Table 3.

Components of fiscal space

Fiscal space pillar	Explanation and example
1. Macroeconomic conditions	Increased GDP growth For example, sustained economic growth in Turkey, from 2000 to 2008, allowed the government to increase public sector funding for health at an average annual growth rate of 9.1%, paving the way for UHC scale-up.71
2. Reprioritisation of government budget	Increased health budget as a proportion of national fiscus For example, Increasing country health budgets to 15% of the national GDP in African nations, as outlined by the Abuja Declaration.42
3. Health sector-specific resources	Sugar-tax to finance diabetic screening at primary healthcare level For example, Introducing excise taxes on specific goods or purchases such as tobacco,72 alcohol73 or sugar and reducing emergency subsidies.74
4. Efficiency of existing resources	Evaluation of National Health Accounts to identify and reduce wasteful expenditure Improving both technical and allocative efficiency could provide an efficiency gain of up to US$8 per capita.75
5. External sources	Increase funding from bilateral organisations For example, the United States Agency for International Development (USAID) channelled US$27.2 million to The Human Resources for Health programme in Rwanda, which allowed the country to rapidly increase physicians needed to delivery Universal Health Coverage.76
6. Innovative financing	Global Fund financing of antiretrovirals to support a National HIV/AIDS programme For example, US$ 973 395 559 disbursed to South Africa helped to provide anti-retroviral's to 4.35 million people with HIV/AIDS77

Source: Adapted from Tandon and Cashin⁵².

GDP, gross domestic product; UHC, Universal Health Coverage.