Health financing in Côte d'Ivoire

Dr. Ambroise KOBENAN is the Liaison Officer of the Global Financing Facility (GFF) in Cote d’Ivoire. He is a medical doctor with an expertise in health economics and public health and significant experience working in Cote d’Ivoire’s health sector. He notably contributed to the preparation of a number of studies and policy documents for the Ministry of Health in Cote d’Ivoire.

Health financing in Côte d’Ivoire

Coordination of health financing

Côte d’Ivoire, whose health financing coordination initiative was already existent but non-functional, is in the process of reactivating its National Platform for Health Financing Coordination. Established in July 2019 under the aegis of the Global Financing Facility (GFF) and by order of the Prime Minister, the National Platform for Health Financing Coordination (NPHFC) is a forum that aims to establish consensus on the health expenditure objectives to be achieved; to ensure the harmonization of internal and external financing around these objectives; and to monitor the implementation of sectoral health strategies as defined in the National Health Development Plan and the Investment Case.

This platform has the potential to make a significant contribution to the improvement of health financing coordination, especially since it is composed of four major stakeholders, each of which has an important role to play, namely (i) the State and its divisions, (ii) the private sector, (iii) technical and financial partners and (iv) civil society organizations.

The NPHFC is composed of the following three bodies:

1. The Technical Working Groups: they are tasked with examining specific issues in order to formulate proposals relating to objectives or opinions.
2. The Technical Secretariat: This is the implementing body in charge of the daily management of the Platform’s activities.
3. The Steering Committee: This is the decision-making body of the platform, which is responsible for ensuring that funding and investments are aligned with national priorities.

The COVID-19 pandemic, along with some organizational concerns, have hindered the optimal functioning of the NPHFC. Nevertheless, the determination of the government focal point, with the support of the GFF Liaison Officer and partners, has made it possible to provide the NPHFC with a framework that will enable it to be an effective governance tool for the health sector.

The determination of the government focal point resulted, among other things, in a meeting with the Minister of Health, in order to present the usefulness of the NPHFC to him and to request his ownership, support and leadership. As for the Liaison Officer, he patiently but continuously mobilized the Secretariat of the aforementioned platform through reminders and well planned meetings. The partners adhered to the idea of relaunching the NPHFC and provided their technical support, as did civil society organizations.

Therefore, the NPHFC has just been reactivated under the leadership of the new Minister of Health, with the assistance of all interested parties, to the great satisfaction of all stakeholders who had been waiting for this body for several months.

One of the first challenges will be to maintain this involvement of all actors, in order to achieve the objectives of coordination and alignment of all with the government’s health priorities.

Primary Health Care Financing

In Côte d’Ivoire, a large share of financing is allocated to secondary and tertiary level care, at the expense of primary health care (PHC).

One of the objectives of the NPHFC and the health financing reforms underway in the country is to help overcome the challenges of reversing this trend. There is no doubt that we will not be able to do so this year, but we hope to be able to do so in the medium term.

To this end, the platform intends to carry out advocacy campaigns – with the support of all technical and financial partners, as well as the civil society and the Ministry of Budget and State Portfolio – so that the commitments to increase domestic resources for health may be effective and directed towards PHC.

An analysis of the health budget over the last three years (2020 to 2022) to show the (low) percentage of financing devoted to PHC and the development of a set of political arguments will be made to support this advocacy work.