ABSTRACT:
Global reductions in external health funding have reshaped the financing landscape for health systems, particularly in countries with high disease burdens and long-standing donor dependence. In South Africa, declining support for HIV and sexual and reproductive health programmes has intensified pressure on primary health care (PHC) amid rising demand from infectious diseases, non-communicable diseases, alcohol-related harm, and unintended pregnancy, especially in rural areas. Health taxes on tobacco, alcohol, and sugar-sweetened beverages are an evidence-based mechanism to reduce harmful consumption while generating public revenue. The World Health Organization’s 3 by 35 initiative creates a policy window for countries to move beyond inflation-based excise increases towards strategic health tax reform to strengthen PHC and advance universal health coverage (UHC). The organised session uses a structured health tax policy simulation grounded in health systems and political economy approaches. Participants take part in a policy simulation exercise on fiscal space for health in a post-donor context. Using a national scenario, participants analyse and debate competing financing pathways: continued reliance on inflation-based excise taxes, partial tax reform and strategic health taxes. Participants will assess revenue potential, health system implications, and political feasibility for PHC investment. This is followed by an advocacy component on communicating policy positions to decision-makers. The session is expected to strengthen participants’ capacity to assess health financing options and evaluate how different tax policies shape PHC funding and equity outcomes. Participants will gain practical skills in translating global health tax guidance into national policy and advocacy strategies. By simulating real-world policy choices rather than abstract budget allocation, this workshop positions health taxes as a strategic governance tool for domestic resource mobilisation. The approach supports health professionals, policymakers, government officials, and civil society actors to engage meaningfully with health tax reform as a pathway to sustainable PHC and health system resilience.