Health services need resources every day—not only during a crisis. Financing determines how money is raised, pooled and used. Resource mobilisation brings together money, people, equipment, information, transport, supplies and partnerships. Efficiency and sustainability ensure that today’s service does not exhaust the ability to care tomorrow.
- Explain revenue collection, pooling and purchasing in health financing.
- Identify finance sources and non-financial resources needed for health services.
- Differentiate fair allocation, technical efficiency and allocative efficiency.
- Apply sustainability principles to ambulance, emergency-unit and referral services.
| Function | Meaning | Why it matters |
|---|---|---|
| Revenue collection | Raising funds through taxes, government budgets, insurance contributions, grants, donations or direct payments. | Determines resources available for staff, medicines, oxygen, buildings and emergency transport. |
| Pooling | Combining funds so the cost of illness is shared across people. | Protects households from carrying the full financial risk when illness or injury strikes. |
| Purchasing | Deciding what services, providers and inputs are paid for, and how payment is organised. | Can encourage availability, quality, prevention and appropriate referral rather than volume alone. |
When health care relies heavily on payment at the time of illness, patients may delay treatment, avoid referral or sell assets. Financial protection is therefore a clinical and equity issue—not only an accounting issue.
| Source | Strength | Risk to manage |
|---|---|---|
| Government revenue | Can support public health, essential services and vulnerable populations. | Needs transparent planning, fair allocation and predictable release. |
| Insurance / prepayment | Shares risk before illness occurs. | Benefit packages and payment arrangements must protect access and quality. |
| Partners and external aid | Can expand technical support, commodities and service capacity. | Must align with national priorities and avoid parallel, short-lived systems. |
| Household payment | May fill immediate gaps. | Can cause hardship and delay care; never use ability to pay as a triage criterion. |
| Community/private/in-kind support | May provide transport, facilities, volunteers, blood drives or supplies. | Needs accountability, quality assurance, maintenance and clear role boundaries. |
Resources are not only cash. A functioning emergency service needs a competent workforce, leadership, time, beds, oxygen, medicines, blood, vehicles, communications, data, buildings, maintenance, community trust and reliable referral agreements.
Buying an ambulance is a capital investment. Sustainable operation also needs trained staff, dispatch and communication, fuel, tyres, servicing, oxygen, PPE, monitoring equipment, authorised medicines, documentation, receiving-facility links and a replacement plan. Without these recurrent inputs, the vehicle may exist but the service fails.
Exam point: resource mobilisation includes identifying needs, mapping assets, prioritising gaps, obtaining support, tracking use and maintaining what has been obtained.Allocation is how scarce resources are shared across programmes, areas and facilities. Fair allocation considers population size, disease burden, poverty, remoteness, emergency risk, existing capacity, workforce gaps and cost of reaching underserved groups. It is not simply giving every facility the same amount.
“Who has the greatest unmet need, and what additional support is required for them to achieve a comparable outcome?”
- A remote facility may need extra transport/communication support because distance raises the cost of safe referral.
- A high-trauma road corridor may need more emergency readiness because injury burden is higher.
- A facility with a young catchment population may need stronger maternal, newborn and paediatric readiness.
- Technical efficiency: producing a service with the least waste while maintaining quality, e.g., stock rotation and preventative maintenance.
- Allocative efficiency: directing resources toward interventions with the greatest health benefit for population need, e.g., funding life-saving emergency readiness rather than low-value spending.
Cutting essential staff, safety steps or oxygen may reduce a budget line today but increase complications, transfers, disability and cost later. Economy never means informal rationing, discrimination or unsafe shortcuts.
- Use stock cards and first-expiry-first-out practice to reduce losses and expiry.
- Maintain oxygen systems, vehicles and equipment before failure occurs.
- Use approved checklists, protocols and referral criteria to reduce error and duplication.
- Match tasks to competence; provide supervision, training and rest to reduce burnout and mistakes.
- Use service data to identify bottlenecks such as delayed triage, repeat transfer or stock-outs.
A sustainable service continues to provide safe, quality care over time without exhausting people, funds or the environment. It needs recurring funding, local ownership, supply-chain reliability, workforce development, maintenance, resilience to shocks, accurate data and honest performance review.
| Area | Sustainable practice | Unsafe / unsustainable practice |
|---|---|---|
| Equipment | Service, calibration, training, spare parts and replacement plan. | Buying equipment with no user training, maintenance or consumables. |
| Supplies | Forecasting, stock monitoring and safe storage. | Emergency purchasing after stock-out or allowing expiry. |
| Workforce | Training, supervision, fair rosters and support after stressful events. | Chronic overload, unclear scope and no skills refreshment. |
| Environment | Safe waste segregation, rational energy/water use and infection prevention. | Unsafe reuse of single-use items or disposal that harms staff/community. |
A facility receives concentrators, but there is no training, voltage protection, maintenance contact, spare parts plan or record of who checks them each shift.
- Problem: resource acquisition occurred without full mobilisation and sustainability planning.
- Risk: equipment may fail during an emergency, resulting in unsafe care and wasted investment.
- Correct action: assign accountability, train users, establish daily checks and maintenance, document faults, plan power backup and include replacement/repair in the budget.
- Use supplies carefully; report loss, breakage, expiry and stock-outs promptly.
- Check vehicle/equipment at start and end of duty; report defects before they become emergencies.
- Complete patient-care and referral records accurately; data justify resources and reveal service gaps.
- Never decide who deserves care based on money, status or personal connection.
- Participate in drills, audit, quality improvement and feedback within scope.
- Explain revenue collection, pooling and purchasing.
- Why can out-of-pocket payment delay emergency care?
- List eight resources needed for a sustainable ambulance service.
- Differentiate technical and allocative efficiency.
- Why is equal allocation not always equitable allocation?