Budgetary space for health in Ukraine. Policy document to support budget preparation dialogue for 2021(2020)

Ukraine is kick-starting dialogue on increasing funding for health care; a challenging task in the current macro-fi scal context, which is overshadowed globally by coronavirus disease (COVID-19). With the country’s public spending on health care standing at 3.2% of gross domestic product (GDP) in 2019 – considerably behind its central European neighbours (OECD, 2020) – along with consistently declining levels of consolidated government spending on health, and the spotlight the global pandemic has placed on health system weaknesses and poor resourcing practices, the Government of Ukraine has restarted discussions on ways to better fund health. Despite the political will to fi nd extra resources for health, in times of macro-fi scal turmoil this remains a political and technical challenge. This summary paper provides background on each of these dimensions of potential budgetary space for health in Ukraine, along with draft recommendations on how to enlarge that space in the medium term. Intended as a technical brief, it is based on the new methodology for budgetary space diagnostics proposed by Barroy & Gupta (2020), and uses health fi nancing analysis undertaken for the upcoming World Bank public expenditure review (World Bank, 2020) to provide ideas for policymakers working on extending and developing health and budgeting reforms in Ukraine, while also being useful for wider civil society and international observers.