**6. Strategies for providing and accessing reliable healthcare financing**

Broadly, to provide and access reliable healthcare financing, three strategies are cogent: Efficient collection of revenue, reprioritisation of government budgets, and engagement of innovative healthcare financing strategies especially through social support [5]. Principally, there are four models of revenue collection and these include compulsory prepayments, voluntary prepayments, external aid and out-of-pocket payment (OOP) [12]. Since OOP is an inequitable, unreliable and unsustainable source of healthcare financing, to provide and access reliable healthcare financing for the elderly therefore requires that countries pay more attention to other revenue collection mechanisms and provide means of accessing these financial resources. While all countries of the world, both poor and rich, can raise more health funding or diversify their funding sources, the number of countries that have any chance of creating sustainable fund from domestic sources alone is very minimal especially in Africa [5]. Hence, the need for global solidarity in order to ensure that many African countries are not denied access to reliable healthcare financing. If countries and international agencies were to fulfil their international pledges, external aid in developing countries will greatly increase and the shortfall in fund to provide reliable healthcare financing especially for the elderly would be virtually eliminated [5].

Given priority to government budgets can also contribute greatly to the provision of and access to reliable healthcare financing. Government budgets in Africa often give health a somewhat low priority. For instance, very infinitesimal number of African countries could reach the target that was agreed to by their Heads of States in the 2001 Abuja Declaration, to spend 15 per cent of their annual budget on health. Currently, only Madagascar allots above the agreed 15 per cent (15.6 per cent) to health [12, 30]. Taken as a group, low- and middle-income countries (LMIC) could raise extra over US\$ 15 billion/year for health from local sources by increasing the proportion of health expenditure in total government expenditure to 15 per cent [5]. Many developed countries who are near toward achieving universal health coverage allot considerable share of total government expenditure on health [30]. It is therefore incumbent upon many African countries to follow this path so as to aid the provision of and enhance access to reliable healthcare financing, although, in the long-run, relying solely on government budget to finance healthcare services may not be sustainable.

Generally, reliable healthcare financing can be provided through innovative sources of healthcare financing as well as innovative governance in managing

health resources [31], and can be accessed by putting social, political, economic and cultural factors into consideration. Innovative sources of healthcare financing refers to committed funding sources for healthcare services, and these funds come from reserved taxes from health hazardous products such as alcohol, tobacco, sugary and salty foods; contributions from social health insurance or dedicated government budget allocation; taxes on air tickets; diaspora bonds (sold to expatriates); levy on foreign exchange transactions; solidarity levies on a range of products and services such as mobile phone calls; social support from social networks such as spouse, children, siblings, friends, association and community members, among many others [5, 31]. The potential to increase social support exists in many countries. If this is well examined and allocated to health, providing and accessing reliable healthcare financing would be greatly enhanced. On the other hand, innovative governance can be referred to as management of funds for healthcare services such that healthcare seekers have access to such funds [31]. These funds may be managed by a statutory body that is independent of government with its own governing body and represented by multi-stakeholders such as community health partnership [12]. Some countries such as Singapore and Hong Kong, among many others, follow this innovative governance and it is helpful in accessing reliable healthcare financing.
