Reconfiguring financing arrangements to build health system resilience to disasters and multi-hazards: a framework and evidence review of co-financing arrangements.

Background: Climate hazards represent a substantial risk to health systems and financing, especially when they compound.  Building resilient and sustainable health systems requires intersectoral or co-financing arrangements that jointly support health and climate goals.   However, it is unclear what opportunities exist for co-financing, across which financing functions, and at which health system scales.  We propose a framework for studying co-financing for health and climate goals which considers the degree of integration between sector funding, and whether arrangements are ‘passive’, when cross-sectoral goals are indirectly affected, or ‘strategic’, when they are pre-emptively supported to build resilience and sustainability.   Using this framework, we describe the range of co-financing arrangements that have been used to support climate and health goals based on a rigorous evidence review.  We also summarize evidence on enablers and barriers to implementation, and research gaps and future priorities. 

Methods:  We undertook a rigorous narrative review.  We identified key terms pertaining to financing and to health systems and climate goals to guide the review.  We then searched the international literature using Pubmed and Web of Science from 2013-2023, the websites of key health and climate agencies for grey literature and consultation with stakeholders.  We synthesized evidence according to our co-financing framework describing arrangements together with enablers and barriers to implementation. 

Results: A total of 97 studies were included in the review.  More than half were from low-and middle-income countries, with 36 focusing on health financing for climate goals and 39 on climate finance for health goals (promotive).  Studies mostly addressed passive co-financing, assessing the consequences of climate inaction, including the impact on government health expenditure, health insurance and out of pocket payments. There was limited evidence of strategic co-financing or integrative co-financing. Several lessons emerged for designing effective co-financing mechanisms for health and climate needs including: 1) involving staff with climate and health sector knowledge in the design and implementation of co-financing arrangements; 2) the alignment and/or linkage of information systems across sectors; 3) clear communication and consistency of entitlements, and facilitating access to climate finance, to ensure funds target needs; and 4) flexibility in the use and allocation of funds to meet emerging needs. 

 

Conclusion: Co-financing is critical to filling the financing gap for health sector adaptation and achieving recent COP29 funding pledges. Our study highlights issues to consider in the design and implementation of these schemes to maximise their benefit for health systems; and draws attention to some of the limitations of specific arrangements, identifying areas for further research.