This document outlines the background to and design of the Health Financing Progress Matrix (HFPM), WHO’s standardized qualitative approach to assessing country health financing systems. Primarily qualitative in nature, but drawing on extensive quantitative indicators, the HFPM assesses a country’s health financing institutions, processes, policies and their implementation, against good practice in the context of universal health coverage (UHC). Benchmarks are defined in terms of nineteen desirable attributes, which crystallize evidence about what works in health financing in order to make progress to UHC. The paper also details a number of processes which govern the implementation of the HFPM in countries, to ensure the results are objective and credible. While health financing is only one of the core functions of a health system, it significantly influences both the extent to which the population can access health services, as well as the extent to which they face financial hardship in the process. Through a forward-looking design, the HFPM not only assesses the current situation in a country, but also makes clear recommendations of priority directions for policy and implementation, both accelerating progress towards UHC, and helping to build resilience across the health systems.

Since independence, Bangladesh has achieved impressive economic growth and social development, making steady progress in reducing poverty and significant improvements in living standards. The COVID-19 pandemic interrupted this long period of robust economic performance, deepening some earlier vulnerabilities. Stagnating job growth, rising inequality, and slowing poverty reduction remain challenges. Revenues are low, and financial sector vulnerabilities continue to be high. Substantial productive investment in infrastructure, human capital, and climate resilience is needed to achieve the authorities’ aspiration to reach the upper-middle income status in 2031.

This document provides detailed advice in support of implementation of version 2.0 of the Health Financing Progress Matrix (HFPM) released in December 2020, detailed in Assessing country health financing systems: the health financing progress matrix. Geneva: World Health Organization; 2020. The HFPM is WHO’s standardized qualitative approach to assessing country health financing systems, and comprises two stages. Stage 1 provides a descriptive landscape of the different coverage schemes and programmes in the health system, including how the health budget is organized. Stage 2 comprises thirty-three questions which look in detail at the way health financing institutions and policies are organized, and how they are implemented. For each question the guide discusses why it is important to ask, and what progress looks like, together with country illustrations. Thoughts on information sources and quantitative indicators which can support the assessment are also provided.

This report summarizes the findings of the Health Financing Progress Matrix assessment for Zambia. Recognizing the remarkable progress towards UHC made by the country over the past twenty years, the report also highlights weaknesses in the current health financing system and, extending from this, those priority issues to be addressed in order to further accelerate Zambia’s progress towards universal health coverage (UHC). Specifically, the report notes the importance of sustaining levels of public funding for health, progressively reducing reliance on external funding, and reinforcing the provision of free services in primary care facilities. Further recommendations include the need to accelerate the shift from passive to strategic purchasing, and institutionalizing shifts in the public financial management system to ensure that adequate operational funds reach frontline service providers in a timely fashion. Finally, the duplication in benefits across the budget-funded EPHS, the National Health Insurance Scheme, and some services provided through vertical disease programmes need to be addressed, for example through the establishment of a unified benefits framework. The latest information on Zambia’s performance in terms of UHC and key health expenditure indicators are also presented. This report is intended both to inform current health financing policy, and to provide a baseline for the future monitoring of Zambia’s progress in developing and implementing UHC-oriented health financing reforms.

This report provides a concise summary of the Health Financing Progress Matrix assessment in Georgia, where WHO has a long engagement on health financing issues. The report was conducted using a highly participatory process, including robust discussion with the MoH. In addition to identifying strengths and weaknesses in Georgia’s health financing system, priority areas are highlighted in order to drive progress towards UHC. The latest data on key health expenditure, financial protection, and service coverage indicators are presented. The final report will be released with the date 2023. Detailed responses to individual questions are available on the WHO HFPM database of country assessments or upon request.