Innovative Financing for Health Promotion: A Global Review and Thailand Case Study

Abstract

In the light of increased burden from noncommunicable diseases (NCDs) worldwide, the availability of guidelines on effective and cost-effective prevention and control interventions for NCD, and the political commitment to address NCD epidemics, there is a need for mobilizing adequate funding for health promotion which addresses primary and secondary prevention of these NCD. This article reviews the progress in financing health care in general and health promotion in particular and provides a global review of innovative financing for health promotion in selected countries having such a specific dedicated tax and/or innovative governance mechanisms to manage health promotion expenditure. The article also draws on lessons from an in-depth case study of Thai Health Promotion Foundation which contributes to sustainable financing in supporting multisectoral and multidisciplinary actions on health promotion. Assessment of financing health care indicates that countries in Africa and Southeast Asia Regions, facing fiscal constraints and lack of political will to spend on health of their people, spent merely US$109 and US$71 per capita, respectively, in 2013. This level is well below the indicative benchmark of US$86 (in 2012 term) to achieve health of the population. Only one-third of total 194 WHO Member States countries produce complete data on health promotion expenditure. In 2012, the current financing level of health promotion was low, the global average of 3.9% of Total Health Expenditure or at US$61 per capita spending on health promotion in 2012. There is no increasing trend in health promotion expenditure between 1995 and 2012. In 2012, expenditure on health promotion was merely US$10.3 and US$7.2 per capita in Africa and Southeast Asia Region. This level cannot make significant contribution to health promotion in the context of increased diseases burden from NCD. Innovative funding sources from dedicated tax such as from products, which are harmful to health, such as tobacco, alcohol, energy-dense processed foods, or earmarks from other sources such as insurance fund, though provide additional new resources for health promotion, require effective governance mechanisms for resource allocation with participation by other non-health sector and civil society organizations. Even there is limited political will to support innovative financing health promotion from dedicated tax such as sin tax, countries may apply innovate governance mechanisms to manage effectively the annual budget allocation to health promotion often by the Ministries of Health. Lessons can be drawn from several countries introducing innovative financing for health promotion and innovative governance mechanisms in maximizing health gains from limited resources.