02 FINANCING

States Parties should have adequate funding for IHR implementation through the national budget and other mechanisms. The country should have financial resources that can be easily accessible and disbursed for the routine implementation of IHR capacities, preparedness and response to health emergencies, in order to ensure a timely and adequate response.

IMPACT:

Financial resources are available and agile public financial management systems are in place to enable IHR implementation, including core
capacity development and maintenance, as well as for the health emergency response.

MONITORING AND EVALUATION:

Adequate financial resources are available to enable effective IHR implementation and response to all health emergencies.

Benchmark 2.1

Financing is available and disbursed for the implementation of IHR capacities

Objective To ensure financing is available for the implementation of IHR capacities

01 NO CAPACITY

  1. No specific budget line or budgetary allocation available to finance the implementation of IHR capacities, or financing is handled through extrabudgetary means or off budget external resources.

02 LIMITED CAPACITY

  1. Identify and convene key stakeholders to review financing for implementation of IHR capacities from both domestic and/or external sources. *
  2. Establish a national coordination mechanism (with drafted ToRs) to coordinate prioritized IHR related funds and corresponding alignment of budget lines allocated to implementation of IHR in relevant sectors at the national level. *
  3. Identify different types of budgetary resources available for implementation of IHR capacities (including for capital and recurrent sources of expenditure) and provide recommendations to prioritize IHR implementation actions to match the available funds. *
  4. Collate and review cost estimates for the implementation of national action plans relevant to IHR capacities that align with a costed operational national action plan for health security (NAPHS). If a costed operational NAPHS is not available, then develop one with costing experts and focal points of each technical area, as needed. *
  5. Identify and convene key stakeholders who face financial risks linked to health emergencies.

03 DEVELOPED CAPACITY

  1. Conduct resource mapping and associated financing advocacy analysis/strategy for the implementation of IHR capacities to determine what activities are being funded, what are the sources of funding (domestic and/or external), and where are the funding gaps across sectors at the national level. *
  2. Analyse current domestic and external financing for IHR capacities and compare resources available to resource needs to understand funding gaps and opportunities. *
  3. Prioritize, as needed, activities in the national action plan (e.g. NAPHS) and/or operational plans based on estimated costs, expected impacts and available resources and funding. *
  4. Routinely update cost and impact evidence, as well as resource mapping evidence, to allow for reprioritization and reallocation of IHR-related budgets. *
  5. Develop and institute flexible mechanisms for funds disbursement to match evolving needs and allow reallocations as needs change. *
  6. Develop a methodology/framework for monitoring relevant multisectoral IHR related expenditures *

04 DEMONSTRATED CAPACITY

  1. Source sufficient budget at national and subnational levels for the implementation of all IHR capacities in relevant ministries or sectors. *
  2. Routinely track IHR budget allocation, disbursement, spending and accounting embedded within routine expenditure monitoring systems to assure funding is disbursed and spent effectively by relevant ministries at national and subnational levels. *
  3. Implement and review the use of available financing and its effectiveness in achieving IHR implementation benchmark actions. *
  4. Conduct a political (i.e. political cycle and budget process) and legal (i.e. legislative and administrative pathways) landscape analysis and impact assessment to build the case for increased investment in the implementation of IHR capacities. *
  5. Accelerate program-based or output oriented budgeting reforms to provide more flexibility and accountability in resource allocation and management.. *

05 SUSTAINABLE CAPACITY

  1. Engage a national coordination group in annual operational planning for the implementation of IHR capacities, prepare annual budget requests and advocate for funding levels for relevant ministries or sectors. *
  2. Document and disseminate information on the timely distribution and effective use of funds to strengthen health security capacities at the national and subnational levels in relevant ministries or sectors. *
  3. Develop open access platforms embedded within routine expenditure monitoring and accountability systems to assure transparency and accountability of IHR related budgets. *
  4. Engage relevant sectors regarding multisectoral program-based budgeting for IHR implementation. *

Benchmark 2.2

Financing available for timely response to health emergencies

Objective To put in place financing mechanisms to ensure that funds are available and flexible for timely response to health emergencies

01 NO CAPACITY

  1. No mechanism of financing exists to respond to health emergencies.
  2. Funds are allocated and distributed in an ad hoc manner from different sources during health emergencies.

02 LIMITED CAPACITY

  1. Define potential sources of and mechanisms to access general, earmarked or contingency funding to support timely response to health emergencies. *
  2. Establish regulations that allow the government to activate emergency funding to respond to health emergencies. *
  3. Define protocols for activating emergency funding to respond to health emergencies, including levels of funding and deployment modalities. *
  4. Conduct a stakeholder analysis to identify domestic and external partners who can support rapid mobilization of funds during health emergencies. *
  5. Identify flexible funding sources and map key decision-makers and processes for reallocation of funds during a health emergency.. *

03 DEVELOPED CAPACITY

  1. Identify and convene key stakeholders to conduct a legal and regulatory review to understand the various legal mechanisms to access sources of domestic funding in the case of a health emergency. *
  2. Establish or make certain any emergency funds that can be accessed for health emergencies and are able to, at bare minimum, support national level urgent responses, and when required a national authority which can coordinate the receipt and distribution of funds to local and subnational levels. *
  3. Develop links between domestic and international mechanisms for joint financing of timely response to health emergencies and procurement of key resources, such as personal protective equipment (PPE), medicines and vaccines. *
  4. Develop or revise mechanisms and structures to receive and rapidly disburse funds during health emergencies. *
  5. Analyse current health system capacity for routine service continuity during a health emergency and devise a plan to address financial constraints for routine service delivery during a health emergency. *
  6. Review and make recommendations to ensure the functionality of emergency public financing mechanisms (PFM), particularly the mobilization of funds when needed at the national and subnational levels for relevant sectors. *
  7. Develop and share training packages to raise awareness and train relevant stakeholders on PFM to enable timely response to health emergencies. *
  8. Disseminate, build capacity and ensure awareness of exceptions to routine PFM rules for health emergency funding. If external funding is being used for health emergencies, external funding accounting and procurement rules are well understood. *
  9. Demonstrate and document that sources of funding have been identified and could be mobilized in advance of a health emergency. *
  10. Develop mechanisms and guidelines to adapt routine provider payment mechanisms, such as diagnosis related groups, outcomes-based payment, or capitated payments, in a health emergency. *
  11. Engage relevant stakeholders, such as civil service commission or national audit authority, to investigate exemptions that could be applicable whenever health emergency funding is released

04 DEMONSTRATED CAPACITY

  1. Demonstrate that relevant ministries and levels of government have capacity to access and utilize the PFM for early detection, notification, response and recovery operations. *
  2. Develop standard operating procedures (SOPs) to support actors not usually involved with public sector services (e.g. nongovernmental organizations (NGOs) and the private sector) to access emergency funds when needed. *
  3. Develop SOPs or memorandum of understanding (MoUs) that fasttrack procurement and service agreements (within existing PFM guidelines or approved by finance ministry) that can be activated during emergencies to expedite response. *
  4. Review, with the finance ministry, effectiveness of the emergency financing mechanism following any response to health emergencies and make recommendations to finance ministry to adjust procedures to ensure speed, transparency and accountability of all funds. *
  5. Develop guidance on engaging additional resources called upon as regular or complementary human resources for health to work on addressing the health emergency, including funding to support the efforts of unwaged volunteers *

05 SUSTAINABLE CAPACITY

  1. Establish a link and/or MoU with other regional or global emergency contingency funds, through which a national authority can coordinate and distribute funds. *
  2. Establish a mechanism for multisectoral review of functionality and adequacy of health emergency financing whenever the financing is accessed. *

* Participation and contribution of other sectors to action.

Tools