Evaluating Honduras’ health financing system: a comprehensive application of the WHO Health Financing Progress Matrix

Objective: To determine the current state of Honduras' health financing system. Methods: This study applied a qualitative design based on the World Health Organization's Health Financing Progress Matrix (HFPM) to evaluate the health financing system in Honduras. Data were collected through 18 in-depth interviews with informants from diverse institutions, tailored to their expertise. The results were internally validated via a workshop including 12 additional experts. Thematic coding was used to classify findings across seven health financing assessment areas and 19 attributes. The HFPM's desirable attributes framework allowed the researchers to classify the findings into four relevant categories: emerging (score of 1.00-1.99), progressing (score of 2.00-2.99), established (score of 3.00-3.99), and advanced (score of 4.00). Results: The overall score for Honduras' health financing system was 1.72 of 4.00, indicating an emerging level of development. While attributes related to institutional capacity achieved a progressing score (2.02), domains regarding financial protection lagged at an emerging level (1.33). Critical weaknesses were identified in resource pooling (1.20) and in benefit entitlements and access conditions (1.20), both of which consistently showed low performance. Conversely, public financial management scored higher (2.40), though accountability and budget alignment gaps persist. Regarding Universal Health Coverage objectives, most dimensions scored below 2.00. Among the intermediate objectives, transparency and accountability scored the highest (1.83). Of the final objectives, quality approached progressing (2.33). Conclusion: The health financing system of Honduras exhibits limited institutional maturity and significant structural challenges in financing its health care system. Future reforms must effectively aim to reduce financial barriers for the population.