Classification and Review of Health Financing Frameworks: What do they Focus on to Assess and Improve the Situation?

Abstract Objective Health financing assessment is of growing interest to policy makers to develop reform strategies towards achieving universal health coverage. Different frameworks for assessing of health financing systems have been developed. The purpose of this study is to review the current frameworks for understanding and assessing health financing and draw out the dimensions of conceptual frameworks and how different concepts are used in relation to the concept of health financing assessment. Lessons learned from different frameworks would guide the future use and formulation of such frameworks. Methods We carried out a systematic search strategy, using the PubMed database to find peer reviewed published literature. A search using generic search engines (Google Scholar and the Google) was also performed through a less structured search to find additional documents and reports published. To increase the comprehensiveness of search, Websites of World Health Organization (WHO) and World Bank were also searched. We included any type of report or peer reviewed journal article that reported frameworks to assess, review and map financing functions and sub-functions and highlight different factors that affect it. Results Fifteen frameworks/tools developed during 2001 until 2020 were found. We classified frameworks by grouping them into systems approach- analytical frameworks, indicator-based, and descriptive/ narrative categories. These frameworks vary in the concepts, functions and processes, dimensions, strategies and meet various international or country-specific challenges. Conclusion The process of framework development for health financing review is becoming more comprehensive with pushing universal health coverage to the international agenda. Despite being diverse, various health financing frameworks/ tools offer synergistic views to the health financing system and provide a comprehensive picture of the health financing system. While some frameworks covered the majority of the elements, not any of the frameworks on its own covered all the elements. Health financing review is a laborious endeavor, which usually needs diverse data and an expert team. It is sometimes infeasible to access ready and user-friendly information; therefore, it is important to apply them with some flexibility.