Public Financial Management and Health Service Delivery: A Literature Review

This chapter provides a summary review of the existing academic literature, both theoretical and empirical, on the contributions of public financial management (PFM) systems and reforms to improving the effectiveness of health service delivery based on a literature review conducted by Goryakin et al. (2017). We consider both population health indicators as well as more proximate process indicators related to health system performance. The existing literature is limited and only 53 articles are reviewed, divided across three subthemes: first, “system quality” studies, on the impact of PFM quality and good governance generally; second, “health system strengthening” studies, including articles on medium-term expenditure frameworks (MTEFs), reforms related to budget transparency and participatory budgeting and decentralization; third, studies on the impact of donor-related reforms such as the introduction of sector-wide approaches (SWAps). The theoretical literature predicts that high-quality PFM systems will have a positive impact on various dimensions of performance; whereas evidence from empirical studies is more limited, though generally positive. Overall, evidence shows good governance has an important role in health service delivery. Increased public funding of health programmes is likely to be more effective in countries with better governance, but what this means in practice is highly context-specific.