)
Editor(s)
Abstract
Malawi’s population has grown rapidly from almost 3.6 million in 1960 to around 16.3 million in 2015 with about 85 percent of the population residing in rural areas. During the past twenty-five years, Malawi has made significant progress in increasing coverage for key maternal, child health and nutrition services, leading to improvements in several health outcomes. However, Significant health system bottlenecks limit service coverage and provision of quality health care. Gaps in service coverage and poor quality of service are symptomatic of a poorly financed and or inefficient health system. This report is organized as follows. The next section of this paper (Section 2) outlines the country context including the population and demographic characteristics, health service delivery, macro-fiscal situation, and the health financing profile. Section 3 presents the results from the fiscal space for health analysis for each of the five pillars namely: (i) Conducive macroeconomic environment; (ii) Re-prioritization for health; (iii) Generating additional resources for health; (iv) Increased health sector-specific foreign aid; and (v) Improved efficiency in the health sector. Section 4 provides the results from the review of the proposed areas for earmarked taxation while Section 5 summaries these results. Suffices to say that revenue forecasts on fuel and motor vehicle insurance are provided in the main body of the report while the analyses on extractives industry, alcohol, and tobacco products are provided in the Annexes. Lastly, Section 6 outlines the key conclusions and recommendations from the study.
Link to Data Set
Citation
“World Bank Group. 2017. Fiscal Space for Health in Malawi and Revenue Potential of 'Innovative Financing'. © World Bank. http://hdl.handle.net/10986/28404 License: CC BY 3.0 IGO.”
Digital Object Identifier
Associated URLs
Associated content
Other publications in this report series
Journal
Journal Volume
Journal Issue
Collections
Related items
Showing items related by metadata.
Publication Fresh Money for Health? The (False?) Promise of 'Innovative Financing' for Health in Malawi(Taylor and Francis, 2018-10-29)Since 2013, the government of Malawi has been pursuing a number of health reforms, which include plans to increase domestic financing for health through “innovative financing.” As part of these reforms, Malawi has sought to raise additional tax revenue through existing and new sources with a view to earmarking the revenue generated to the health sector. In this article, a systematic approach to assessing feasibility and quantifying the amount of revenue that could be generated from potential sources is devised and applied. Specifically, the study applies the Delphi forecasting method to generate a qualitative assessment of the potential for raising additional tax revenues from existing and new sources, and the gross domestic product (GDP)-based effective tax rate forecasting method to quantify the amount of tax revenue that would be generated. The results show that an annual average of 0.30 USD, 0.46 USD, and 0.63 USD per capita could be generated from taxes on fuel and motor vehicle insurance over the period 2016/2017–2021/2022 under the low, medium, and high scenarios, respectively. However, the proposed tax reform has not been officially adopted despite wide consultations and generation of empirical evidence on the revenue potential. The study concludes is that revenue generation potential of innovative financing for health mechanisms in Malawi is limited, and calls for efforts to expand fiscal space for health to focus on efficiency-enhancing measures, including strengthening of governance and public financial management.Publication South Asia Economic Focus, June 2012: Creating Fiscal Space through Revenue Mobilization(Washington, DC, 2012-06)This book focuses on the creation of fiscal space through revenue mobilization, although such efforts are best made using a comprehensive framework that examines all available sources. Those sources include: (a) reducing lower-priority spending, (b) enhancing the capacity to implement priorities so that capital investment and social service provision can be carried out at reduced cost, (c) reforming subsidies or transfer programs to make them more targeted and efficient, and (d) rationalizing administered prices of publicly provided goods and services. The book is organized as follows: chapter two examines the factors that could account for the low revenue collection in South Asia. Chapter three describes the tax systems in South Asia and assesses them against a number of benchmarks that are commonly used in the literature, such as international comparisons, estimates of buoyancy, and tax yields, and then discusses key elements of tax administration in South Asia. Chapter four presents information on nontax revenues, and chapter five concludes with some key policy implications.Publication Fiscal Space for Health in Bangladesh(World Bank, Washington, DC, 2016-05)A strong health financing system will be an important priority as Bangladesh seeks to meet theexpectations of its population and embrace its future as a middle-income country. The objective of this report is to present policymakers with a foundation for an informed discussionabout government health spending and future health financing options in Bangladesh. It analyzesalternative sources of additional health financing and their potential contribution to higher spending in the sector. The findings will be relevant to both the Ministry of Finance (MoF) and Ministry of Health and Family Welfare (MoHFW) and can inform a dialogue between the two Ministries as the government seeks a way forward.Fiscal space for health is a particularly important policy challenge for Bangladesh because it currently has one of the lowest levels of government health spending in the world.Fiscal space for health refers to the availability of budgetary room that would allow a government to increase health spending without jeopardizing the sustainability of its fiscal position. In general there are five potential sources of fiscal space: (1) economic growth which translates into more overall government revenues and, in turn, a larger health budget; (2) a reprioritization within the budget in favor of health, resulting in higher expenditures; (3) increased overseas development assistance (ODA) for health; (4) an increase in health-specific resources, such as earmarked taxation or insurance contributions; and (5) greater efficiency in the use of existing health budget resources such that additional resources become available for new spending.The report also presents illustrative scenarios to show the potential impact that these channels can have on fiscal space for health in Bangladesh going forward. In summary, financing health in Bangladesh over the short to medium term will require a combination of existing and additional domestic resources that result from economic growth, improved tax collection, and most significantly a moderate re-prioritization of the budget in favor of the health sector. A longer-term agenda will relate to the possibility of generating additional resources through individual contributions starting with the formal employed sector, if that is the path chosen.Publication Tobacco and Alcohol Excise Taxes for Improving Public Health and Revenue Outcomes(World Bank, Washington, DC, 2015-11)Excise taxes on alcohol and tobacco have long been a dependable and significant revenue source in many countries. More recently, considerable attention has been paid to the way in which such taxes may also be used to attain public health objectives by reducing the consumption of products with adverse health and social impacts. Some have gone further and argued that explicitly earmarking excise taxes on alcohol and tobacco to finance public health expenditures—marrying sin and virtue as it were—will make increasing such taxes more politically acceptable and provide the funding needed to increase such expenditures, especially for the poor. The basic idea—tax “bads” and do “good” with the proceeds—is simple and appealing. But designing and implementing good “sin” taxes is a surprisingly complex task. Earmarking revenues from such taxes for health expenditures may also sound good and be a useful selling point for new taxes. However, such earmarking raises difficult issues with respect to budgetary rigidity and political accountability. This note explores these and other issues that lurk beneath the surface of the attractive concept of using increased sin excises on alcohol and tobacco to finance “virtuous” social spending on public health.Publication Fiscal Space for Health in the Kyrgyz Republic(World Bank, Washington, DC, 2019-05-21)This report is organized into five chapters. Chapter one provides an estimate of the relative efficiency position of the Kyrgyz Republic based on its health outcomes and health expenditure. It is then analyzed to understand whether the sector is mostly in need of additional funding or needs to spend more effectively, or a combination of both. Chapter two derives the base fiscal space scenario: what the health sector can hope for given macroeconomic projections, expectations of external funding, and options to reprioritize health in the budget. These options do not require any specific action short of some active lobbying to drag more resources toward health over arguments that the country overall would gain by getting more. Chapter three examines potential new sources of funds through feasibly and sustainably raising new domestic revenues for health or sources of budgetary savings that will come from limiting financing responsibilities of the health sector. Reforms needed mostly involve the general government as they imply changes in taxes or benefits.
Users also downloaded
Showing related downloaded files
Publication Classroom Assessment to Support Foundational Literacy(Washington, DC: World Bank, 2025-03-21)This document focuses primarily on how classroom assessment activities can measure students’ literacy skills as they progress along a learning trajectory towards reading fluently and with comprehension by the end of primary school grades. The document addresses considerations regarding the design and implementation of early grade reading classroom assessment, provides examples of assessment activities from a variety of countries and contexts, and discusses the importance of incorporating classroom assessment practices into teacher training and professional development opportunities for teachers. The structure of the document is as follows. The first section presents definitions and addresses basic questions on classroom assessment. Section 2 covers the intersection between assessment and early grade reading by discussing how learning assessment can measure early grade reading skills following the reading learning trajectory. Section 3 compares some of the most common early grade literacy assessment tools with respect to the early grade reading skills and developmental phases. Section 4 of the document addresses teacher training considerations in developing, scoring, and using early grade reading assessment. Additional issues in assessing reading skills in the classroom and using assessment results to improve teaching and learning are reviewed in section 5. Throughout the document, country cases are presented to demonstrate how assessment activities can be implemented in the classroom in different contexts.Publication Digital Africa(Washington, DC: World Bank, 2023-03-13)All African countries need better and more jobs for their growing populations. "Digital Africa: Technological Transformation for Jobs" shows that broader use of productivity-enhancing, digital technologies by enterprises and households is imperative to generate such jobs, including for lower-skilled people. At the same time, it can support not only countries’ short-term objective of postpandemic economic recovery but also their vision of economic transformation with more inclusive growth. These outcomes are not automatic, however. Mobile internet availability has increased throughout the continent in recent years, but Africa’s uptake gap is the highest in the world. Areas with at least 3G mobile internet service now cover 84 percent of Africa’s population, but only 22 percent uses such services. And the average African business lags in the use of smartphones and computers as well as more sophisticated digital technologies that catalyze further productivity gains. Two issues explain the usage gap: affordability of these new technologies and willingness to use them. For the 40 percent of Africans below the extreme poverty line, mobile data plans alone would cost one-third of their incomes—in addition to the price of access devices, apps, and electricity. Data plans for small- and medium-size businesses are also more expensive than in other regions. Moreover, shortcomings in the quality of internet services—and in the supply of attractive, skills-appropriate apps that promote entrepreneurship and raise earnings—dampen people’s willingness to use them. For those countries already using these technologies, the development payoffs are significant. New empirical studies for this report add to the rapidly growing evidence that mobile internet availability directly raises enterprise productivity, increases jobs, and reduces poverty throughout Africa. To realize these and other benefits more widely, Africa’s countries must implement complementary and mutually reinforcing policies to strengthen both consumers’ ability to pay and willingness to use digital technologies. These interventions must prioritize productive use to generate large numbers of inclusive jobs in a region poised to benefit from a massive, youthful workforce—one projected to become the world’s largest by the end of this century.Publication World Development Report 2011(World Bank, 2011)The 2011 World development report looks across disciplines and experiences drawn from around the world to offer some ideas and practical recommendations on how to move beyond conflict and fragility and secure development. The key messages are important for all countries-low, middle, and high income-as well as for regional and global institutions: first, institutional legitimacy is the key to stability. When state institutions do not adequately protect citizens, guard against corruption, or provide access to justice; when markets do not provide job opportunities; or when communities have lost social cohesion-the likelihood of violent conflict increases. Second, investing in citizen security, justice, and jobs is essential to reducing violence. But there are major structural gaps in our collective capabilities to support these areas. Third, confronting this challenge effectively means that institutions need to change. International agencies and partners from other countries must adapt procedures so they can respond with agility and speed, a longer-term perspective, and greater staying power. Fourth, need to adopt a layered approach. Some problems can be addressed at the country level, but others need to be addressed at a regional level, such as developing markets that integrate insecure areas and pooling resources for building capacity Fifth, in adopting these approaches, need to be aware that the global landscape is changing. Regional institutions and middle income countries are playing a larger role. This means should pay more attention to south-south and south-north exchanges, and to the recent transition experiences of middle income countries.Publication World Development Report 2006(Washington, DC, 2005)This year’s Word Development Report (WDR), the twenty-eighth, looks at the role of equity in the development process. It defines equity in terms of two basic principles. The first is equal opportunities: that a person’s chances in life should be determined by his or her talents and efforts, rather than by pre-determined circumstances such as race, gender, social or family background. The second principle is the avoidance of extreme deprivation in outcomes, particularly in health, education and consumption levels. This principle thus includes the objective of poverty reduction. The report’s main message is that, in the long run, the pursuit of equity and the pursuit of economic prosperity are complementary. In addition to detailed chapters exploring these and related issues, the Report contains selected data from the World Development Indicators 2005‹an appendix of economic and social data for over 200 countries. This Report offers practical insights for policymakers, executives, scholars, and all those with an interest in economic development.Publication Doing Business 2014 : Understanding Regulations for Small and Medium-Size Enterprises(Washington, DC: World Bank Group, 2013-10-28)Eleventh in a series of annual reports comparing business regulation in 185 economies, Doing Business 2014 measures regulations affecting 11 areas of everyday business activity: Starting a business, Dealing with construction permits, Getting electricity, Registering property, Getting credit, Protecting investors, Paying taxes, Trading across borders, Enforcing contracts, Closing a business, Employing workers. The report updates all indicators as of June 1, 2013, ranks economies on their overall “ease of doing business”, and analyzes reforms to business regulation – identifying which economies are strengthening their business environment the most. The Doing Business reports illustrate how reforms in business regulations are being used to analyze economic outcomes for domestic entrepreneurs and for the wider economy. Doing Business is a flagship product by the World Bank and IFC that garners worldwide attention on regulatory barriers to entrepreneurship. More than 60 economies use the Doing Business indicators to shape reform agendas and monitor improvements on the ground. In addition, the Doing Business data has generated over 870 articles in peer-reviewed academic journals since its inception.