Tracking health financing for universal health coverage in the era of shocks - "FINTRACK Project"

Ifakara Health Institute in collaboration with London School of Hygiene & Tropical Medicine (LSHTM) is set to conduct the Financing Tracking Analysis (FINTRACK) Project which aims to track health financing indicators in the context of shocks, such as the COVID-19 pandemic in Sub-Saharan Africa. The project will examine financing arrangements, equity and efficiency effects, and universal health coverage (UHC) performance during such shocks, using COVID-19 as a case study. It is being implemented across six countries: Tanzania, Malawi, Zambia, Senegal, and Sierra Leone.

Background
Health systems in LMICs have faced significant challenges due to the COVID-19 pandemic. These challenges include economic disruptions that lead to sustainability risks economically and worsen resource limitations. This has led to risks in providing essential health services such as a shift in donor priorities towards pandemic preparedness risks diverting funding from critical areas like reproductive, maternal, newborn, and child health (RMNCH). However, there is limited evidence on how COVID-19 has affected UHC progress.

FINTRACK linkage to Countdown2030
FINTRACK builds on the Countdown2030 initiative, which tracks progress in RMNCH and UHC globally. Launched in 2015 as “Countdown 2015” to track MDG health goals the initiative collaborates with researchers and academics from global, regional and country institutions, and international and civil society organizations to track progress for RMNCH. 

Tanzania is among 22 country collaborators under the Countdown2030. Through Ifakara Health Institute, the Ministry of Health and GFF Tanzania, Tanzania plays a key partner in Countdown’s efforts. The Countdown Initiative has transitioned through several phases, including Phase I (2016-2019), which focused on global-level tracking aligned with the SDGs; Phase II (2020-2022), which expanded to country-level and partnered with public health institutions in 15 countries under the Global Financing Facility (GFF); and Phase III (2023-2025), with further expansion at country to include collaborations, with a further 7 countries (totaling 22 countries) from Africa mainly and few Asian countries.

Countdown2030 has established Data Analysis Centres (DACs). 6 DACs support countdown countries in data analysis in key health focus areas. Dr. Peter Binyaruka through Ifakara Health Institute, falls within the Health Financing DAC, focusing on tracking financial data for equity and efficiency in health financing for UHC. In 2023, Financing DAC secured additional funding for secondary data analysis, supported by the UKRI/Economic and Social Research Council (ESRC).

Aim and objectives of FINTRACK
FINTRACK aims to assess whether and how COVID-19 has affected progress in health financing for UHC, in terms of health financing arrangements, efficiency, equity and UHC goals in 5 countries: Tanzania, Malawi, Zambia, Senegal and Sierra Leone.
The project will assess the effects of COVID-19 on health financing in LMICs with six specific objectives which include;

• Identify changes in health funding levels and sources since COVID-19 and potential fund displacement from RMNCH to infectious diseases
• Analyze trends in aid alignment and harmonization for RMNCH and infectious diseases
• Examine subnational health funding trends by source
• Measure health financing efficiency and its relationship to UHC outcomes
• Assess equity in health financing allocation across subnational regions
• Explore the interplay between efficiency, service coverage, and financial protection goals in UHC.

Ifakara’s roles in the project
IHI, in collaboration with the London School of Hygiene and Tropical Medicine (LSHTM) under the Countdown2030 initiative, will lead objectives 3-6 in five countries (Tanzania, Malawi, Zambia, Senegal, and Sierra Leone). The research involves secondary data analysis, leveraging insights from Countdown’s Data Analysis Centres to strengthen health financing equity and efficiency.