Local Block Grants in Health

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Helpdesk Query:

Provide a literature / evidence review of the effectiveness – or otherwise – of sub-national flexible block grants in health in delivering public health or health system objectives in developing countries.


It was difficult to find examples that met the criteria of sub-national flexible block grants in health. Sections 2 and 3 cover the main two that were identified.  These are the Tanzania Essential Health Interventions Project (TEHIP) and Generasi, Indonesia.

TEHIP aims to bring health spending more in line with cost-effective approaches to the local disease burden. Information from Demographic Surveillance Systems allows planners to determine spending priorities. A series of simple management tools enable those district planners to allot funds to interventions that will have a greater impact on local causes of mortality.

PNPM Generasi is an incentivised community block grant program that builds on the architecture of the Government of Indonesia’s (GOI’s) community driven development programme. It uses a facilitated community decision-making process to allocate block grant funds to target 12 health and education indicators. Communities work with facilitators and health and education service providers to improve access to and use of health and education services. To give communities incentives to focus on the most effective polities to target program indicators, the GOI determines the size of the village’s PNPM Generasi block grant for the subsequent year partly on the village’s performance on each of the 12 targeted health and education indicators.

Section 4 covers other examples in Nigeria, Pakistan, Brazil and Kenya.

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