In 2015, EAC mandated the development of a Sustainable Financing Analysis report on Universal Health and HIV Coverage for the region, which found that the UHC funding gap in East Africa up to 2030 is as large as $18 billion annually. Following this report, an Issue Paper on Sustainable Financing proposed a Framework of Action (EFoA) for all Partner States. This framework was adopted during the High Level Ministerial dialogue on Sustainable Financing for Universal Health and HIV Coverage , held on 23rd June 2016, during which EAC Ministers of Health and Finance committed to:
• Adopting the recommended EAC Framework of Action (EFoA) strategic activities, which called for reprioritization of public spending towards meeting the 15% Abuja Declaration; tax regime efficiency to expand fiscal space and enable additional investments to health; and minimize costs through increasingly efficient service delivery.
• Conducting efficiency audits in the health sector to inform EAC policies on improved service delivery;
• Implementing mechanisms to strengthen health regulatory authorities for better quality health care delivery in pursuit of Universal Health Coverage;
• Designing and implementing innovative financing mechanisms to ensure sustainable access and optimal utilization of quality healthcare services;
• Promoting the use of Information and Communication Technologies (ICTs), research and evidence to Universal Health Care (UHC) Financing investment cases, that also support advocacy;
• Promoting multi-sectoral synergies including Public Private Partnerships to leverage additional health and HIV financing in the Partner States; and • Sponsoring and convening the 1st EAC Summit on Investment in Health with the aim of attaining health related Sustainable Development Goals (SDGs) by 2030 in all Partner States.
The 13th Sectoral Council of Ministers responsible for Health noted the need for clear strategies to mobilize resources to support implementation of the EAC Framework of Action on Sustainable Financing for Health and HIV and approved Terms of Reference to develop a resource mobilization strategy to support its implementation (EAC/Health/SCM13/Decision 15). Subsequently, the EAC Secretariat performed country consultations in each of the EAC Partner States to analyze and report on the status of implementation of EFoA, to inform development of this EAC Universal Health and HIV /AIDS Coverage (UHHC) Resource Mobilization Strategy 2018 – 2023. This strategy was developed with financial and technical support from the Swedish International Development Agency (Sida) and UNAIDS Regional Support Team (RST).
Although national budgets and compulsory contributions through indirect taxes towards national and community health insurance schemes remain the preferred source of UHC financing, Health and HIV Financial Landscape Analyses conducted in 20175, reveal that no single individual financing source - not even government revenue - can sustain the nearly $200 billion health sector financing gap facing EAC Partner States during the next ten years, as estimated in the EAC (2015) report on Sustainable Financing Analysis of Universal Health and HIV Coverage.
The EAC health sector financing gap and disease burden are increasing while external financing, the region’s largest source of health sector financing, is decreasing according to a UNAIDS and KFF (2015) analysis of international assistance towards HIV, with adverse effects on the sector. In fact, the UNAIDS (2015) analysis and Global Fund (2016) replenishment outcomes already shows a marked decline in bilateral and multilateral funding, averaging about $1 billion between 2012 and 2015. These gaps remain large even if fiscal space is increased. Filling the UHC gap in Burundi would cost a fifth of her GDP; Two fifths of Uganda’s budget; more than 26% of Tanzania’s budget, 23% of Rwanda’s and one tenth of Kenya’s budget at 2016 rates. South Sudan’s needs would be higher, compounded by the need to rehabilitate about one third of her health infrastructure (at least 20% of health facilities), and rebuild Human 5 Validated Funding Landscapes for the Republics of Burundi, Kenya, South Sudan and Tanzania, towards the Global Fund Funding Requests for the March and May 2017 Application Windows. 8 Resources in many of the country’s states. It may be argued that short of prioritizing Universal Health Care as a development priority and strategically mobilizing additional resources, Partner States may not meet EFOA goals.