Abstract

Public health financing in low-resource countries has undergone significant transformation over the past three 
decades, shaped by globalization, market liberalization, technological change, and shifting international 
development priorities. While many low- and middle-income countries (LMICs) adopted market-oriented reforms 
that prioritized supply-side financing, cost recovery, and user fees, global health partners simultaneously 
intensified support for primary health care and universal health coverage (UHC). Despite these efforts, health 
systems in low-resource settings continue to face chronic underfunding, weak governance, inequitable access, and 
structural reliance on donor funding. This paper examines the evolution, challenges, and performance of major 
health financing strategies, including general government health expenditures, innovative financing mechanisms, 
international aid, philanthropy, community-based models, and social health insurance. It highlights persistent 
inefficiencies in resource allocation, limited risk pooling, and the difficulty of extending financial protection to 
informal-sector populations. The analysis further explores governance reforms such as separating financing from 
service delivery, strengthening procurement and price negotiation, improving health information systems, and 
implementing anti-corruption frameworks. Case examples from sub-Saharan Africa, South Asia, and Small Island 
Developing States demonstrate how context-specific strategies influence progress toward UHC. Finally, the paper 
outlines policy options for advancing sustainable and equitable health financing, emphasizing resilience, climate
responsive financing, and pandemic preparedness. Achieving UHC in low-resource countries requires not only 
increased revenue generation but also stronger institutions, transparent governance, and strategic investment in 
health system resilience.