Towards a typology of financial autonomy of primary healthcare facilities in LMICs

In August 2024, Professor Sophie Witter of ReBUILD’s Queen Margaret University team spoke at the Collaborative Africa Budget Reform Initiative (CABRI) Policy Dialogue on public financial management (PFM) as an enabler of greater health facility autonomy. The PFM system is often viewed as a bottleneck to increasing autonomy. It can, however, also be an important enabler, supporting greater operational efficiency and accountability. This CABRI Policy Dialogue brought together ministries of finance, health and local government representatives to reach a shared understanding of how each can contribute to facility financial autonomy and improved health outcomes.

Sophie’s presentation – Towards a typology of financial autonomy of primary healthcare facilities in low- and middle-income countries (LMICs) – was part of a session on the status of facility autonomy and direct financing in LMICs. The session explored how facility autonomy can be categorised across LMICs by reflecting on how much autonomy facilities across selected countries have to allocate and manage their own resources; how resources flow between levels of government and to the facility; what PFM arrangements are used; the sources of this funding (development partners, general revenue, user fees, health insurance agency); and what types of expenditure they have autonomy over.

Read the PDF of Sophie’s presentation here.

Read a French version of this presentation here.

There’s more on the Policy Dialogue and the other presentations featured on the CABRI website [opens new tab].