Making the case for public investment in health: lessons learned from a TSI project

Abstract In September 2022, a Technical Support Instrument (TSI) project funded by the Directorate-General for Structural Reform Support (DG REFORM) of the European Commission was launched together with Austria, Belgium and Slovenia to strengthen capacity to advocate for public investment in health. This project mapped tools and analytical approaches for making the case for such investments. This presentation will highlight findings from the report that was published in early 2024. The report offers a framework combining five key arguments and examples of tools, data, indicators and methods to support public health funding by meeting public financial management objectives. It also discusses other factors enabling successful negotiations between health and finance policymakers. One argument is that these investments address health needs and improve health, including through prevention. While it seems logical that investing in prevention and primary care leads to long-term health and societal benefits, providing evidence is often challenging due to delayed and hard-to-quantify benefits, especially at the population level. Measuring co-benefits on sectors like the economy or education is also difficult due to methodological issues and confounding factors. Robust data and analysis are crucial, but evidence alone typically is not enough in budget negotiations. Success often depends on political will, compelling narratives, alignment with finance stakeholders’ goals, effective communication, stakeholder engagement and seizing opportunities. These non-evidence factors can be key in driving investment forward. This contribution will highlight arguments and evidence stakeholders can use to advocate for public investment in prevention, addressing challenges and complexities. Additionally, it will discuss governance factors and political economy aspects influencing the success of public investment in prevention.