Côte d’Ivoire’s economic growth has been among the highest in the world in recent years, but wide inequities have left 28% of the population in poverty.1 The country has some of the lowest health indicators in the region and a UHC index of 47 out of 100. At around 5% of the national budget, health financing is insufficient and responses to some health challenges have depended heavily on external funding.
A boy listens to a radio-broadcast class in the village of Morovine, in the North of Côte d’Ivoire. © UNICEF / Frank Dejongh
Recognizing that increased and more sustainable and equitable health financing was required, the Government of Côte d’Ivoire held a national dialogue on health financing in April 2019, with support from development partners, including several GAP agencies.
Recognizing that increased and more sustainable and equitable health financing was required, the Government of Côte d’Ivoire held a national dialogue on health financing in April 2019, with support from development partners, including several GAP
agencies. An investment case prepared with support from the GFF and input from a wide variety of stakeholders was presented, which led to commitments from the Government to increase the health budget by 15% every year, improve the efficiency and equity
of public health expenditure and better coordinate and align both domestic and external resources for health through a national platform for coordinating health financing. The platform was launched in July 2019 under the leadership of the Prime Minister’s
office. In November 2019, the Government announced
the health budget for 2020, which the Ministry of Health indicates is 16.6% higher than the previous year, but still around 5% of the national budget. The extent to which this increase will benefit
the priorities agreed to in the investment case, most of which relate to PHC, remains to be determined.
Updated estimates of gross national income in July 2019 indicate that Côte d’Ivoire will enter the “accelerated transition phase” from Gavi support in 2022 – two years later than initially planned – which offers additional opportunities for collaboration. Gavi and other GAP signatory agencies, including WHO, UNICEF, the Global Fund and the World Bank, together with other partners, are actively engaged in the transition strategy. In addition, Gavi has supported the establishment of a multi-donor programme management unit, so that other agencies, including the Global Fund and the World Bank, can align their financing after the results of the first Gavi implementation report are available. In light of the Government’s commitment and engagement to improve the efficiency and coordination of health financing and effective collaboration among the many partners in the country, including the Government of France and the United States Agency for International Development, a list of clear priorities for support by GAP and other agencies has been drawn up. These are strengthening domestic resource mobilization by training civil society in budget advocacy; coordinated joint messaging from in- country partners; support to achieve better technical and allocative efficiency in health expenditure; and support for the health financing coordination platform. All development partners, including the GAP agencies, are working to coordinate better among themselves and participate in the platform with a consistent voice; ensure greater transparency and commitment from the Government, the private sector and other partners, including civil society organizations; improve the efficiency and sustainability of health financing and national capacity to manage health funding; and ultimately contribute to better health outcomes through improved coverage of and access to PHC, especially for populations and regions that are not currently reached.
Enabling factors for better coordinated support and more efficient health expenditure in Côte d’Ivoire include:
- A shared, evidence- based narrative among the agencies and the Government on health financing priorities;
- Collaboration among partners in developing shared high-level messaging, with institutional buy-in from GAP signatory agencies and other partners;
- Leveraging opportunistic strategies to strengthen joint advocacy for improved health financing, such as the World Bank spring meetings and the replenishment meetings of Gavi, GFF and the Global Fund; and
- Alignment of support to national budget and planning cycles and encouraging joint missions.
Remaining challenges include maintaining momentum while electoral campaigns are starting in the country; implementing a functioning system for tracking and monitoring health expenditure; continuing support for implementation of the platform; and designing joint modalities for implementation support.
Côte d’Ivoire has been focused on COVID-19 since the first case appeared in the country in March 2020. As in other countries, individual and joint support by the agencies aims to ensure not only that the Government has adequate resources to
respond to
the pandemic but also that service delivery and supply chains continue to function effectively.
1. Côte d’Ivoire poverty and equity brief. Washington DC: World Bank Group; 2019 (accessed 5 May 2020).