Raising revenues for health care in low- and middle-income countries: evidence and lessons for cross-country learning
1
Erasmus School of Health Policy, Innovation and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
Popul. Med. 2026;8(Supplement Supplement 1):A1781
ABSTRACT
ABSTRACT:
Low-and middle-income countries (LMICs) face increasing pressure to expand fiscal space for health amid declining development assistance for health (DAH). Over the past decade, DAH has contracted substantially, culminating in a sharp reduction in 2025 that left many LMICs experiencing an ‘aid shock’ following the withdrawal of high contributory official development assistance (ODA). At the same time, rising debt burdens and persistent underinvestment in public health budgets have contributed to stalled progress toward universal health coverage (UHC). Despite these challenges, health financing has regained global policy attention, with renewed commitments to strengthen domestic resource mobilisation through initiatives such as the G20, Defining Sustainable Finance for Health: A Common Taxonomy to Mobilise Global Investment, and Africa’s CDC Health Financing in a New Era. This review synthesises empirical studies published since 2019 on revenue-raising mechanisms for health across LMICs, assessing which mechanisms have been implemented and the institutional preconditions under which they succeed or face constraints. The review examines both traditional and ‘innovative’ financing approaches, adopting a global LMIC perspective rather than regionally or program-specific focus. Importantly, it incorporates evidence from underrepresented regions, including Latin America, Francophone Africa, and small island states. The findings indicate that while reforms such as national and social health insurance schemes are widely implemented, their capacity to generate new revenues beyond pooling and redistributing existing resources remains mixed. Overall, the evidence on revenue-raising mechanisms is fragmented, with limited assessment of design features and enabling conditions. By consolidating evidence across LMICs, this review aims to support cross-country learning through a structured assessment of revenue-raising mechanisms and their preconditions for success, thereby informing policy responses to close financing gaps and advance sustainable progress towards UHC.
Low-and middle-income countries (LMICs) face increasing pressure to expand fiscal space for health amid declining development assistance for health (DAH). Over the past decade, DAH has contracted substantially, culminating in a sharp reduction in 2025 that left many LMICs experiencing an ‘aid shock’ following the withdrawal of high contributory official development assistance (ODA). At the same time, rising debt burdens and persistent underinvestment in public health budgets have contributed to stalled progress toward universal health coverage (UHC). Despite these challenges, health financing has regained global policy attention, with renewed commitments to strengthen domestic resource mobilisation through initiatives such as the G20, Defining Sustainable Finance for Health: A Common Taxonomy to Mobilise Global Investment, and Africa’s CDC Health Financing in a New Era. This review synthesises empirical studies published since 2019 on revenue-raising mechanisms for health across LMICs, assessing which mechanisms have been implemented and the institutional preconditions under which they succeed or face constraints. The review examines both traditional and ‘innovative’ financing approaches, adopting a global LMIC perspective rather than regionally or program-specific focus. Importantly, it incorporates evidence from underrepresented regions, including Latin America, Francophone Africa, and small island states. The findings indicate that while reforms such as national and social health insurance schemes are widely implemented, their capacity to generate new revenues beyond pooling and redistributing existing resources remains mixed. Overall, the evidence on revenue-raising mechanisms is fragmented, with limited assessment of design features and enabling conditions. By consolidating evidence across LMICs, this review aims to support cross-country learning through a structured assessment of revenue-raising mechanisms and their preconditions for success, thereby informing policy responses to close financing gaps and advance sustainable progress towards UHC.
| eISSN: | 2654-1459 |
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