Table 3 Strategies and sub-strategies identified for the development of the fiscal space in the field of health

Structural reforms

Precedence of prevention over treatment in health budgetary allocation

[8, 12, 14, 18, 28, 33, 34, 41–44]

Reprioritization of the health budget within the government budget

[15–18, 25, 44–48]

Budget flexibility in special circumstances

[15, 16, 18, 30, 35, 49]

Budget prioritization for health based on changes in epidemiology and disease burden

[16–18, 35, 50]

Modeling and forecasting the growth trend of health costs and financial strategies

[16, 17, 18, 35, 50]

Increasing the share of insurance (private and public) and prepaid financial resources in health system financing

[29, 30, 51]

Establishing R&D centers and applied research in the field of health system financing

[15, 52]

Development of zero-based budgeting

[12]

Budgetary allocation based on achievements in the treatment sector

[53]

Allocating a certain percentage of the country’s GDP to the health sector

\(\checkmark\)

Establishment and development of an operational budgeting approach (based on performance) in the health system

\(\checkmark\)

Allocating part of the budget to encourage achievements related to health

\(\checkmark\)

Increase in Efficiency of Health Expenditures

Evaluating the optimal use of available resources and reducing waste of resources

[9, 12, 14, 16–18, 29, 34, 41, 42, 44, 49, 53–55]

Development of universal health coverage plans

[9, 12, 16, 17, 28, 30, 34, 41, 42, 52, 53, 55]

Increasing skill development (or skill enhancement) of healthcare workers

[9, 14, 17, 26, 33, 41, 42, 49, 55, 56]

Evaluating the efficiency of budgetary allocation in the health sector

[12, 17, 26, 33, 41, 44, 52, 56]

Supply and demand management in the health sector and supply chain improvement and strategic purchase of drugs and equipment

[12, 14, 18, 44, 53, 56]

Prevention of corruption, rent, and conflict of interest in health governance

[14, 18, 25, 41, 42, 49, 57]

Development of public health education, self-care, and the level of literacy and health capabilities of society

[12, 17, 18, 33, 37, 56]

Modifying the payment mechanism to health service providers

[17, 18, 30, 46, 58]

Use of decision support systems and evidence-based policy development

[9, 16, 52, 59]

Multi-layered financing of the health system to allocate public resources to vulnerable groups

\(\checkmark\)

Development of resistance economy approach in the health system

\(\checkmark\)

Integrating basic social insurance funds

\(\checkmark\)

Outsourcing services with an emphasis on systematic monitoring

\(\checkmark\)

Strengthening the monitoring of the performance of service delivery units

\(\checkmark\)

Identifying and reducing induced demand in providing health care based on clinical guidelines

\(\checkmark\)

Identifying and reducing the moral risks of the insured in the health system

\(\checkmark\)

Separation of the roles of supervision, provision of care, and monitor the health system

\(\checkmark\)

Health Sector-Specific Grants and Foreign Aid

Use of foreign aid

[12, 16, 18, 25, 26, 30, 35, 46, 49, 56]

Foreign borrowing

[12, 17, 26, 30, 33–35, 56, 57]

Foreign aid through technology transfer

[16, 56]

Conducive Macroeconomic Conditions

Development of the country’s taxation system

[12, 30, 35, 37, 41, 46, 49, 52, 54, 55]

Planning to reduce sanctions and the economic effects it caused

[7, 16, 18]

Increasing the government budget balance

[7, 60]

Reducing economic dependence on oil exports and underground resources

[7, 18]

Control and management of the health sector inflation

\(\checkmark\)

Increase in Health Sector-Specific Resources

Establishing and increasing earmarked taxes for the health sector

[7, 15, 17, 28, 30, 33–35, 44, 45, 46, 48, 49, 52, 54, 57, 61–63]

Encouraging private investment in the health sector

[12, 34, 41, 44–46, 49, 51, 64]

Attracting the participation of non-governmental organizations and philanthropists in the health sector

[25, 35, 62, 64]

Allocation of resources from the targeting of subsidies to the health sector

[16, 18, 47]

Withdrawal from financial funds and strategic reserves of the country in times of health crisis

\(\checkmark\)

Development of joint healthcare plans and investments with other government agencies

\(\checkmark\)

donation-based crowdfunding and voluntary participation of people

\(\checkmark\)

Encouraging foreign investment in health

\(\checkmark\)

Using the capacity of the capital market for macro healthcare project financing

\(\checkmark\)

Tax exemptions for economic activists in the health sector during the crisis

\(\checkmark\)

Allocating a share of public service payments to the health sector

\(\checkmark\)