Financial planning for the implementation of the SDGs will be more successful if governments treat the 2030 Agenda as a whole and use disaggregated data (by gender, age, disability, place of residence) as much as possible in planning, monitoring and performance evaluation of investments. It is also important to ensure a gender-responsive approach when tracking spending.
This is especially significant for healthcare systems, reflected in the indicators of SDG 3, but are also critical for the implementation of other SDGs. Considering the prevalence of state financing of the healthcare system, improving the efficiency of public finance management based on result-based budgeting approaches is especially relevant for the Republic of Belarus.
UNFPA in Belarus, under the framework of the Joint Programme “Promoting new tools of sustainable development budgeting that prioritize vulnerable populations in Belarus” (Joint SDG Fund), has the leading role in the process of budgeting practices change at a local and national level during 2020–2022 by profound research and analytical work on performance-based budgeting in health financing system. The achieved result is strengthening the capacities of the healthcare facilities management through identifying their needs on results-based budgeting.
The initial survey involving 97 medical organizations of Belarus showed and identified the needs to strengthen the capacity of healthcare managers and economists on the implementation of certain strategic area of reforms – measuring costs and revenues on a diagnosis related group (DRG) basis. Proposed better financing practices in the health sector found relevant feedback due to an implemented capacity-building programme for healthcare managers and the introduction of performance-based budgeting in a permanent healthcare training programme. This ensured sustainability of the result and became the basis of an experiment on financing inpatient medical care in Grodno region.
In addition, supported and realized comprehensive analysis of the impact of the introduction of a budget expenditure planning system based on the use of expenditure standards per patient in inpatient settings by DRG on the budgets of healthcare organizations, including a Comparative analysis of model budgets and actually used budget funds of healthcare organizations in the Grodno region, led to continuation of piloting by the Ministry of Health in accordance with the Resolution No. 146 of the Council of Ministers of the Republic of Belarus of 23 February 2023.
Implementation of the DRG model as a result-based budgeting method has made it possible to justify the needs and reallocate funds worth well over 800,000 United States dollars to cover the costs of inpatient medical care for state healthcare providers in the Grodno region for 2023. The formation of the basic standard cost per patient for inpatient care has improved the financing of the Grodno region: the minimum standard for budgetary provision of healthcare costs per inhabitant of that region for 2023 amounted to 312.2 USD25 against 238.6 USD26 in 2022. It has also become one of the factors improving citizens’ financial protection in healthcare all over the country. Thus, the minimum standard for budget provision of healthcare costs per inhabitant in the Republic of Belarus for 2023 amounted to 408.7 USD25 against 351.5 USD26 in 2022.
25 Law of the Republic of Belarus No.231-3 on the republican budget for the year 2023. Exchange rate of the National Bank of the Republic of Belarus as of 1 January 2023.
26 Law of the Republic of Belarus No.142-3 on the republican budget for the year 2022. Exchange rate of the National Bank of the Republic of Belarus as of 1 January 2022.
Ongoing and supported reforms are a good example of joint efforts and source mobilization for SDG 17. UNFPA expertise allowed the country to save sustainable results of health outcomes and financial allocations for social and medical care services for its population in the conditions of the geopolitical escalation, epidemiological and economic challenges. For instance, life expectancy in Belarus of 72.4 years is higher than in the neighbouring Russia (69.4 years) and Ukraine (69.6 years).27 The Government spends almost 20 per cent of its expenditures on health28, ensuring Universal Health Coverage (UHC) Service Coverage Index of 79 in 2021, which was similar to Estonia’s and exceeds the value of Lithuania and Latvia29.
27 The World Bank, World Bank Open Data.
28 Bulletin on the execution of the consolidated and republican budget, 2021. Ministry of Finance of the Republic of Belarus.
29 World Health Organization, The Global Health Observatory. (2021) UHC Service Coverage Index (SDG 3.8.1).
United Nations Economic Commission for Europe
Palais des Nations, Geneva
