A New Era in Health Financing and Public Financial Management
The government of Senegal and the Global Fund recently concluded a high-level regional meeting that marks a significant milestone in aligning health financing with national public financial management (PFM) systems. Over four days, representatives from finance and health ministries, supreme audit institutions, and civil society from 15 Francophone African countries collaborated to strengthen the transparency, effectiveness, and sustainability of investments in the health sector.
This meeting comes at a critical time when countries in Francophone Africa are facing multiple challenges, including limited national budgets, reduced external funding, increased social pressure on public finances, and the need for financial sovereignty. The event aimed to address these issues by fostering dialogue and cooperation among key stakeholders.
Strengthening Health Systems Through Effective PFM
The Global Fund plays a crucial role in leveraging its PFM strategy to help countries maintain their gains in the health field, save lives, and strengthen national sovereignty. Rigorous and transparent PFM is essential for better planning, execution, and control of health spending, while preparing for the transition to sustainable domestic financing.
Since its inception, the Global Fund has supported the transition of 52 disease components in 38 countries. In the current cycle, this involves 12 components in eight countries, marking the largest transition to date. With 72% of its investments made in sub-Saharan Africa, the Global Fund aims to increase institutional capacity for efficient resource management. It also demonstrates that when aid is properly invested, it promotes sustainable change, strengthens financial governance, and supports the transition to resilient, fully country-led health systems.
Key Statements and Commitments
Adda Faye, Chief Financial Officer of the Global Fund, emphasized the importance of integrating external funding into national systems. “Integrating external funding into national systems is essential for building mutual trust between governments and partners and for ensuring sustainable impacts and a successful transition,” she stated. Countries in the subregion have shown a clear willingness to combine public resources, private capital, and partner funding to build more resilient health systems aligned with their national health priorities.
Senegal, the meeting’s host country, illustrated this dynamic through its experience in program-based budgeting, digitizing public spending, and increasing coordination between the ministry of finance and budget and the ministry of health, as well as audit institutions. Mr. Gorgui Fall, Chief of Staff representing the Minister of Economy, Planning, and Cooperation, highlighted the significance of the meeting in renewing the dialogue between the state, technical and financial partners, and supreme audit institutions to ensure a more strategic and credible use of public resources.
Progress and Challenges in Integration
Several participating countries demonstrated significant progress and a genuine commitment to full integration. Benin presented major changes to its PFM system and structural innovations that are helping the country better integrate partner funding into health programs. Burkina Faso, Côte d’Ivoire, and Mali highlighted their progress on digitizing expenditures, strengthening audits, and gradually including Global Fund support in the national budget and treasury accounts.
Chad, Madagascar, and Togo discussed persistent challenges related to fragmented financial flows and the predictability of disbursements. They shared promising initiatives such as decentralizing authorizations, strengthening national audits, and increasing the use of public financial information systems to improve the consistency of resource availability and reduce parallel mechanisms.
Role of Supreme Audit Institutions
Supreme audit institutions highlighted reforms undertaken to modernize public auditing, including digitizing procedures, adopting international standards, and improving the quality of reports. They reiterated the central role they play in financial accountability, especially in a context where most health funding comes from external resources.
Dr. Ibrahima Sy, Senegal’s Minister of Health and Public Hygiene, emphasized the importance of national systems in sustaining health progress. “The sustainability of our health progress depends on the strength of our national systems. They must be transparent, grounded in accountability, and rooted in trust. Strengthening their funding by gradually integrating external support requires us to assert our health sovereignty and guarantee quality health services for all citizens.”
National Roadmaps and Future Steps
At the end of the meeting, delegations adopted national roadmaps for:
- Gradually integrating Global Fund financing into national budgets and systems.
- Strengthening audit and transparency mechanisms, in particular by increasing the involvement of inspectorates general and courts of audits.
- Accelerating the process of digitizing budget and health information systems.
Participants also emphasized the importance of proactively managing risks, publishing audit reports in a timely way, and holding stakeholders accountable for the recommendations made.
“This collective effort is based on a simple principle: responsibility must be shared,” concluded Ms. Adda Faye. “In Wolof, the expression juub, jubal, jubanti reflects the spirit of this meeting: integrity, rigor, and mutual responsibility. Every investment we make must translate into a concrete, sustainable, and measurable impact on our populations. Together, we can build systems for Africa, in Africa, and with Africa.”