Emerging Lessons from the Development of National Health Financing Strategies in Eight Developing Countries

As countries advance economically, they are increasingly under pressure to mobilize and properly manage domestic resources to provide affordable health care for their citizens. The World Health Organization and international donors have encouraged countries to develop a health financing strategy (HFS) to plan how to best achieve these objectives. This article highlights lessons and considerations for countries developing HFSs and for donors supporting the process, in the areas of data use, cross-country learning, evaluation, leadership involvement, and stakeholder management. This article's review of the United States Agency for International Development (USAID)-supported Health Finance and Governance (HFG) and Health System Strengthening Plus projects' experiences assisting eight countries with HFS development concludes that the HFS development process generates demand among low- and middle-income country policy makers for health financing data and that countries that complete HFSs accept that basing a strategy on imperfect data is better than not having a strategy. The article also concludes that cross-country learning, through guided study trips and reviews of other health systems and HFS processes, is paramount for developing an HFS and that most countries have not included monitoring and evaluation plans in their HFSs. Finally, in HFG's experience, countries developing HFSs have been successful in fostering ownership among a broad coalition of stakeholders but diverge in their approaches to involving political leaders in detailed technical debates about health financing reform. These lessons and challenges, based on real-world experiences, can help low- and middle-income countries to develop politically feasible HFSs that promote financial sustainability of the health sector, protect people from burdensome health care costs, improve efficiency, and advance universal health coverage.