SynthesisJournal of global health2020
Improving fiscal space for health from the perspective of efficiency in low- and middle-income countries: What is the evidence?
Synthesis in Journal of global health, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
What it found
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
13 citing papers in PubMed.
- Do Fossil Fuel Subsidies Crowd Out Health Expenditure? A Country-Level Longitudinal Analysis.Health economics · 2026Article
- Efficiency in COVID-19 inpatient care: findings from public hospitals in Iran.Health economics review · 2025Article
- Stakeholder-Driven Cost Management Approaches in Iranian Hospitals: A Qualitative Thematic Analysis.Medical journal of the Islamic Republic of Iran · 2025Article
- Fiscal space for the immunisation program in Zambia- an efficiency analysis approach.BMC research notes · 2024Article
- How does Public Financial Management (PFM) influence health system efficiency: A scoping review.Wellcome open research · 2024Article
- Providing a model for financing the treatment costs during biological crises using the fiscal space development approach.Health economics review · 2023Article
- Budget monitoring, accountability practices and their influence on the efficiency of county health systems in Kenya.PLOS global public health · 2023Article
- Exploring the possible sources of fiscal space for health in India: insights from political regimes.Health research policy and systems · 2022Article
- Understanding the performance of county health service delivery in Kenya: a mixed-method analysis.Health policy and planning · 2022Article
- Do efficiency gains really translate into more budget for health? An assessment framework and country applications.Health policy and planning · 2021Review
- Fifteen years later: moving forward Heller's heritage on fiscal space for health.Health policy and planning · 2021Article
- A practical measure of health facility efficiency: an innovation in the application of routine health information to determine health worker productivity in Ethiopia.Human resources for health · 2021Article
- Ethical Frameworks and Global Health: A Narrative Review of the "Leave No One Behind" Principle.Inquiry : a journal of medical care organization, provision and financingReview
Corrections and comments
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Authors and funding
5 authors.
Funding
Abstract
backgroundConceptual frameworks of fiscal space for health have traditionally considered health system efficiency improvements as a means to free up resources for the sector. However, there has been no comprehensive review of the evidence to confirm the relationship between efficiency and fiscal space.
methodsWe conducted a systematic review to synthesize evidence on whether efficiency gains increase fiscal space for health. We searched bibliographic databases for specific keywords - namely, fiscal space, efficiency and health - and identified 22 articles that examined links between efficiency gains and fiscal space for health. The articles, which encapsulated 28 case studies, were included in the analysis.
resultsThe 28 case studies varied widely with regard to how efficiency was evaluated, the extent to which efficiency was explored, and how efficiency gains could be achieved. Half of the studies assessed both technical and allocative efficiency, and the other half assessed technical efficiency only. The indicators to examine potential inefficiencies varied substantially among studies. The most frequently cited inefficiencies stemmed from public financial management (budget implementation, budget allocation and strategic purchasing) and governance issues, even though these were characterized in various ways. The second most cited set of inefficiencies that caused health systems to function poorly were those related to health service delivery. Procurement and delivery of input factors was also mentioned in some studies as a source of inefficiency. Though most studies conceded that efficiency gains were a potential means to improve fiscal space for health, very few quantified the potential gains or explored practical mechanisms to translate efficiency gains into fiscal space for health.
conclusionsWhile the conceptual link between efficiency gains and fiscal space for health may be assumed, there is no direct empirical evidence proving that efficiency gains translate into more resources for the health sector. Mechanisms to translate efficiency gains into fiscal space are barely explored in the fiscal space literature. Public financial management rules and related rules for reallocating funds within the sector need to be further examined to guide countries in the transformation of efficiency gains into more resources for health.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.