Event summary: Partnership in action – Sustaining the momentum for country-led and self-reliant health financing amid fiscal constraints

The session aimed to sustain momentum around health financing reforms and help shape the narrative for the 2027 United Nations High-Level Meeting on Universal Health Coverage (UHC). It brought together senior government officials and other key health and development stakeholders to discuss challenges of domestic health financing in the current context of a rapidly changing global health architecture and geopolitical uncertainty. 

Across the board, speakers underscored that domestically financed UHC is essential for equitable and resilient health systems, health security, and sustainable development. They highlighted the importance of stronger collaboration between ministries of health and finance, improved public financial management, and sustained political commitment to health financing reforms. They also strongly welcomed the creation of the UHC Knowledge Hub in Tokyo, Japan, and expressed their interest in collaboration with the Hub. 

The event was moderated by Dr. Cecilia Mundaca Shah, Vice President for Global Health at the UN Foundation, who set the scene by noting key gaps in progress towards UHC and the need for strong partnership, not only between Ministries of Health and Finance, but also with communities. She invited countries to explore how to build more sustainable, domestically financed health systems ahead of UNGA UHC meeting in 2027. 

Dr. Ayoade Alakija, Nigeria’s Ministerial Global Envoy on Antimicrobial Resistance and FIND Chair, underscored that countries need to shift from aid dependency to domestically financed health systems and improved public financial management. Domestic health financing will allow countries to decide what they needed, instead of being dictated by donor. She welcomed the establishment of the UHC Knowledge Hub as an important tool for North-South and South-South transfer.

Mr. Masayuki Kamiya, Parliamentary Vice-Minister of Health, Labour and Welfare, Japan, emphasized that UHC is the cornerstone of human security and mentioned in the SDGs. As an early UHC champion, Japan has been promoting UHC as one of key issue in global health with a focus on strengthening health financing using domestic resources. He recalled that Japan decided to establish the UHC Knowledge Hub to serve as a global center to support LMICs in building UHC. One of key activities is to provide capacitiy building support for MoF and MoH to strengthen health financing, as well as to organize the UHC High-Level Forum in December each year. 

Dr. Yukiko Nakatani, Assistant Director General, Health Systems, noted the world is off-track to achieve the UHC goals defined in the SDGs. She recommended to focus the efforts on two priorities: First, improve health equity, as 4.6 billion people still lack access to essential health services and 2.1 billion people face financial hardship. And second, countries need to transition to domestically financed health systems. She commended the partnerships with Japan and the World Bank as well as the EU to advance on UHC. Finally, she underscored that action must be guided by evidence and data to help maximize impact. 

Ms. Monique Vledder, Global Director of Health and GFF, World Bank, reiterated the World Bank’s objective to provide additional 1.5 billion people with quality services by 2030. The National health compacts provide a key vehicle to bring WB technical expertise to countries. So far, 16 National health compacts have been established and by December 2026, 24 additional compacts will be ready. She shared that multilateral development banks are aligning their efforts of financing the health sector. She added that efficiency in health spending needs to be improved and the private capital mobilized. New fiscal space could be achieved by debt swaps and other instruments.

Overview of Panel 1: Advancing Health Finance for UHC

Dr. Albert Francis Domingo, Undersecretary of Health and Chief of Staff, Philippines, noted that the National Health Compact has become a reference, including for US support. He shared that the Philippines have been introducing zero balance billing for local government units. The out-of-pocket payment have been successfully lowered from 44 % in 2023 to 42 % in 2024 and are projected to reach 39% in 2025. The Philippines government provides subsidies for LGU to bring down health expenditures. Furthermore, PhilHealth improved the benefits package. Finally, he reminded that the Philippines transitions out of support by the Global Fund.

Dr. Hatem Amer, Associate Minister for International Relations, Ministry of Health and Population, Egypt , told the audience that for the case of Egypt, UHC has become a key pillar of national development agenda. Egypt is progressively implementing a whole-of- government approach. In his view, sustainable health finance requires a close collaboration between the Ministries of health and finance. Looking forward, Egypt will pursue the debt for health model, so that part of Egypt’s debt service could be redirected to health investment. According to Dr. Khaled Abdel Ghaffar, debt for health could become a model across the African region to mobilize additional funding for health. In his conclusion, he emphasized that progress towards UHC needs more global solidarity, more domestic resource mobilization and innovative financing solutions.

H.E. Dr. Lo Veasnakiry, Secretary of State, Ministry of Health Cambodia, informed that Cambodia had anticipated the shift in donor funding and prepared for greater reliance on domestic resource already 15 years ago. In the meantime, the government has been able to increase coverage for informal workers, to reduce fragmentation, to move towards capitation and to incentivize quality care. Currently, a PFM reform program was ongoing in order to manage resources more effectively. 

Dr. Victor Bampoe, CEO of the Ghana National Health Insurance Authority, mentioned that external assistance is becoming less predictable and thus placing pressure on government to finance systems sustainably. The key question is thus how to mobilize, allocate and govern resources. Ghana has recently expanded the fiscal space in health, including by allocating additional resources for the national health insurance scheme in 2026. The New Ghana Medical Trust Fund tries to address high-cost diseases, such as kidney failure. Furthermore, a free primary health care initiative was launched in 2026 to further bring down out-of-pocket payments which are currently at 30%. The government also plans to achieve stronger accountability through digital claims process. He concluded by stating the domestic resource mobilization needed strong political leadership and accountability and that reforms needed to be country owned. 

H.E. Budi Gunadi Sadikin, Minister of Health Indonesia, reminded the audience that compared to recent global financial crises, the current crisis in health finance was not that big; spending for health has returned to pre-pandemic levels. Furthermore, ample opportunities existed to obtain concessional interest loans from MDBs. For Indonesia, his objective is to tackle supply side constraints by using loans from MDBs to equip health care centers with needed health technologies. In his view, Ministries of Health were often not savvy enough to explain their needs to colleagues from the Ministry of Finance. Furthermore, he recommended to tap into the potential of the private sector to improve UHC. In this view, not all hospitals need to be built by public sector, instead an appropriate incentive mechanism can ensure the private sector will come in. Finally, he noted that the costing is highly untransparent in the health sector and more increased transparency helps to push down prices. 

Overview of Panel 2: From Dialogue to Declaration: Securing Health Financing in 2027

Mr. Martin Seychell, Deputy Director General, Directorate for International Partnership, European Commission, stated that prioritizing health in national budgets was very important and that external partners must help with domestic resource mobilization. Furthermore, he reminded that the EU supported the UHC Partnership with WHO which supports country-led health systems reforms. He also called for a fairer global health architecture, especially to enforce the commitments of the Lusaka Agenda, to ensure that MDB’s health investment in PHC is appropriate to debt sustainability, to strengthen regional bodies, including the Africa CDC, as well as to promote regional pooled procurement and local manufacturing. He urged to scale up innovative financial instruments to increase health investments.

Dr. Jadej Thammatacharee, Secretary-General of the National Health Security Office (NHSO), Thailand, reminded the audience that UHC advanced in Thailand because of consistent political commitment. Sustainable UHC means spending more and spending more wisely. In addition, adequate resources for health services are needed along with health technology assessments. Global partnerships, such as the UHC Knowledge Hub, remain key to advance the UHC agenda. 

Ms. Amy Boldosser-Boesch, Senior Director for Health Policy, Advocacy, and Engagement at Management Sciences asked whether health financing reforms would be done for people or with people. She lamented that citizen participation is often absent from political decisions. However, citizen participation  is a pillar of equitable and resilient health systems. She therefore requested to institutionalize social participation as well as to finance that participation. Ultimately, UHC can only achieved through strong social contracts that are based on trust. 

Dr. Rahul Sankrutyayan Reddy Kadarpeta, Executive Director of the Joint Learning Network (JLN) of UHC at Amref Africa highlighted the role of peer learning and collaboration, with the JLN bringing together policymakers and practitioners to co-develop practical solutions, enabling countries to learn from one another and accelerate health system reforms.

In her conclusion, Dr. Cecilia Mundaca Shah, Vice President for Global Health at the UN Foundation, stressed that efforts to build UHC must be sustained. As preparations begin for the 2027 UN High-Level Meeting on UHC, the dialogue reinforced a clear message: achieving sustainable and self-reliant health systems will require strong country ownership, partnerships across sectors, and continued investment in health financing reforms that place people at the center.