Fiscal Space for Health: A Review of the Literature


Countries the world over are faced with the challenge of finding adequate resources to finance their health system. Increasing attention is thus being given to the question of how to increase financial resources to health while respecting macroeconomic fundamentals – referred to as expanding fiscal space for health. This paper surveys the literature on fiscal space for health. Several key findings are highlighted. First, while current knowledge on how countries have expanded fiscal space for health is summarised in the paper, it is clear few studies scratch below the surface to examine this question. Many countries lack the data to build an accurate picture of the sources of financial resources for health over time. This is a prerequisite for understanding what policies, measures, or decisions have been successful (or unsuccessful) in generating greater fiscal space. Empirical work at the country level has tended to be forward-looking assessments of potential ways to increase fiscal space rather than rigorous examinations of how a particular country has increased fiscal space. Second, much of the literature on fiscal space has tilted towards improving our conceptual understanding of fiscal space. Useful advances have been made in conceptualising what fiscal space means for the health sector and, in particular, how it can provide a framework to assess how to increase financial resources for health. But this often raises more questions than it answers. Attempts to use improved conceptual understanding to undertake rigorous empirical work remains in its infancy. Third, the literature frames fiscal space either as a macroeconomic issue or with specific reference to the health sector. There is very limited analysis of fiscal space in other sectors, such as education. The health sector has been quickest in realising the relevance of fiscal space. The paper concludes by highlighting a number of knowledge gaps and future avenues for research.


Powell-Jackson, T.; Hanson, K.; McIntyre, D. Fiscal Space for Health: A Review of the Literature. London School of Hygiene and Tropical Medicine, UK (2012) 30 pp. [RESYST Working Paper 1]

Fiscal Space for Health: A Review of the Literature

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