This publication explores the policy options to finance more resilient health systems whilst maintaining fiscal sustainability. It finds that the scale of the additional health financing needs requires ambitious and transformative policy changes.

Norway’s economy is slowing as inflation and higher interest rates weigh on consumption and investment. The labour market is tight and wage growth robust, while labour shortages and job mismatches are high and rising. Inflation is falling but still way above the target of 2%. The fiscal stance is expansionary. It should become contractionary to support monetary policy. While Norway is one of the OECD’s most productive countries, productivity growth over the past decade has been weak. Making skills more relevant, notably by strengthening vocational education and training, could help raise productivity and ease tight labour markets. Higher and broader taxation of greenhouse gas emissions and investing in lower‐cost emission cuts would help achieve emission reductions more efficiently. Public spending as a share of GDP is the highest in the OECD, which brings important benefits in the form of high-quality public services. However, oil revenues are set to decline, and ageing costs to rise, foreshadowing strains on public finances in the future. Norway could benefit from applying a medium-term expenditure framework, introducing a spending rule, and establishing a full-fledged fiscal council. Reforming the very generous sickness and disability scheme could help reduce spending pressures and increase employment. Regional policy should become more cost-conscious. Infrastructure investment is very high, and imposing a minimum benefit-cost ratio on individual projects and strengthening ex-post evaluations could help improve its effectiveness. SPECIAL FEATURE: RAISING THE EFFECTIVENESS OF PUBLIC SPENDING

The Kenyan economy faces multiple near-term challenges—including limited fiscal and external buffers, elevated cost of living, exchange rate pressures, tight financial conditions—while global headwinds are weighing on activity. Tackling these challenges and ensuring a steady reduction of Kenya’s debt and debt vulnerabilities will require addressing difficult policy trade-offs with mutually reinforcing policies and carefully prioritizing the authorities’ “bottom-up” reform agenda. Downside risks to the program baseline are significant in the near term from elevated uncertainty in major economies’ outlook and in the event of insufficient policy actions to sustainably address the FX market dislocation, elevated inflation, and emerging slowdown in tax revenues.

The global attention in recent years has focused primarily on water quantity and allocation issues. Water quality has received significantly less attention than water quantity. Commendable progress has been made by the developed world to control point sources of pollution, but commensurate progress in reducing non-point sources has not been made. In the third world countries both point and non-point sources of pollution are becoming increasingly a serious concern. Already, nearly all water bodies in such countries near and around urban centres have been severely polluted, with very high health and environmental costs. The book assesses the current status of water quality management in both developed and developing worlds, as well as analysing the effectiveness of economic instruments and legal and institutional frameworks to control water contamination. It outlines the importance of building up social and political awareness to reverse the trend of continuing water quality deterioration, which is likely to be a most challenging task in the coming years. This book was published as a special issue of International Journal of Water Resources Development.

The health systems we enjoy today, and expected medical advances in the future, will be difficult to finance from public resources without major reforms. Public health spending in OECD countries has grown rapidly over most of the last half century. These spending increases have contributed to ...

The global movement toward universal health coverage (UHC) is accompanied by requests for large increases in government health spending in some countries. This combined with the global economic situation and stagnant economic growth across many low- and middle-income countries make it more critical than ever to place health financing discussions firmly in the context of macroeconomic and fiscal realities. Unfortunately, there is often a disconnect in decision making, with key fiscal decisions made in the absence of a clear understanding on the one hand of the potential consequences for the health sector, and on the other, the consequences for the country’s macroeconomic and fiscal position of increasing or reallocating government spending. Constructive health financing policy dialogue aims to reach a common understanding between health sector leaders and central budget authorities about policy objectives for the health sector and the resources needed to achieve those objectives, how much priority will be given to health in the government budget, and how the health sector will be held accountable for using funds effectively. This common understanding should be built on a realistic picture of the country’s macroeconomic and fiscal context, the constraints and competing priorities in the budget-setting process. When ministries of health and ministries of finance have a common understanding of macroeconomic and fiscal constraints, discussions can focus productively on using funds within the potential health resource envelope in the most effective way to achieve health system objectives. This guidance note outlines the key components of the macroeconomic, fiscal, and public financial management context that need to be considered for an informed health financing discussion at the country level. The guidance note is organized around four sets of questions that are key to placing the health financing dialogue in the context of a country’s macroeconomic and fiscal context. Each section points to measures, resources, and analytical tools that are available to assist in answering these questions for a specific country. The guidance note draws on case studies from 11 countries moving toward or sustaining universal health coverage conducted as part of the Japan†“World Bank Partnership Program on UHC as well as from other country examples.