Publications & Reports

Sustainable Health Financing in the Pacific: Tracking Dependency and Transparency

Joel Negin, Wayne Irava, David Leon, Clement Malau, Chris Morgan


Using recently conducted national health accounts, the key questions that this working paper aims to answer are:

• How much of health sector spending is contributed by external development partners in selected Pacific Island countries?

• Are there any areas of health financing that are particularly reliant on external funding?

• Do any of these contributions represent “dependence”?

The external contribution to health sector spending is 9 per cent of total health expenditure in Fiji, 17 per cent in Vanuatu, 21 per cent in Samoa, 39 per cent in Tonga and 60 per cent in the Federated States of Micronesia (FSM). The US contribution to the health sector in FSM represents almost US$200 per person per year.

Within the health sector, prevention and public health services are relatively reliant on donors, 30 per cent of finance for this area in Fiji and 51 per cent in Tonga coming from donors. This level of spending might allow donors to influence sector priorities. There is no set definition of “dependence”, but this brief highlights the need for more data transparency and openness in health aid investments, especially in light of recent statements by AusAID and the World Bank about the need for long-term support to the social sectors of Pacific Island countries. Greater data transparency is needed to ensure accountability on all sides. Improved data sharing can lead to better policy making and ultimately more aid effectiveness.


  • Journal: Health Policy and Health Finance Knowledge Hub: Working Paper 22
  • Published: 01/11/2012