Can earmarking mobilize and sustain resources to the health sector?

The way a health system is organized and financed is one of the key determinants of whether it provides equitable access to essential health care and improves population health. Financing is important as it determines access to and availability of health care, and the level of protection against catastrophic costs of illness. In lowand middle-income countries, financing becomes a central issue of health reform, especially in the light of fiscal constraints that result in a large proportion of out-of-pocket payments for health, leading to financial catastrophe and impoverishment for some households.1 In the 58th session of the World Health Assembly in May 2005, WHO Member States endorsed Resolution WHA58.33 urging countries to strive towards sustainable health financing and achieving universal coverage, through applying a mix of prepayment health financing systems such as social health insurance and tax-financed national health services based on their specific context and institutional capacity. Social health insurance has a limited role in developing countries due to the small size of the formal employment sector. When commitment towards the Millennium Development Goals is at stake, what are effective mechanisms in securing and sustaining resources to the health sector in the light of limited fiscal space and multiple players at international and national levels? This question challenges policy-makers in low-income countries. We review and discuss the contributions of specific diseases funding from global health initiatives (GHIs) and from earmarked taxes on specific goods and services to assess their strengths and weaknesses and provide appropriate policy recommendations. Global health initiatives